Dega osteotomy for the treatment of congenital dysplasia of the hip.
BACKGROUND
In 1969 Dega described a transiliac osteotomy to treat residual acetabular dysplasia secondary to congenital hip dysplasia or dislocation. We were unable to find a thorough description of the technique in the English-language orthopaedic literature, and the number of clinical follow-up series is small.


METHODS
Twenty-two children (twenty-four hips) with an average age of five years and ten months and varying degrees of congenital hip dysplasia, subluxation, or dislocation were treated with a Dega osteotomy. Twenty hips (83%) had a concomitant femoral osteotomy and thirteen (54%) had an anterior open reduction of the hip in addition to the Dega osteotomy. To be included in the study group, each patient had to have complete clinical documentation of the range of motion, presence or absence of a limp, limb-length discrepancy, hip pain, and limitation of activity. Radiographs were reviewed to determine the acetabular index, the center-edge angle, whether the Shenton line was intact or broken, and any change in the projection of the obturator foramen.


RESULTS
At an average of fifty-five months postoperatively, all patients demonstrated unlimited physical activity and no limp. The average acetabular index changed from 33 degrees preoperatively to 12 degrees at the time of follow-up. The center-edge angle ranged from less than -30 degrees to 18 degrees preoperatively and from 18 degrees to 40 degrees (average, 31 degrees) at the time of follow-up. A change in the obturator foramen was observed in fourteen hips (58%). The Shenton line was broken in seventeen hips preoperatively but in none postoperatively. One Dega osteotomy was revised immediately after the index operation, and three hips underwent late repeat correction of the proximal part of the femur; one of the repeat corrections was performed together with a repeat Dega osteotomy.


CONCLUSIONS
Our initial experience with the Dega osteotomy demonstrated it to be a valuable surgical treatment of congenital dysplasia of the hip in a child of walking age. Our experience is comparable with that of many European authors, including those reporting studies from Dega's own institution.
Grudziak
J S
JS
Children's Hospital of Pittsburgh and the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
Ward
W T
WT
D000077:Acetabulum / Q000000981:diagnostic imaging; D000293:Adolescent; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007085:Ilium / Q000601:surgery*; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies