Evaluation of the results of operative treatment of hip dysplasia in children after the walking age

Available online 25 February 2012

Peer review under responsibility of Alexandria University Faculty of Medicine.

Figures & data

Figure 7 (a) 3-year old patient with right DDH, acetabular index (40°), grade 4, (b) immediate post-operative X-ray after open reduction, femoral shortening varus derotation and Salter's innominate osteotomy, (c)18 month post-operative X-ray. Improvement of the acetabular index (25°), good position of the femoral head. CEA (30°), Severine Class І, clinical score 100.

Figure 8 (a) 4-year old patient with right DDH, acetabular index (48°), grade 4, (b) one day post-operative X-ray; open reduction, femoral shortening and derotation, Degaostotomy, (c) 9 months post-operative, good position, improved acetabular index (24°), Severine Class I, CEA (40°), clinical score 90.

Table 1 Modified MacKay criteria and modified Harris hip score.

Pain
No pain	40
Mild pain, no effect on ordinary activities	30
Moderate pain, moderate limitation of ordinary activities	20
Severe pain, severe limitation of ordinary activities	10
Pain at rest	0
Limp
No	10
Limp	0
Trendelenburg sign
Absent	10
Present	0
Stability of the hip in supine position
Stable	10
Unstable	0
Deformity
Absence of deformity	10
Presence of deformity where any of the following is present	0
More than 30° fixed flexion deformity
More than 10° fixed adduction contracture
More than 10° fixed internal rotation in extension
Limb length discrepancy more than 2 cm
The range of motion
Full range	20
Mild limitation	15
Moderate limitation	10
Severe limitation	0
The range of motion is calculated according to the following
	Arc of motion	Index	Max. possible
Flexion	0–45° (45°)	1	45
	45–90° (45°)	0.6	27
	90–110° (20°)	0.3	6
	110–130° (20°)	0	0
Abduction	0–15° (15°)	0.8	12
	15–20 (5)	0.3	1.5
	20–45 (25)	0	0
External rotation in extension	0–15	0.4	6
	Over 15°	0	0
Internal rotation in extension	Any	0	0
Adduction	0–15	0.2	3
	Over 15	0	0
Extension	Any	0	0
Total maximum possible value = 100.5
Overall range of motion = Total maximum possible value × 0.05

Overall range of motion = 5 → full range of motion, =4– < 5 → mild limitation, =3– < 4 → moderate limitation, =2–< 3 → severe limitation. The overall clinical result is considered satisfactory when the final score is excellent (91–100) or good (81–90) and unsatisfactory when the score is either fair (71–80) or poor (less than 70).

Table 2 Modified Severin radiographic criteria.

Class І (excellent)	Normal hip with a center-edge angle > 25^o
Class II (good)	Concentric reduction, abnormal shape of head, neck or acetabulum with CEA > 25^o
Class III (fair)	Dysplastic hip with mal developed acetabulum roof. CEA < 20^o, no subluxation
Class ІV (poor)	Subluxation (femoral head displaced cranially and laterally)
Class V (poor)	Femoral head articulates with a false acetabulum
Class VІ (poor)	Complete redislocation

Table 3 Methods of treatment.

Method	Frequency	Percent
Open reduction (OR), Salter	2	5
OR, femoral osteotomy, Salter	30	71
OR, femoral osteotomy, Dega	8	19
Femoral osteotomy, Salter	2	5
Total	42	100

Femoral osteotomy included shortening, varus and derotation.

Figure 1 (a) Adductor tenotomy. (b and c) Anterior iliofemoral incision for open reduction.

Figure 2 Femoral osteotomy.

Figure 3 Salter osteotomy.

Figure 4 Dega osteotomy.

Table 4 The overall final clinical result.

Final clinical result	Frequency	Percent
Excellent	13	31
Good	24	57
Fair	4	9.50
Poor	1	2.50
Total	42	100

Table 5 The final radiological result.

Severin criteria	Frequency	Percent
Class І	26	62
Class II	11	26
Class III	3	7
Class ІV	2	5
Total	42	100

Figure 5 X-ray 1.5 year post-operative shows AVN of the femoral head.

Figure 6 X-ray 6 months post-operative shows subluxed femoral head.