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TREATMENT OF DDH IN OLDER CHILDREN – AGA KHAN UNIVERSITY HOSPITAL EXPERIENCE

The Aga Khan University Hospital, PO Box 3500, Stadium Road, Karachi, 74800, Pakistan

Introduction: Developmental dysplasia of the hip is a congenital anomaly that is best treated immediately after birth. The deformity, if not treated early, usually progresses with time and becomes more complicated to treat. Its treatment in an older child requires a complete understanding of the primary disease process as well as correction of the secondary anatomical deformities which have matured at that time. In this study, we present our experience with the treatment of this complex problem in older children.

Materials & Methods: All patients who presented to us with idiopathic DDH beyond 18 months of age at the Aga Khan University Hospital were included in the study. We operated on 20 patients with 25 hips from 1990 to 1998. There were 13 females and five patients with bilateral disease. The mean age was 48 months and the average follow-up was 13 months. Patients were classified according to the Tonnis class and the acetabular index and the central edge angle were measured both pre- and post-operatively. Functional evaluation was then done using MacKay’s scoring system.

Results: There were 7 (28%) hips in the Tonnis class II, 10 (40%) hips in Tonnis class III, and 8 (32%) hips in the Tonnis class IV at the time of presentation. We were able to achieve closed reduction in five (20%) hips, and satisfactory open reduction without any bony procedure was performed in four (16%) hips. The triple procedure of open reduction, femoral and innominate osteotomy was performed in 16 hips in 13 patients. The acetabular index improved from an average of 350 pre-operatively to an average of 180 post-operatively. The MacKay score was good to excellent in 22(88%) hips and we had a failure in 1(4%) hip joint. The Severin class was good to excellent in 21 (82%) patients at the time of final evaluation. There were 3 cases of posterior subluxation and 1 case each of avascular necrosis and myositis ossificans.

Conclusions: Tonnis class and age of the patients are important determinants of the final outcome. The triple procedure of open reduction, femoral and innominate osteotomy gives the best results in an older child with DDH.

The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.