One-stage hip reconstruction for developmental dysplasia of the hip presenting in children between 3 and 5 years of age

Background
Developmental dysplasia of the hip (DDH) is a broad term of anatomical abnormalities that can lead to permanent disability. The goals of management are to establish normal anatomy of the femoral head and acetabulum and then maintenance of this anatomy to promote normal development of the hip.
Aim
The purpose of this study is to evaluate the results of one-stage hip operation in DDH presented between 3 and 5 years of age.
Patients and methods
A prospective study was conducted on 32 children (36 hips) presented with DDH at an age between 3 and 5 years old. A total of 15 hips were Tonnis grade III and 21 hips were grade IV. The study had been done in Zagazig University Hospital between March 2011 and October 2014. Open reduction with shortening and derotation of the femur was done for all hips. Varus angulation for excessive valgus was added to the osteotomy in 18 (50%) hips, and Dega pelvic osteotomy was performed in 20 (55.6%) hips. Postoperatively hip spica was done for all the patients for 12 weeks.
Results
The mean follow-up period was 3 years and 4 months (range, 2–5 years). According to McKay system for clinical assessment, the outcomes for 20 (55.6%) hips were excellent, 11 (30.5%) hips were good, three (8.3%) were fair, and two (5.5%) were poor. According to Severin’s classification system for radiological assessment, the outcomes for 20 (55.6%) hips were excellent, 10 (27.7%) hips were good, four (11%) were fair, and two (5.5%) were poor.
Conclusion
DDH in older children is better to be treated with one-stage hip reconstruction operation, where adequate stable concentric reduction can be achieved, and this can result in remodeling of the acetabulum and stable concentric reduction of the dislocated hip. DDH Tonnis grade III is risky for residual acetabular dysplasia and subluxation after one-stage hip reconstruction.