[A treatment algorithm for developmental dysplasia of the hip for infants 0 to 18 months of age and its prospective results].
OBJECTIVE
We evaluated the results of treatment in patients who were treated according to an algorithm established for developmental dysplasia of the hip (DDH) during the first 18 months of life.


METHODS
We developed an algorithm for DDH to be used in infants at 0 to 18 months of age. Patients who did not respond to, or who did not have the indication for, the use of Pavlik harness were treated according to our algorithm and evaluated prospectively. Thirty-three hips (24 patients; 21 girls, 3 boys; mean age 7.4 months; range 2.5 to 18 months) were followed-up for a mean of 42 months (range 15 to 90 months). Ultrasonographic evaluation was performed using the Graf method. Avascular necrosis was evaluated according to the Kalamchi and MacEwen classification, and radiological results according to the Severin classification.


RESULTS
The mean acetabular index angles before and after treatment were 37.3 degrees (range 20 degrees to 58 degrees ) and 21.8 degrees (range 15 degrees to 30 degrees ), respectively. According to the Kalamchi and MacEwen classification, six hips (18.2%) had type I, three hips (9.1%) had type II, and one hip (3%) had type III avascular necrosis. According to the Severin criteria, 21 hips were considered in group I, 10 in group II, and two hips in group III. Acetabular osteotomies were performed in four hips. All patients had full range of motion without any pain and limp.


CONCLUSIONS
Successful clinical results obtained in the hips treated according to this algorithm for DDH may serve to justify its use as a standard algorithm in the treatment of infants at ages 0 to 18 months.
Demirhan
Mehmet
M
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Istanbul University, 34390 Capa, Istanbul, Turkey. msdemirhan@hotmail.com
Dikici
Fatih
F
Eralp
Levent
L
Onen
Mehmet
M
Göksan
Bora
B
D000465:Algorithms; D003663:Decision Trees; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed