[The results of open reduction through a medial approach for developmental dysplasia of the hip in children above 18 months of age].
OBJECTIVE
Open reduction through a medial approach for the treatment of developmental dysplasia of the hip has been advocated in children younger than 18 months of age. In this study, we evaluated the results of this technique in children above 18 months of age.


METHODS
A retrospective evaluation of 34 hips (22 patients; 16 girls, 6 boys) was made, whose treatment was performed using open reduction through a medial approach between 1987 and 1997. Only typical dislocations were included. The ages of the patients at the time of surgery were either 18 months or above (mean age 23.7 months; range 18 to 54 months). Clinical and radiographic evaluations were made according to the modified McKay and Severin's criteria, respectively. The hips in which avascular necrosis developed were evaluated according to the Bucholz-Ogden classification. The mean follow-up was 10 years (range 5 to 14 years).


RESULTS
Secondary interventions were required in 24 hips (70.6%). Avascular necrosis developed in nine hips (26.5%). Final clinical results, together with secondary procedures, were excellent in 18 hips (52.9%), good in 10 hips (29.4%), moderate in four hips (11.8%), and poor in two hips (5.9%). Radiographically, there were six hips in Severin class I (17.7%), 11 hips (32.4%) in class II, 10 hips (29.4%) in class III, six hips (17.7%) in class IV, and one hip (2.9%) in class V.


CONCLUSIONS
These data show that, because of high rates of secondary interventions and ensuing avascular necrosis, open reduction through a medial approach cannot be considered to be successful for the treatment of developmental dysplasia of the hip in children above 18 months of age.
Sener
Muhittin
M
Karadeniz Teknik Universitesi Tip Fakültesi, Ortopedi ve Travmatoloji Anabilim Dali, Trabzon. muhits@tnn.net
Baki
Celal
C
Aydin
Hafiz
H
Yildiz
Mehmet
M
Saruhan
Sertaç
S
D000077:Acetabulum / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D005271:Femur Head Necrosis / Q000209:etiology; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology