One-stage correction of neglected developmental dysplasia of the hip by open reduction and pemberton osteotomy.

BACKGROUND AND PURPOSE

Pemberton osteotomy is commonly used for correction of hip-dysplasia. Its application in treating hip dislocation is rarely reported. The purpose of this study was to determine the efficacy of one-stage open reduction and Pemberton osteotomy of neglected developmental dysplasia of the hip (DDH).

METHODS

We retrospectively reviewed the clinical and radiographic results of one-stage total correction in 75 patients with neglected DDH (86 hips) from 1984 through 1996. Sixty-nine patients (77 hips) aged 13 to 76 months (mean, 21.5 mo) underwent open reduction, Pemberton osteotomy, and hip spica for 8 weeks. Seven patients (9 hips) aged 29 to 73 months (mean, 46.6 mo) underwent additional femoral shortening (another hip in one bilaterally involved patient underwent only open reduction and Pemberton osteotomy).

RESULTS

Acetabular index improved markedly from 40.4 degrees (range, 25-60 degrees) preoperatively to 16.2 degrees (range, 0-30 degrees) postoperatively. Complications included redislocation in four patients (4 hips) and avascular necrosis in three patients (3 hips). Reoperation was performed in four patients (4 hips). All patients were followed up for at least 3 years. By Severin's classification, all operated hips had excellent (18) or good (68) final radiographic results. The functional results, evaluated by McKay's criteria, were also excellent (52 patients/60 hips) and good (23 patients/26 hips).

CONCLUSIONS

Neglected DDH was safely and effectively treated by open reduction, Pemberton osteotomy, and optional femoral shortening with limited complications.