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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



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.


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.


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.



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.


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.


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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  1. 1.

    Ganger R, Radler C, Petje G, Manner HM, Kriegs-Au G, Grill F (2005) Treatment options for developmental dislocation of the hip after walking age. J Pediatr Orthop B 14:139–150

  2. 2.

    Grudziak JS, Ward WT (2001) Dega osteotomy for the treatment of congenital dysplasia of the hip. J Bone Joint Surg Am 83-A:845–854

  3. 3.

    Lalonde FD, Frick SL, Wenger DR (2002) Surgical correction of residual hip dysplasia in two pediatric age-groups. J Bone Joint Surg Am 84-A:1148–1156

  4. 4.

    Hak DJ, Gautsch TL (1995) A review of radiographic lines and angles used in orthopedics. Am J Orthop 24:590–601

  5. 5.

    Berkeley ME, Dickson JH, Cain TE, Donovan MM (1984) Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am 66:412–420

  6. 6.

    Iwersen LJ, Kalen V, Eberle C (1989) Relative trochanteric overgrowth after ischemic necrosis in congenital dislocation of the hip. J Pediatr Orthop 9:381–385

  7. 7.

    Ward WT, Vogt M, Grudziak JS, Tümer Y, Cook PC, Fitch RD (1997) Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Joint Surg Am 79:656–663

  8. 8.

    Bursali A, Tonbul M (2008) How are outcomes affected by combining the Pemberton and Salter osteotomies? Clin Orthop Relat Res 466:837–846

  9. 9.

    Tavares JO (2004) Modified Pemberton acetabuloplasty for the treatment of congenital hip dysplasia. J Pediatr Orthop 24:501–507

  10. 10.

    Chung CY, Choi IH, Cho TJ, Yoo WJ, Lee SH, Park MS (2008) Morphometric changes in the acetabulum after Dega osteotomy in patients with cerebral palsy. J Bone Joint Surg Br 90:88–91

  11. 11.

    El-Sayed M, Ahmed T, Fathy S, Zyton H (2012) The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up. J Child Orthop 6:471–477

  12. 12.

    Sales de Gauzy J (2010) Pelvic reorientation osteotomies and acetabuloplasties in children. Surgical technique. Orthop Traumatol Surg Res 96:793–799

  13. 13.

    Jóźwiak M, Marciniak W, Piontek T, Pietrzak S (2000) Dega’s transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy. J Pediatr Orthop B 9:257–264

  14. 14.

    Canale ST, Beaty JH (2013) Campbell’s operative orthopaedics, 12th edn. Elsevier, New York

  15. 15.

    Kobayashi D, Satsuma S, Kuroda R, Kurosaka M (2010) Acetabular development in the contralateral hip in patients with unilateral developmental dysplasia of the hip. J Bone Joint Surg Am 92:1390–1397

  16. 16.

    Omeroglu H, Bicimoglu A, Agus H, Tumer Y (2007) Acetabular development in developmental dysplasia of the hip. A radiographic study in anatomically reduced and uncomplicated hips. Bull NYU Hosp Jt Dis 65:276–279

  17. 17.

    Canale ST, Beaty JH (2013) Campbell’s operative orthopaedics, 12th edn. Elsevier, New York

  18. 18.

    Benson MK, Fixen JA, Macnicol M (1994) Children’s orthopaedics and fractures. Churchill Livingston, London

  19. 19.

    Cashman JP, Round J, Taylor G, Clarke NM (2002) The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. J Bone Joint Surg Br 84:418–425

  20. 20.

    Tasnavites A, Murray DW, Benson MKD (1993) Improvement in acetabular index after reduction of hips with developmental dysplasia. J Bone Joint Surg Br 75:755–759

  21. 21.

    Canale ST, Beaty JH (2013) Campbell’s operative orthopaedics, 12th edn. Elsevier, New York

  22. 22.

    Aksoy C, Yilgor C, Demirkiran G, Caglar O (2013) Evaluation of acetabular development after Dega acetabuloplasty in developmental dysplasia of the hip. J Pediatr Orthop B 22:91–95

  23. 23.

    Reichel H, Hein W (1996) Dega acetabuloplasty combined with intertrochanteric osteotomies. Clin Orthop Relat Res 323:234–242

  24. 24.

    Domzalski M, Synder M, Drobniewski M (2004) Long-term outcome of surgical treatment of developmental dyplasia of the hip using the Dega and salter method of pelvic osteotomy with simultaneous intratrochanteric femoral osteotomy. Ortop Traumatol Rehabil 6:44–50

  25. 25.

    Ruszkowski K, Pucher A (2005) Simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip in children under 24 months of age. J Pediatr Orthop 25:695–701

  26. 26.

    McNerney NP, Mubarak SJ, Wenger DR (2000) One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop 20:93–103

  27. 27.

    Koch A, Jozwiak M, Idzior M, Molinska-Glura M, Szulc A (2015) Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy. Bone Joint J 97-B:270–276

  28. 28.

    Pemberton PA (1965) Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 47:65–86

  29. 29.

    Pemberton PA (1974) Pericapsular osteotomy of the ilium for the treatment of congenitally dislocated hips. Clin Orthop Relat Res 98:41–54

  30. 30.

    Portinaro NM, Porteous A, Parafioriti A, Panou A, Benson MK MK (2011) Growth of the acetabular lateral cartilage in relation to congenital and developmental dysplasia of the hip. An histological study. Hip Int 21:9–13

  31. 31.

    Wang TM, Wu KW, Shih SF, Huang SC, Kuo KN (2013) Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome? J Bone Joint Surg Am 95:1081–1086

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

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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).

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  • Acetabulum
  • Osteotomy
  • Child
  • Walking
  • Retrospective studies


  • Hüftgelenkspfanne
  • Osteotomie
  • Kind
  • Gehfähigkeit
  • Retrospektive Studien