title: Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months.
abstract: BACKGROUND
  Developmental dysplasia of hip (DDH) is a common condition presenting to a pediatric orthopedic surgeon. There is a consensus on the surgical treatment of children with ages ranged from 18 to 24 months where majority agree on open reduction and hip spica. Open reduction was done with an additional pelvic procedure wherever required to get better results and prevent residual acetabular dysplasia (RAD) and early osteoarthritis.
  
  
  METHODS
  35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2-7 years).
  
  
  RESULTS
  No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI) of 35° and above. These were all from the group where open reduction alone was done.
  
  
  CONCLUSIONS
  We feel that a preoperative AI of >40° and a per-operative safe-zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum.
authors.affiliation: Department of Paediatric Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Narasimhan
authors.initials: N
authors.lastname: Ramani
authors.affiliation: Department of Paediatric Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Mithun S
authors.initials: MS
authors.lastname: Patil
authors.affiliation: Department of Paediatric Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Madhur
authors.initials: M
authors.lastname: Mahna
keywords: Dega osteotomy; Osteotomy; children; congenital; developmental dysplasia of hip; hip dysplasia; pediatrics; pelvic procedure