Arthroscopic-assisted surgical treatment for developmental dislocation of the hip

Abstract

Purpose: Treatment of developmental dislocation of the hip (DDH) includes surgical management in older children or in those who cannot be treated conservatively. However, complication rates of surgical treatment are quite high. The purpose of this report is to introduce our new surgical technique that can eliminate existing pathologic changes in DDH. Type of Study: A small case series. Methods: We performed arthroscopic-assisted surgical treatment in 4 hips of 4 female children who had DDH and no previous treatment. Their ages ranged from 11 to 14 months. Closed reduction under general anesthesia was tried just before the surgical intervention, but it failed in all of them. Tightness of the iliopsoas tendon was released followed by dissection of capsular adhesions using an anterolateral mini-incision. Excision of the hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue was carried out using a double-portal arthroscopic procedure. We performed percutaneus adductor tenotomies in 2 cases. A spica cast and abduction splint were used for 12 to 17 weeks postoperatively. The follow-up of the patients was a minimum of 1 year. Although a 1-year follow-up period is adequate to evaluate the short-term results, it has been considered that there is a need for further studies that include long-term follow-up. We used the acetabular index and Shenton's line for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively in respect to range of motion restriction and the leg length discrepancy. Results: The mean follow-up was 13.7 months (range, 12 to 16 months). Acetabular index measurements of the cases in the preoperative/postoperative periods were as follows: in the first case, 34 degrees/27 degrees; in the second case, 35 degrees/22 degrees; in the third case, 52 degrees/39 degrees; and in the fourth case, 40 degrees/28 degrees. Hip joint restriction and leg length discrepancy were not observed postoperatively. Conclusions: All the intra-articular structures (hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue) in the acetabulum that impede the reduction of the femoral head have been eliminated by using the arthroscopic technique. The arthroscopic-assisted surgical treatment of DDH is successful in the short-term follow-up period.