EC Orthopaedics

Hip dysplasia is a common childhood condition that is usually successfully treated based on potential alone in the majority of cases. However, whether the patient comes alive or does not respond to non-technical treatment, there are still some possible treatments. Highlights the prominent definitions for each can protect the exact tactics of rescue for the methods mentioned, as well as descriptive and visual explanations of how to perform these surgeries. We also discuss the wilderness care for patients undergoing DDH surgery and outline the potential evidence. Undiagnosed and untreated hip dysplasia can lead to health conditions, hip pain, and rapidly progressive osteoarthritis. Some patients may find evidence of variation after treatment with a pelvic girdle. Although there is excellent potential for a good outcome when DDH is diagnosed and treated, osteonecrosis continues to be a concern with all treatment methods.
A subset of patients from this young cohort will continue to have residual dysplasia or recurrent dislocation requiring return to the operating room. In the long term, hips without complications related to DDH treatment tend to do well. The most worrying complication is avascular necrosis of the bone head, ranging from 0% to 5%. Some post-operative complications such as Dislocation, Coxa Magna. However, it is necessary to consider before proceeding with hip reconstruction. Some classical surgical techniques are still performed for avascular necrosis of the femoral head. Recently, the author has performed incomplete proximal femoral osteotomy with good results. With Coxa Magna, the work of measuring the femoral head and neck ratio should be performed by several methods and determined and compared with the results of other authors. Consider before tactical treatment with clinical symptoms such as pain, limited mobility. Re-dislocation after a primary open reduction was the consequence of errors in surgical technique. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus, and densing anterior capsule. So, therefore, limbus, dense anterior capsule, with all hips cleared of scar tissue; adductor tenotomy; hips requiring iliopsoas tendon release, limbus eversion; hips requiring transverse ligament release.

 Keywords: Acetabular Osteotomy; Open Reduction; Complications, Developmental Dysplasia of the Hip, Osteotomy Techniques

1. Wedge JH and Wasylenko MJ. “The natural history of congenital dislocation of the hip: a critical review”. Clinical Orthopaedics and Related Research 137 (1978): 154-162.
2. Wedge JH and Wasylenko MJ. “The natural history of congenital disease of the hip”. Journal of Bone and Joint Surgery British Volume 61-B.3 (1979): 334-338.
3. Weinstein SL. “Natural history of congenital hip dislocation (CDH) and hip dysplasia”. Clinical Orthopaedics and Related Research 225 (1987): 62-76.
4. Crawford AH., et al. “The fate of untreated developmental dislocation of the hip: long-term follow-up of eleven patients”. Journal of Pediatric Orthopaedics5 (1999): 641-644.
5. Barlow TG. “Early diagnosis and treatment of congenital dislocation of the hip”. Proceedings of the Royal Society of Medicine 9 (1963): 804-806.
6. Escribano García C., et al. “Developmental dysplasia of the hip: Beyond the screening. Physical exam is our pending subject”. Anales de Pediatría (English Edition) 4 (2021): 240-245.
7. Alhaddad A., et al. “An overview of developmental dysplasia of the hip and its management timing and approaches”. Cureus9 (2023): e45503.
8. Kolb A., et al. “Development of an electronic navigation system for elimination of examiner-dependent factors in the ultrasound screening for developmental dysplasia of the hip in newborns”. Scientific Reports 1 (2020): 16407.
9. Hassebrock JD., et al. “Costs of open, arthroscopic and combined surgery for developmental dysplasia of the hip”. Journal of Hip Preservation Surgery 3 (2020): 570-574.
10. Kuo KN., et al. “Classification of Legg-Calvé-Perthes disease”. Journal of Pediatric Orthopaedics2 (2011): S168-S173.
11. Catterall A. “Legg-Calve´-Perthes disease”. Churchill Livingstone, New York (1982): 8-33, 81-109.
12. Hosalkar H., et al. “Triple innominate osteotomy for Legg- Calve´-Perthes disease in children: does the lateral coverage change with time?” Clinical Orthopaedics and Related Research9 (2012): 2402-2410.
