Varus Femoral Osteotomy Mandatory in Developmental Dysplasia of the Hip

• Sanad Mahmoud Mousa

  Department of Orthopedic Surgery, Faculty of Medicine, University of Omar Almokhtar, Libya

  Author

• Ali Mohammed Ali

  Department of Orthopedic Surgery, Faculty of Medicine, University of Omar Almokhtar, Libya

  Author

• Arhoma Yahya Mohammed

  Department of Orthopedic Surgery, Faculty of Medicine, University of Tobruk, Libya

  Author

Developmental dysplasia of the hip (DDH) is a spectrum of pediatric hip abnormalities in which treatment aims to obtain a stable, concentric reduction while minimizing complications. Proximal femoral varus osteotomy is commonly used when proximal femoral deformity is considered to compromise containment, but it may introduce additional deformity and complications. This retrospective, non-randomized clinical study assessed the outcomes of acetabular reshaping osteotomy combined with mid-shaft femoral derotation osteotomy while preserving the neck-shaft angle in children with idiopathic DDH. Thirteen children involving 17 hips, treated at El Byda Hospital and Tobruk Medical Center between July 2017 and June 2023, were included; teratologic and revision cases were excluded. The reported age range was 18–60 months, and the study group included 12 girls and 1 boy. Acetabular osteotomy and femoral derotation osteotomy were performed in all hips, with concomitant femoral shortening in 14 hips (82.4%); no varus correction was performed. At follow-up, all 17 hips were classified as excellent according to Barrett’s modification of McKay’s criteria. The mean acetabular index decreased from 38.31 ± 3.79° preoperatively to 22.62 ± 2.17° at three years. No postoperative subluxation, dislocation, or avascular necrosis was reported. 

Alhaddad, A., Gronfula, A. G., Alsharif, T. H., Khawjah, A. A., Alali, M. Y., & Jawad, K. M. (2023). An overview of developmental dysplasia of the hip and its management timing and approaches. Cureus, 15(9), e45503. https://doi.org/10.7759/cureus.45503 DOI: https://doi.org/10.7759/cureus.45503

Azar, F. M., Beaty, J. H., & Canale, S. T. (2021). Campbell’s operative orthopaedics (14th ed.). Elsevier.

Barkmann, R., & Schütt, S. (2020). Geometric software measurements in pediatric hip dysplasia: Evaluation of acetabular index and center-edge angle. European Journal of Orthopaedic Surgery & Traumatology, 30(4), 615–622. https://doi.org/10.1007/s00590-020-02631-z

Buly, R. L., Sosa, B. R., Poultsides, L. A., Caldwell, E., & Rozbruch, S. R. (2018). Femoral derotation osteotomy in adults for version abnormalities. Journal of the American Academy of Orthopaedic Surgeons, 26(19), e416–e425. https://doi.org/10.5435/JAAOS-D-17-00623 DOI: https://doi.org/10.5435/JAAOS-D-17-00623

Castañeda, P., Masrouha, K. Z., Ruiz, C. V., & Moscona-Mishy, L. (2018). Outcomes following open reduction for late-presenting developmental dysplasia of the hip. Journal of Children’s Orthopaedics, 12(4), 323–330. DOI: https://doi.org/10.1302/1863-2548.12.180078

Chen, Q., Deng, Y., & Fang, B. (2015). Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6 years old. Acta Orthopaedica Belgica, 81, 375–383.

Czubak, J., Kowalik, K., Kawalec, A., & Kwiatkowska, M. (2018). Dega pelvic osteotomy: Indications, results and complications. Journal of Children’s Orthopaedics, 12, 342–348. https://doi.org/10.1302/1863-2548.12.180091 DOI: https://doi.org/10.1302/1863-2548.12.180091

Dickschas, J., Harrer, J., Reuter, B., Schwitulla, J., & Strecker, W. (2015). Torsional osteotomies of the femur. Journal of Orthopaedic Research, 33(3), 318–324. https://doi.org/10.1002/jor.22758 DOI: https://doi.org/10.1002/jor.22758

Ding, J., Dai, Z. Z., Liu, Z., Wu, Z. K., Zhang, Z. M., & Li, H. (2021). Risk factors for implant-related fractures after proximal femoral osteotomy in children with developmental dysplasia of the hip: A case-control study. Acta Orthopaedica, 92(2), 228–234. DOI: https://doi.org/10.1080/17453674.2020.1848315

El-Sayed, M., Ahmed, T., Fathy, S., & Zyton, H. (2012). The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age. Journal of Children’s Orthopaedics, 6(6), 471–477. DOI: https://doi.org/10.1007/s11832-012-0451-x

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Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly

