Ali Akhtar, Ali Shami, Muhammad Shoaib.
Evaluation of Prospects of Successful Surgery in Patients of Developmental Dysplasia of Hip.
Ann Pak Inst Med Sci Jan ;10(3):145-9.

Objective: Evaluation of important prospects of successful surgery and incidence of recurrent post-surgical dislocation of hip joint in patients of Developmental Dysplasia of Hip whom underwent open reduction, capsuloraphy, derotational and shortening femoral osteotomy and Salter Innominate Osteotomy followed by hip spica synthetic cast Materials and Methods: This study was carried out among the patients of DDH that underwent through open reduction followed by capsuloraphy and hip spica cast. Thirty eight (38) patients were operated with soft tissue procedures only followed by synthetic hip spica. Twenty four (24) patients were preceded with additional bony procedures including derotation, shortening femoral osteotomy and Salter Innominate Osteotomy followed by synthetic hip spica. Results: During four year period of the study, one patient was excluded because she died of anesthesia complication. There was a significant difference of success and post operative failure between two groups of soft tissue only and soft tissue with bony procedures. The patients in which all necessary bony procedures were opted (Salter Innominate osteotomy, derotation femoral osteotomy gave excellent resultsof containment of femoral head in the acetabulum. Only two cases of post operative dislocation were noticed in this category. However in patients of soft tissue procedures only, the surgical steps were minimized and limited up to the open reduction and tight capsuloraphy of hip joint followed by the synthetic hip spica cast. No bony procedures were carried out in this group. This group had a higher post operative dislocation rate because of 10 post operative dislocations. Conclusion: This study showed that the minimal procedure surgery is not quite enough to get the good desired results for the containment of femoral head in the acetabulum. Above the age of one and half year, bony procedures (Innominate osteotomies, derotation and shortening femoral osteotomies) adjunct to soft tissue procedures are necessary and there is no compromise on it. Even the hips that seem stable during the surgery and give some clue of soft tissue procedures adequacy, ultimately fail in maintaining the hip joint in reduced form.

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