Single-Stage Combined Surgery for Treating Neglected Bilateral Developmental Hip Dysplasia after Walking Age

Abstract

Objectives: To determine outcome in Single Stage Surgery of Both Hips in Bilateral Developmental Dysplasia of Hip in Children after walking age. Methods: This was a retrospective review of 20 hips in 10 patients (7 females and 3 males), operated at the children's hospital and the institute of child health, Lahore between 2014 and 2016. The age of patients was between 2 and 5 years. There were 10 hips in grade IV, 6 in grade III and 4 in grade II according to Tonnis classification. Both hips were operated in single stage. Open reduction of hip joint was done by anterolateral approach in all children. Salter osteotomy was done in every child while femoral shortening was needed in 10 hips. Outcome of single stage surgery was assessed by radiological assessment of Severin's scoring system and functional assessment of MacKay's scoring system at final followup after 2 years of suegery. Results: There was no effect of age, gender, malnutrition, body mass index on outcome. According to Severin's scoring system, 14 hips (70%) were in grade I while 6 (30%) in grade II. Outcome was excellent in 6 hips (30%), good in 13 (60%) and fair in 1 (5%) by applying MacKay's scoring system. Hip spica of one child was changed after one month due to wetting with urine. There was no hip dislocation or subluxation in any case. Conclusion: Single stage surgery of both hips can be done safely in bilateral developmental dysplasia of hip by anterolateral approach in late presented children.