The result of medial limited open reduction in developmental dysplasia of the hip

Aim: In treatment of developmental dysplasia of the hip (DDH); limited open reduction technique is a new form of treatment applied by loosening extracapsuler structures without opening the joint capsule in Tönnis type II and III hips. In this study radiologic and clinical outcomes of patients with Tönnis type II and III hips, operated with posteromedial approach accompanied by intraoperative arthrography and achieved concentric and stable reduction were examined. Material and Method: A total of 30 patients, 27 female and 3 male, including 37 hips at least 18 months follow up period with Tönnis type II and III dysplasia, operated with posteromedial approach without opening the joint capsule accompanied by intra operative arthrography and only adductor longus and iliopsoas tenotomies performed were retrospectively analyzed. Patients evaluated with preoperative, postoperative and last check acetabular indexes, McCay clinical evaluation criteria, radiological assessments, Kalamchi-MacEwan score and secondary acetabular surgery intervention requirements evaluated. In our cases, patients requirements for secondary acetabular surgery intervention evaluated with secondary acetabular displasia criterias as breakage of Shenton-Menard line, 35° or higher acetabular index after 2 years of reduction and upward sloping of acetabular sourcil. Evidence: The youngest patient was 5 months old, the oldest was 23 months old, average age was 12,36 months. Follow-up period of at least 18 months, a maximum of 43 months with a mean of 24.53 months. Preoperative acetabular index angle average of thirty-seven hips was 34.5135 (± 4.574), postoperative acetabular index angle average was 27.7297 (± 4.433), the last check acetabular index angle average was 23.0541 (± 5.328) and repeated angular values in the periods showed statistically significant change (F = 85.00; p <0.001). According to McCay clinical evaluation criteria 36 of 37 hips (%97,3) showed Grade I excellent results. Radiologically 29 of 37 hips (%78,4) were excellent, 8 (%21,6) were considered as good result. Two of 37 hips (%5,4) had Grade I avascular necrosis. In this study 3 of 37 hips (%8,1) required secondary acetabular surgery intervention. Result: We believe that in treatment of developmental dysplasia of the hip, in Tönnis type II and III hips, limited open reduction method applied by loosening extracapsuler structures (adductor longus and iliopsoas tenotomies) without opening the joint capsule, provided stable concentric reduction with only flexion and abduction of the hip, do not requires major intervention, technically easy and requires less experience. Keywords: Developmental dysplasia of the hip, posteromedial limited open reduction.