Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age.

OBJECTIVE To determine the outcome of one-stage combined operative management of congenital dislocation of hips in children aged 18-36 months. METHODS The descriptive case series study was conducted at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from January 2005 to December 2011. Children aged 18-36 months suffering from congenital dislocation of hips were included. Those with Tonnis stage III and IV were managed with one-stage operative procedure without preliminary traction. The operative procedure included adductor tenotomy, open reduction, capsulorraphy, Salter's osteotomy and a femoral derotation osteotomy. Catteral's 'Test of Stability' was used after open reduction as an indicator for need of pelvic and femoral osteotomies. Follow-up ranged between 1 and 7 years. The patients were evaluated clinically on McKay's criteria and radiologically on Severin's criteria. Klisic's overall rating was used to know mean of the assessments. RESULTS There were 38 patients with 50 congenital dislocations of hip. There were 26 (68.42%) females and 12 (31.57%) males with a female-to-male ratio of 2:1. Mean age at the time of operation was 24.26 ± 7.6 months. Of the total, 12 (31.57%) patients had bilateral involvement, 11 (28.94%) had right-sided and 15 (39.47%) had left-sided involvement. Right side to Left ratio was 1:1.2. At the time of last follow-up, 25 (50%) hips behaved excellent on McKay's criteria. According to radiographic classification on Severin's criteria, 24 (48%) hips were in excellent class. Avascular necrosis of femoral head was noted in 3 (6%) hips, re-subluxation/re-dislocations were observed in 3 (6%) hips and 1 (2.6%) patient had 1 cm femoral lengthening. CONCLUSION One-stage open reduction, capsulorrapyhy, Salter's osteotomy and femoral derotation osteotomy without preliminary traction to re-locate congenital dislocation of hips in late presenting children is a safe and highly effective method. It produces a low rate of complication and need for repeat surgery. It reduces the cost of treatment, minimises socio-economic burden and psychological trauma incurred by lengthy hospitalisation of treatment with traction followed by closed reduction.