El-Sayed, M. M. H., Hammad, M. E., Khalifa, A. M., Eltanahy, A. F., & Nada, A. A. (2023). Modified capsulorrhaphy technique in open reduction of developmental dysplasia of the hip. Journal of Pediatric Orthopedics, 43(8), e625–e632. https://doi.org/10.1097/BPO.0000000000002445 DOI: https://doi.org/10.1097/BPO.0000000000002445

Gornitzky, A. L., Georgiadis, A. G., Seeley, M. A., Horn, B. D., & Sankar, W. N. (2016). Does perfusion MRI after closed reduction of developmental dysplasia of the hip reduce the incidence of avascular necrosis? Clinical Orthopaedics and Related Research, 474(5), 1153–1165. https://doi.org/10.1007/s11999-015-4387-6 DOI: https://doi.org/10.1007/s11999-015-4387-6

Jawad, M. J., & Saadoon, R. A. (2016). Management of DDH in children between age of 1–2.5 years old by open reduction & derotation osteotomy without pelvic osteotomy. Mustansiriya Medical Journal, 15(2), 1–8. DOI: https://doi.org/10.4103/2070-1128.247883

Karadimas, J. E., Holloway, G. M., & Waugh, W. (1982). Growth of the proximal femur after varus-derotation osteotomy in the treatment of congenital dislocation of the hip. Clinical Orthopaedics and Related Research, 162, 61–68. DOI: https://doi.org/10.1097/00003086-198201000-00011

Kotlarsky, P., Haber, R., Bialik, V., & Eidelman, M. (2015). Developmental dysplasia of the hip: What has changed in the last 20 years? World Journal of Orthopedics, 6(11), 886–901. https://doi.org/10.5312/wjo.v6.i11.886 DOI: https://doi.org/10.5312/wjo.v6.i11.886

Lahoti, O., Turnbull, T. J., & Hinves, B. L. (1998). Separation of the proximal femoral epiphysis after derotation varus osteotomy of the femur. Journal of Pediatric Orthopedics, 18(5), 662–664. DOI: https://doi.org/10.1097/00004694-199809000-00021

Liu, K. Y., Wu, K. W., Lee, C. C., Lin, S. C., Kuo, K. N., Chang, J. F., & Wang, T. M. (2022). A long-term study of alignment correction following proximal femoral varus osteotomy and Pemberton osteotomy in children with Legg-Calvé-Perthes disease and developmental dysplasia of the hip. Frontiers in Pediatrics, 10, 835447. https://doi.org/10.3389/fped.2022.835447 DOI: https://doi.org/10.3389/fped.2022.835447

Mazloumi, M., Omidi-Kashani, F., Ebrahimzadeh, M. H., Makhmalbaf, H., & Hoseinayee, M. M. (2015). Combined femoral and acetabular osteotomy in children of walking age for treatment of DDH: A five-year follow-up report. Iranian Journal of Medical Sciences, 40(1), 13–18.

Nelitz, M. (2018). Femoral derotational osteotomies. Current Reviews in Musculoskeletal Medicine, 11(2), 272–279. https://doi.org/10.1007/s12178-018-9483-2 DOI: https://doi.org/10.1007/s12178-018-9483-2

Paul, M. S., Mahmud, C. I., Arifeen, K. N., Selimullah, A., & Chowdhury, A. (2020). Surgical outcome of one-stage treatment of developmental dysplasia of the hip in children of walking age. International Journal of Orthopaedics, 6(4), 934–938. DOI: https://doi.org/10.22271/ortho.2020.v6.i4n.2440

Rudraprasad, Rajappa, K., Shetty, N., Bhasme, A., & Srivatsav, A. (2022). Is the surgery safe for DDH in a walking child? Analysis of approach and medium-term outcomes of surgical management of DDH in walking children. International Journal of Orthopaedics, 8(1), 382–387. DOI: https://doi.org/10.22271/ortho.2022.v8.i1f.3043

Sankar, W. N., Young, C. R., Lin, A. G., Crow, S. A., Baldwin, K. D., & Moseley, C. F. (2011). Risk factors for failure after open reduction for DDH: A matched cohort analysis. Journal of Pediatric Orthopedics, 31(3), 232–239. https://doi.org/10.1097/BPO.0b013e31820c9b31 DOI: https://doi.org/10.1097/BPO.0b013e31820c9b31

Stasikelis, P. J., Ridgeway, S. R., Pugh, L. I., & Allen, B. L., Jr. (2001). Epiphyseal changes after proximal femoral osteotomy. Journal of Pediatric Orthopaedics B, 10(1), 25–29. DOI: https://doi.org/10.1097/01202412-200110010-00005

Venkatadass, K., Durga Prasad, V., Al Ahmadi, N. M. M., & Rajasekaran, S. (2022). Pelvic osteotomies in hip dysplasia: Why, when, and how? EFORT Open Reviews, 7(2), 153–163. https://doi.org/10.1530/EOR-21- DOI: https://doi.org/10.1530/EOR-21-0066

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