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The high osteotomy cut of Dega procedure for developmental dysplasia of the hip in children under 6 years of age

Dega-Osteotomie mit hoher Inzision zur Therapie der Hüftdysplasie bei Kindern unter 6 Jahren

Abstract

Background

Dega osteotomy has gained popularity for the acetabular reconstruction of developmental dysplasia of the hip (DDH). A high-level Dega osteotomy combining the typical Dega procedure with an age limit of under 6 years and the higher pelvic cut height of the Salter osteotomy for walking DDH patients aged 6 or younger was advocated in our department. The purpose of this retrospective study is to introduce this modified Dega procedure and report the preliminary clinical and radiological results in DDH patients under 6.

Materials and methods

From September 2000 to September 2010, a total of 162 patients with 191 dysplastic hips between 1.5 and 6 years old were managed with this high-level Dega osteotomy. From each patient’s record, clinical status was retrospectively assessed using modified McKay criteria; radiological evaluations were assessed according to the modified Severin classification, the mean acetabular index (AI), Sharp angle and center-edge (CE) angle. Any occurrence of complications was recorded postoperatively.

Results

The average age at surgery was 3.6 years (range 1.5 to 6.0), mean duration of follow-up 11.3 years (range 5.0 to 16.9). The latest follow-up fineness (favorable and good) rate in clinical and radiological evaluations was 92.7 % and 91.1 % respectively. There was a marked trend toward normalization of radiographic indices during the follow-up period: the mean AI changed from 38.0° to 20.8°, the mean Sharp’s angle decreased from 59.9° to 39.2°, and the mean CE angle increased from −10.7° to 29.4°, preoperatively and at the latest follow-up respectively. No major complications were recorded during follow-up.

Conclusion

The high osteotomy cut Dega procedure for patients between 1.5 and 6 years of age was found to be sufficient for improving clinical and radiographic outcomes and inducing little morbidity and few complications for late-detected pediatric walking DDH patients.

Zusammenfassung

Hintergrund

Die Osteotomie nach Dega zur Acetabulumrekonstruktion bei entwicklungsbedingter Dysplasie der Hüfte („developmental dysplasia of the hip“, DDH) gewinnt an Zuspruch. Eine Dega-Osteotomie vom hohen Typ, bei der das typische Vorgehen nach Dega mit einer Altersgrenze unter 6 Jahren und einer Beckeninzisionshöhe wie bei der Salter-Osteotomie für DDH-Patienten im Alter von 6 Jahren oder weniger, die bereits laufen konnten, kombiniert wird, wurde in der Klinik der Autoren befürwortet. Ziel der vorliegenden retrospektiven Studie war es, dieses modifizierte Vorgehen nach Dega einzuführen und über vorläufige klinische und radiologische Ergebnisse bei DDH-Patienten unter 6 Jahren zu berichten.

Material und Methode

Von September 2000 bis September 2010 wurde bei insgesamt 162 Patienten zwischen 1,5 und 6 Jahren mit 191 dysplastischen Hüften diese Dega-Osteotomie vom hohen Typ durchgeführt. Retrospektiv wurde aus den einzelnen Krankenakten der klinische Zustand jedes Patienten anhand der modifizierten McKay-Kriterien ermittelt; eine radiologische Beurteilung erfolgte in Bezug auf die modifizierte Severin-Klassifikation, den mittleren acetabulären Index (AI), den Acetabulumwinkel nach Sharp und den Zentrum-Ecken(CE)-Winkel. Auch das postoperative Auftreten von Komplikationen wurde dokumentiert.

Ergebnisse

Das Durchschnittsalter bei der Operation betrug 3,6 Jahre (Spannbreite: 1,5–6,0), die mittlere Dauer der Nachbeobachtung 11,3 Jahre (Spannbreite: 5,0–16,9). Die aktuellsten Erfolgsraten aus den Nachbeobachtungsdaten bezüglich der klinischen und radiologischen Beurteilung betrugen 92,7 % bzw. 91,1 %. Es bestand eine deutliche Tendenz zur Normalisierung der radiologischen Indizes während der Nachbeobachtungsphase: der mittlere AI änderte sich von 38,0° zu 20,8°, der mittlere Winkel nach Sharp nahm von 59,9° auf 39,2° ab, und der mittlere CE-Winkel stieg von −10,7° auf 29,4°, jeweils präoperativ und bei der letzten Nachuntersuchung. Es wurden keine schweren Komplikationen während der Nachbeobachtungsphase angegeben.

Schlussfolgerung

Es stellte sich heraus, dass sich bei Patienten zwischen 1,5 und 6 Jahren mit der Dega-Osteotomie vom hohen Typ die klinischen und radiologischen Ergebnisse verbessern ließen und dieses Verfahren bei den bereits gehfähigen kindlichen Patienten mit spät erkannter DHH zu einer nur geringen Morbidität sowie lediglich wenigen Komplikationen führte.

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Author information

Correspondence to D. Ming-Hua MD or X. Rui-Jiang MD or L. Wen-Chao MD.

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Conflicts of interest

D Ming-Hua, .X Rui-Jiang and L Wen-Chao state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Ming-Hua, D., Rui-Jiang, X. & Wen-Chao, L. The high osteotomy cut of Dega procedure for developmental dysplasia of the hip in children under 6 years of age. Orthopäde 45, 1050–1057 (2016). https://doi.org/10.1007/s00132-016-3283-4

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Keywords

  • Acetabulum
  • Osteotomy
  • Child
  • Walking
  • Retrospective studies

Schlüsselwörter

  • Hüftgelenkspfanne
  • Osteotomie
  • Kind
  • Gehfähigkeit
  • Retrospektive Studien