Surgical Treatment of Developmental Dysplasia of the Hip in Children Three to Five Years of Age

Background: The neglected DDH with adaptive changes in bone and soft tissue is difficult to treat and can lead to permanent disability.The aim of treatment of these cases to establish normal anatomy of the femur and acetabulum to promote normal development of the hip. Aim of the Work:The aim of this study is to evaluate of the results of one-stage surgical treatment of DDH in children between 3-5 years of age.Patients and Methods: A prospective study on 36 children (40 hips) presented by DDH at age between 3-5 years old, 16 hips were Tonnis grade III and 24 hips were grade IV.Open reduction, derotation femoral osteotomy with shortening was done for all hips, Varusangulation for excessive valgus was add to the osteotomy in 16 hips (40%), and Degapel vicosteotomy was added to femoral osteotomy in 24 hips (60%).Post operatively hip spica was done for all the patients for twelve weeks.Results: The mean follow-up period was 40 months (range 24 -60 months).Clinically, according to Mc Kay system, the outcome was excellent for 20 hips (50%) were, good in 14 hips (35%), fair in 4(10%), and poor in 2 h i p s (5%).Radiologically, the Severin's classification criteria for 22 hips (55%) were excellent, in 12 hips (30%) were good, fair in 4 (10%), and were poor in 2 (5 %).Conclusion: One stage hip reconstruction operation is a good approach to treat the cases with late presented developmental dysplasia of hip (DDH).A stable concentric reduction can be achieved which help in remodeling of the acetabulum and stable concentric reduction of the dislocated hip.Tonnis grade III dislocation of DDH is risky for residual acetabular dysplasia and subluxation after one stage hip reconstruction.