13. Green NE., et al. “Epiphyseal extrusion as a prognostic index in Legg-Calve´-Perthes disease”. Journal of Bone and Joint Surgery American Volume6 (1981): 900-905.
14. Wiberg G. “Shelf operation in congenital dysplasia of the acetabulum and in sublaxation and dislocation of the hip”. Journal of Bone and Joint Surgery American Volume1 (1953): 65-80.
15. Ernest YY., et al. “Femoral head asymmetry and coxa magna: Anatomic study”. Journal of Pediatric Orthopaedics4 (2014): 415-420.
16. Stulberg S D., et al. “The natural history of Legg-Calve-Perthes disease”. Journal of Bone and Joint Surgery American Volume7 (1981): 1095-1108.
17. Catterall A. “The natural history of Perthes’ disease”. Journal of Bone and Joint Surgery British Volume1 (1971): 37-53.
18. Christensen F., et al. “The Catterall classification of Perthes’ disease: an assessment of reliability”. Journal of Bone and Joint Surgery British Volume4 (1986): 614-615.
19. Mose K. “Legg-Caluk-Perthes’ disease”. Universitets Forlaget, Aarhus. (1964).
20. Edgren W. “Coxa plana. A clinical and radiological investigation with particular reference to the importance of the metaphyseal changes for the final shape of the proximal part of the femur”. Acta Orthopaedica Scandinavica 84 (1965): 1-129.
21. Weinstein SL. “Natural history of congenital hip dislocation (CDH) and hip dysplasia”. Clinical Orthopaedics and Related Research 225 (1987): 62-76.
22. Holman J., et al. “Long term followup of open reduction surgery for developmental dislocation of the hip”. Journal of Pediatric Orthopaedics 2 (2012): 121-124.
23. Chmielewski J and Albiñana J. “Failures of open reduction in developmental dislocation of the hip”. Journal of Pediatric Orthopaedics 4 (2002): 284-289.
24. Bolland BJ., et al. “Late reduction in congenital dislocation of the hip and the need for secondary surgery: Radiologic predictors and confounding variables”. Journal of Pediatric Orthopaedics 7 (2010): 676-682.
25. Chin MS., et al. “Comparison of hip reduction using magnetic resonance imaging or computed tomography in hip dysplasia”. Journal of Pediatric Orthopaedics 5 (2011): 525-529.
26. Harris NH. “Acetabular growth potential in congenital dislocation of the hip and some factors upon which it may depend”. Clinical Orthopaedics and Related Research 119 (1976): 99-106.
27. Segal LS., et al. “The contribution of the ossific nucleus to the structural stiffness of the capital femoral epiphysis: A porcine model for DDH”. Journal of Pediatric Orthopaedics 4 (1999): 433-437.
28. Clarke NM., et al. “The surgical treatment of established CDH: Result of surgery after planned delayed intervention following the appearance of capital femoral ossific nucleus”. Journal of Pediatric Orthopaedics 4 (2005): 43-49.
29. Cooke SJ., et al. “Ossification of the femoral head at closed reduction for developmental dysplasia of the hip and its influence on the long term outcome”. Journal of Pediatric Orthopaedics B1 (2010): 22-26.
30. Olney BW and Asher MA. “Combined innominate and femoral osteotomy for the treatment of severe Legg-Calve´-Perthes disease”. Journal of Pediatric Orthopaedics 6 (1985): 645-651.
31. Severin E. “Contribution to knowledge of congenital dislocation of hip joint. Late results of closed reduction and arthrographic studies of recent cases”. Acta Chirurgica Scandinavica 63 (1941): 1-142.
32. Kalamchi A and MacEwen GD. “Avascular necrosis following treatment of congenital dislocation of the hip”. Journal of Bone and Joint Surgery American Volume6 (1980): 876-888.
33. McKay DW. “A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip”. Clinical Orthopaedics and Related Research 98 (1974): 124-132.
34. Bucholz RW and Ogden JA. “Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease”. St. Louis MO: CV Mosby Co. (1978): 43-63.
