Mid term results of Pemberton pericapsular osteotomy

BACKGROUND: Treatment for developmental dysplasia of the hip (DDH) varies according to the age of the patient. For children under 3 months, the preferred treatment is Pavlik bandaging and/or dynamic hip orthosis;for children of 3–18 months (with/without arthrography), closed and open reductions (ORs) are most common; and for children 18 months and older, pelvic osteotomies are used. Radiological and functional outcomes of patients between 16 months and 7 years of age who underwent Pemberton pericapsular osteotomy (PPO) were evaluated. MATERIALS AND METHODS: Twelve patients with developmental dysplasia of the hip (DDH) received treatment on 14 hips between 2001 and 2006. All patients with DDH had PPO as pelvic osteotomy. PPO was done solely in 3 hips, PPO and open reduction (OR) in and OR + PPO + femoral shortening in 6. The average age was 39.85 months (range 16–83 months). All had 1-stage surgery. Acetabular index (AI) and the grade of displacement were determined according to Tönnis’. Center-edge (CE) angle was evaluated. Clinical evaluations were made as described by McKay, radiological assessments by Severin's criteria and femoral head avascular necrosis measurements by Kalamchi–MacEwen's criteria. Average followup periods were 83.35 months (range 48–115 months). RESULTS: Preoperative and postoperative average AI levels were 41.92° (range 30–50°) and 19,5° (range 5–34°), respectively (P < 0.001). According to Severin's classification, 11 (78.57%) patients were Ia, 1 (7.14%) was Ib, 1 (7.14%) was II and 1 (7.14%) was III. According to Kalamchi–McEven criteria, 12 (85.71%) patients were type I, 2 (14.28%) patients were type II. CE postoperatively was measured as 24.24° (range 12–41°). Clinically (McKay), the functional results in 13 (92.85%) patients were very good (I) and in 1 (7.14%) was good (II). CONCLUSIONS: Functional and radiological mid term outcomes were found to be comparable in most of the patients with DDH undergoing PPO between the ages of 16 months and 7 years.