title: Evaluation of experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip.
abstract: BACKGROUND
  We aimed to evaluate experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip (DDH) at 5 to 7 years of age.
  
  
  METHODS
  We selected 21 hips from 17 patients who had mid-term and skeletally mature radiographs and who had neither had complications nor secondary surgery until skeletal maturity after having an initial soft tissue surgery for DDH before the age of 18 months. Twenty experienced orthopaedic surgeons evaluated the mid-term follow-up radiographs of these hips in terms of their need for secondary surgery.
  
  
  RESULTS
  On the basis of management grading of the observers at mid-term follow-up, the risk of unnecessary surgical management was 12% in hips that would eventually be normal at skeletal maturity. The risk of not performing needed surgery was 40% in hips that would eventually become dysplastic at skeletal maturity. Experience of the surgeons in terms of years had no significant effect on the management decisions. The center-edge angle, the acetabular index angle (AIA), percentage of femoral head coverage, Shenton line, and the acetabular angle of Sharp were the 5 most commonly used radiographic parameters at mid-term follow-up to assess whether a secondary surgery would be needed. Center-edge angle, AIA, femoral head coverage, and Shenton line correlated, whereas the acetabular angle did not significantly correlate with surgeons' quantitative management decisions on the basis of mid-term radiographs.
  
  
  CONCLUSIONS
  Experienced surgeons are more likely to opt for nonoperative management in hips that show no ischemic changes or instability at 5 to 7 years of age even in the presence of slightly abnormal radiographic measurements. AIA is considered the best radiographic parameter for making decisions regarding the need for secondary surgery in DDH at 5 to 7 years of age.
  
  
  METHODS
  Level II prognostic study.
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey. omeroglu.h@gmail.com
authors.forename: Hakan
authors.initials: H
authors.lastname: Omeroğlu
authors.forename: Haluk
authors.initials: H
authors.lastname: Ağuş
authors.forename: Ali
authors.initials: A
authors.lastname: Biçimoğlu
authors.forename: Yücel
authors.initials: Y
authors.lastname: Tümer
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging*; D000293:Adolescent; D000365:Age Determination by Skeleton; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D012086:Reoperation; D013997:Time Factors; D019564:Unnecessary Procedures