35. McKay DW. “A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip”. Clinical Orthopaedics and Related Research 98 (1974): 124-132.
36. Howorth B. “A lifetime experience with congenital displacement of the hip”. Orthopedic Reviews 11 (1982): 33-45.
37. Dunn PM. “Perinatal observations on the etiology of congenital dislocation of the hip”. Clinical Orthopaedics and Related Research 119 (1976): 11-27.
38. Westin GW., et al. “Total avascular necrosis of the capital femoral epiphysis in congenital dislocated hips”. Clinical Orthopaedics and Related Research 119 (1976): 93-97.
39. Chung SMK. “Hip disorders in infants and children”. Philadelphia: Lea and Febiger (1981).
40. Mose K. “Legg-Calvé-Perthes disease [Thesis]”. Aarhus, Denmark: University of Aarhus (1964).
41. Gower WE and Johnston RC. “Legg-Perthes disease. Long-term follow-up of thirty-six patients”. Journal of Bone and Joint Surgery American Volume4 (1971): 759-768.
42. De Valderrama JA. “The “observation hip” syndrome and its late sequelae”. Journal of Bone and Joint Surgery British Volume 45 (1963): 462-470.
43. Nachemson A and Scheller S. “A clinical and radiological follow-study of transient synovitis of the hip”. Acta Orthopaedica Scandinavica 4 (1969): 479-500.
44. Stulberg SD., et al. “The natural history of Legg-Calve-Perthes disease”. Journal of Bone and Joint Surgery American Volume7 (1981): 1095-1108.
45. McAndrew MP and Weinstein SL. “A long-term follow-up of Legg-Calve-Perthes disease”. Journal of Bone and Joint Surgery American Volume6 (1984): 860-869.
46. Gamble JG., et al. “Coxa magna following surgical treatment of congenital hip dislocation”. Journal of Pediatric Orthopaedics5 (1985): 528-533.
47. Kallio PE. “Coxa magna following transient synovitis of the hip”. Clinical Orthopaedics and Related Research 228 (1988): 49-56.
48. Leitch JM., et al. “Growth disturbance in Legg-Calve-Perthes disease and the consequences of surgical treatment”. Clinical Orthopaedics and Related Research 262 (1991): 178-184.
49. Matani J., et al. “Coxa magna after open reduction for developmental dislocation of the hip”. Journal of Pediatric Orthopaedics3 (1995): 337-341.
50. Shigeno Y and Evans GA. “Quantitative correlation between the initial and final femoral head deformity in Perthes’ disease”. Journal of Pediatric Orthopaedics B1 (1996): 48-54.
51. Luhmann SJ., et al. “The prognostic importance of the ossific nucleus in the treatment of congenital dysplasia of the hip”. Journal of Bone and Joint Surgery American Volume12 (1998): 1719-1727.
52. Rowe SM., et al. “The correlation between coxa magna and final outcome in Legg-Calve-Perthes disease”. Journal of Pediatric Orthopaedics 1 (2005): 22-27.
53. Larson AN., et al. “A prospective multicenter study of Legg-Calve´-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years”. Journal of Bone and Joint Surgery American Volume7 (2012): 584-592.
54. Nguyen Ngoc Hung., et al. “Long-term result after operative hung zigzag osteotomy combined fibular allograft for developmental dysplasia of the hip, and coxa magna in children”. EC Paediatrics1 (2024): 01-27.
55. Ganz R., et al. “Extended retinacular soft tissue flap for intraarticular hip surgery: surgical technique, indications, and results of its application”. Instructional Course Lectures 58 (2009): 241-255.
56. Ganz R., et al. “Algorithm for combined femoral and periacetabular osteotomies in complex hip deformities”. Clinical Orthopaedics and Related Research12 (2010): 3168-3180.
57. Sakamaki T. “Clinical study on coxa magna during the treatment in congenital dislocation of the hip”. Journal of the Japanese Orthopaedic Association 5 (1979): 491-504.
58. Hasegawa A., et al. “Coxa magna”. Hokkaido Journal of Orthopedic and Traumatic Surgery 21 (1976): 1-5.