Presentation and Management of Neglected Developmental Dysplasia of Hip (DDH): 8-years’experience with single stage triple procedure

Objective: To document the clinical presentation of neglected DDH and evaluate the outcome of triple procedure.

Methods: It was a descriptive case series study, conducted at the Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad over a period of 8-years. It included children aged >1 and <9 years who underwent the triple procedure of open reduction, femoral shortening and Salter’s osteotomy. Clinical evaluation was performed using McKay’s criteria. Tonnis classification and Severin’s scoring system were employed for the radiological evaluation.

Results: There were 193 children with 213 DDH affected hips. The mean age was 3.31±1.6 years. The preoperative severity of the femoral head dislocation per Tonnis classification was Grade-I in 7.98%(n=17), Grade-II in 48.35%(n=103) and Grade-III in 43.66% (n=93) hips. The postoperative MacKay criteria was ‘Good’ to ‘Excellent’ in 193(90.61%) hips. The postoperative Severin’s class was I in 113(53%) hips, II in 48(22.53%) hips, III in 43(20.18%) and IV in 9(4.22%) hips. The preoperative acetabular index ranged from 39O to 51O with a mean of 43.91±3.69O. The mean postoperative AI was 18.42±2.99O. The postoperative centre edge angle ranged from 21O to 26O with a mean 23.18 ±1.35O.

Conclusions: The single stage triple procedure offers the surgical remedy of choice with favourable results for managing neglected and late diagnosed DDH among children aged 1-8 years.