Bilateral developmental dysplasia of the hip treated with open reduction and Salter osteotomy: analysis on the radiographic results

Kotzias Neto, Anastácio; Ferraz, Adriana; Foresti, Franco Bayer; Hoffmann, Rafael Barreiros

doi:10.1016/j.rboe.2014.03.023

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Original Articles • Rev. bras. ortop. 49 (04) • Jul-Aug 2014 • https://doi.org/10.1016/j.rboe.2014.03.023 copy

Bilateral developmental dysplasia of the hip treated with open reduction and Salter osteotomy: analysis on the radiographic results^☆ ☆ Please cite this article as: Kotzias Neto A, Ferraz A, Bayer Foresti F, Barreiros Hoffmann R. Displasia do desenvolvimento do quadril bilateral tratada com redução cruenta e osteotomia de Salter: análise dos resultados radiográficos. Rev Bras Ortop. 2014;49:350–358. ^☆☆ ☆☆ Work performed at the Orthopedics and Traumatology Service, Hospital Infantil Joana de Gusmão, Florianópolis, SC, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

To evaluate the radiographic results from patients with bilateral developmental dysplasia of the hip (DDH) who underwent surgical treatment by means of open reduction and Salter osteotomy, with or without associated femoral shortening as described by Ombrédanne.

Methods:

This was a retrospective descriptive study in which 21 patients with bilateral DDH (42 hips) were analyzed. They were treated at Hospital Infantil Joana de Gusmão (HIJG), with operations between August 1997 and October 2009. To evaluate the radiographic results, the acetabular index and the Wiberg center-edge angle were measured, and the Severin and Kalamchi–MacEwen classifications were used. Descriptive and parametric statistical analyses were used to evaluate the data.

Results:

We did not observe any statistically significant difference in analyzing the radio-graphic parameters, making comparisons regarding the side affected, the order of the procedures and whether femoral shortening was performed, although there was a significant difference between them from before to after the operation.

Conclusion:

Open reduction in association with iliac osteotomy as described by Salter presented significant improvements in the radiographic parameters analyzed, comparing the pre- and postoperative values. This improvement occurred independently of whether Ombrédanne femoral shortening was performed. The most prevalent complication in the study group was avascular necrosis of the femoral head.

Hip dislocation, congenital/pathology; Hip dislocation, congenital/etiology; Hip dislocation, congenital/surgery; Hip dislocation, congenital/therapy

Patient	Preoperative AI		AI six weeks after operation		Late postoperative AI
	Right side	Left side	Right side	Left side	Right side	Left side
1	47	44	26	30	18	20
2	30	45	26	28	9	14
3	35	40	15	10	16	10
4	42	42	19	22	27	12
5	35	42	36	26	40	18
6	33	38	19	18	11	12
7	40	38	26	16	12	10
8	40	40	18	18	20	22
9	38	40	26	25	30	19
10	40	42	21	16	20	21
11	38	34	23	17	12	18
12	50	45	10	20	10	8
13	31	31	27	23	19	18
14	37	50	23	18	16	25
15	37	32	20	17	23	20
16	32	33	18	16	17	16
17	41	45	32	26	21	23
18	36	29	32	23	24	23
19	35	40	18	20	22	21
20	25	24	18	16	21	11
21	34	46	27	32	23	15
Mean	36.9	39	22.8	20.8	19.6	16.9
	SD 5.6	SD 6.5	SD 6.2	DP 5.5	DP 7.3	DP 5.0
	38		21.8^a a Significant difference between preoperative AI and AI of six weeks after operation (p < 0.000001).		18.2^b b Significant difference between preoperative AI and late postoperative AI (p = 0.001).
	SD 6.1 (p = 0.2)		SD 5.9 (p = 0.16)		SD 6.3 (p = 0.16)

