One stage surgery using subtrochanteric osteotomy versus two stage surgery using supracondylar femoral derotation osteotomy in treatment of developmental dysplasia of the hip joint for older children


Background: The one stage surgery of open reduction and subtrochantric femoral osteotomy with or without pelvic osteotomy, has been an accepted method of treatment of congenital hip dislocation in older children. This approach obtains predictable reduction and results in a low rate of osteonecrosis despite the higher rate of operative and postoperative morbidity like prolonged anesthesia time, large incisions and more immediate postoperative complications. Two-stage surgery might, therefore, help in avoiding the above-cited disadvantages.Aim of the study: Is to compare the results obtained by using either one-stage surgery by subtrochanteric or two-stage surgery by supracondylar femoral derotational osteotomies in the management of developmental dysplasia of the hip joint.Patients and Methods: This is a randomized controlled trial involving children under the age of 2.5 years with developmental dysplasia of the hip and attending Basrah General Hospital between December 2010 till August 2012. Thorough clinical examination and laboratory investigations were done for all the patients and only 30 patients with 39 dislocated hips whom did not require femoral shortening and need >10-15 degrees of acetabular roof index correction using pelvic osteotomy were included in this study. Each patient was randomly allocated into one of the two surgical procedures; procedure A was one-stage surgery and procedure B was two-staged surgery. At the end of the study period, a total of 30 patients under the age of 2.5 years were recruited for this study, 16 patients underwent procedure A and another 14 underwent procedure B. The patients were followed-up for 12-18 months and evaluated clinically & radiologicaly depending on McKay and Severin’s clinical and radiological criteria respectively.Results: Thirty patients with 39 dislocated hips were managed. Patients age ranged from 1.5 to 2.5 years; all of them were females having no associated skeletal anomaly. The outcome of one-stage surgery showed better clinical (78.9%) and radiological results (88.8%) in comparison to two-stage surgery which showed 45% clinical and 70% radiological results, however, the time of technical procedure and other morbidities for example; risk of infection (20%), preoperative blood transfusion (100%), respiratory distress (13.5%) were relatively greater in one-stage surgery. Conclusion: The results of this study showed that one-stage operation resulted in better joint realignment, without increasing risk of avascular necrosis, and more hip joint physiological and anatomical remodeling affinities, despite of its prolonged time and more rate of immediate postoperative morbidity. While in the two-staged surgery, the clinical and radiological outcomes were less successful than those with one-stage operation, though immediate postoperative morbidities were less.