High trans-iliac incomplete bi-cortical pelvic osteotomy vs dega osteotomy in treatment of developmental dysplasia of the hip in young children: A new technique.

Abstract

Introduction: There are many controversies regarding the ideal pelvic osteotomy in managing Developmental dysplasia of the hip (DDH). We introduce a new high trans-iliac incomplete bi-cortical pelvic osteotomy (HTIBO) by starting the osteotomy at a higher point proximal to the anterior superior iliac spine and hinging on the post limb of the triradiate cartilage, comparing the results with Dega osteotomy (DO).

Hypothesis: HTIBO has superior clinical outcomes to Dega osteotomy and minimizes reliance on intraoperative fluoroscopic guidance.

Patients and methods: This retrospective multicenter comparative study included 72 patients (81 hips) with DDH aged between 18 and 30 months between March 2019 and March 2021. There were 34 patients (38 hips) managed by HTIBO, and 38 patients (43 hips) managed by DO, the mean follow-up was 53.74 ± 7.57 & 52.91 ± 7.59 respectively. Intra-operative fluoroscopic guidance and surgery time were recorded. Patients were evaluated clinically according to McKay criteria, limb length discrepancy, cosmetic deformity, and radiographically for acetabular index, central edge angle, Shenton line continuity, osteotomy site union, and avascular necrosis according to Kalamachi classification.

Results: The HTIBO group recorded lower intra-operative x-ray exposure (P <  0.01) and post-operative cast duration (P < 0.01), and better clinical outcome (P = 0.01). The final acetabular index was 15.11 ± 3.84, 37.68 ± 7.5, and the central edge angle was 14.56 ± 2.65, 34.47 ± 6.26, in HTIBO & DO groups respectively. In both groups, we recorded no cases of limping, restricted ROM, pain, LLD, re-dislocation, graft dislodgement, non-union, infection, or cosmetic deformity.

Discussion: The current osteotomy (HTIBO) is feasible, and reliable, with a satisfactory clinical and radiological outcome, and can be safely performed in young DDH children without fluoroscopic guidance.

Level of evidence: III, retrospective comparative study.