Ali A Al-Iedan
MBChB, CABS, Lecturer in Orthopaedics, Department of Surgery, College of Medicine, University of
Basrah, Basrah – Iraq.
The treatment of developmental dislocation of the hip (DDH) in older children is a challenge
because they have high displacement of the hip, contracted soft tissues, insufficiency of the
acetabulum and increased anteversion of the femoral head. In such patients it is difficult to
reduce the femoral head into the acetabulum, maintain the concentric reduction and obtain a
satisfactory functional hip joint. The aim of this study is to assess the advantage and
disadvantage of one stage combined surgery with femoral shortening in treatment of DDH in
children above 2 years old.
This is a prospective study done in Al-Basrah General Hospital between (June 2008-June
2010), thirty patients were treated (35 hips), 28 females and 2 males. Five hips were right hip
dislocation, 20 hips were left and 5 patients were bilateral. Femoral shortening done for all the
hips and, in 28 hips pelvic osteotomy were performed at the time of open reduction. At the most
recent follow-up (4 months-2 years) According to the radiographic criteria of Severin, 5 hips
were excellent, 15 hips good and 10 hips have fair results, 5 end up hips had poor outcome.
Avascular necrosis developed in 5 of the 35 hips. All patients were followed with respect to
range of motion and recovery from limb-length discrepancy. Different complications were
recorded per or postoperatively. Some complications like pelvic fracture (1 hip), subluxation and
instability (3 hips), dislocation (2 hips) and stiffness (7 hips).
According to the rating system of Mckay's clinical criteria, there were 7 hips excellent, 11 hips
good, 12 hips fair results and 5 hips had a poor result.
It is concluded that children who are two years or older and have DDH, can safely be treated
with an extensive one-stage operation consisting of open reduction combined with femoral
shortening and pelvic osteotomy, without increasing the risk of avascular necrosis. The limb
length discrepancy that is produced by the shortening does not appear to cause a clinical