Patient	Kalamchi and MacEwen classification¹⁸18. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62(6):876–88. for avascular necrosis of the femoral head		Center-edge angle (CÊ) of Wiberg¹⁶16. Wiberg GC. Studies on dysplastic acetabula and congenital subluxation of the hip joint, with special reference to the complication of Osteo-Arthritis (Translated from the Swedish by Helen Frey). Acta Chir Scand. 1939;83 Suppl. 58. (in degrees)		Severin classification¹⁷17. Severin EA. Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reduction and arthrographic studies of recent cases (Translated from the Swedish by Helen Frey); 1941.
	Right side^a a Non-significant difference between the sides affected (p = 0.18).	Left side^a a Non-significant difference between the sides affected (p = 0.18).	Right side	Left side	Right side^b b Non-significant difference between the sides affected (p = 0.08).	Left side^b b Non-significant difference between the sides affected (p = 0.08).
1	–	–	18	22	1B	1A
2	–	–	37	28	1A	1A
3	–	2	17	12	1B	3
4	1	–	20	18	1B	2A
5	3	–	<0	11	4B	3
6	–	–	31	40	1A	1A
7	2	–	34	40	1A	2A
8	2	–	13	8	3	3
9	2	–	<0	16	4B	3
10	–	–	15	24	2B	1A
11	–	4	32	40	1A	2A
12	4	2	35	17	2B	2B
13	–	–	19	19	1A	1A
14	–	–	15	16	2B	1B
15	–	3	10	0	3	4A
16	–	–	10	30	3	1A
17	3	3	19	10	1A	3
18	–	1	18	8	1B	3
19	–	4	33	<0	2A	5
20	–	–	16	30	1B	1A
21	1	–	8	24	3	1A
Mean			18.1	19.7
			SD 11.7	SD 12.3
			19.4
			SD 11.6 (p =0.41)

Patient	Age (in months)		AI six weeks after operation (in degrees)		Late postoperative AI (in degrees)		Kalamchi and MacEwen classification¹⁸18. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62(6):876–88. for avascular necrosis of the femoral head^a a Non-significant difference in relation to the earliness of the intervention (p = 0.7).		Center-edge angle (CÊ) of Wiberg¹⁶16. Wiberg GC. Studies on dysplastic acetabula and congenital subluxation of the hip joint, with special reference to the complication of Osteo-Arthritis (Translated from the Swedish by Helen Frey). Acta Chir Scand. 1939;83 Suppl. 58. (in degrees)		Severin classification¹⁷17. Severin EA. Contribution to the knowledge of congenital dislocation of the hip joint. Late results of closed reduction and arthrographic studies of recent cases (Translated from the Swedish by Helen Frey); 1941.^b b Non-significant difference in relation to the earliness of the intervention (p = 0.09).
	1st S	2nd S	1st S	2nd S	1st S	2nd S	1st S	2nd S	1st S	2nd S	1st S	2nd S
1	42	46	26	30	18	20	–	–	18	22	1B	1A
2	27	33	26	28	9	14	–	–	37	28	1A	1A
3	59	65	15	10	16	10	–	2	17	12	1B	3
4	31	35	22	19	12	27	–	1	18	20	2	1B
5	82	86	36	26	40	18	3	–	<0	11	4B	3
6	23	30	18	19	12	11	–	–	40	31	1A	1A
7	31	39	26	16	12	10	2	–	34	40	1A	2A
8	28	38	18	18	20	22	2	–	13	8	3	3
9	43	46	26	25	30	19	2	–	<0	16	4B	3
10	45	52	21	16	20	21	–	–	15	24	2B	1A
11	40	44	23	17	12	18	–	4	32	40	1A	2A
12	81	96	20	10	8	10	2	4	17	35	2B	2B
13	35	40	27	23	19	18	–	–	19	19	1A	1A
14	48	54	23	18	16	25	–	–	15	16	2B	1B
15	57	64	17	20	20	23	3	–	0	10	4A	3
16	35	42	16	18	16	17	–	–	30	10	1A	3
17	23	33	32	26	21	23	3	3	19	10	1A	3
18	60	71	32	23	24	23	–	1	18	8	1B	3
19	66	79	18	20	22	21	–	4	33	<0	2A	5
20	35	41	18	16	21	11	–	–	16	30	1B	1A
21	35	43	27	32	23	15	1	–	8	24	3	1A
Mean	44.1	51.3	23.2	20.4	18.6	17.9			21.2	20.7
	SD 17.4	SD 18.6	SD 5.7	SD 5.9	SD 7.3	SD 5.3			DP 10.7	DP 10.8
	47.7		21.8		18.2				20.9
	SD 18.2		SD 5.9 (p = 0.1)		SD 6.3 (p = 0.39)				SD 10.7 (p = 0.28)

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[1] *Corresponding author. E-mail: akotzias@kotzias.com.br (A. Kotzias Neto).