Outcome analysis of Management of untreated Developmental Dysplasia of Hip by Klisic Procedure

Abstract:
Introduction:Developmental dysplasia of hip (DDH) is a spectrum of disorders of the developing hip that present in different forms at different ages. As the child becomes older without early treatment more secondary deformities develop which can be grouped on 3 major pathological entities like acetabular dysplasia, femoral head subluxation and soft tissue contractures. The aim of our study is to analyse the effectiveness and functional outcome in neglected developmental dysplasia of hip by one stage Klisic procedure.
Methodology: This is a prospective study conducted in Institute of Child Health and Government General Hospital, Egmore from 2013-2018. Patients presenting with DDH more than 3 years of age were included in the study. All the patients were evaluated radiologically and their acetabular index is calculated and proceeded with one stage Klisic procedure which consist of Open reduction of displaced hip joint with Primary femoral
shortening, Varization and Derotation with Capsulorrhaphy and Pelvic osteotomy namely Salter or Dega for acetabular dysplasia. Post-operative acetabular index on follow up and functional outcome is evaluated by Modified Mc Kay’s classification. Results:We included 12 hips from 10 patients in the study of which 8 were female and 2 male children with age
range between 3-15 yrs (Mean 7 yrs). There were 7 left sided hips and 5 right sided hips and 2 bilateral hips. 4 patients had unsuccessful surgical attempts earlier. Mean follow up is 3.7 yrs with range between 2.5-5 yrs. Mean preop acetabular index was 42°. On final follow up mean acetabular index was 33°. According to Modified McKay’s classification 25% (3) had Excellent results while 16.67%(2) had Good and 41.66% (5) had Satisfactory and 16.67% (2) had Poor results. We had complications like secondary subluxation in one patient and superficial infection in one and lateral popliteal nerve palsy in one patient due to valgus deformity correction in knee. Conclusion: The one stage correction procedure can be considered as a safe and effective option in neglected developmental dysplasia of hip in patients more than three years of age. If the procedure is done in relatively younger children the functional outcome is better compared to older children. This procedure has the advantage
of decreasing the need for subsequent surgeries in multistage procedure and eliminating the need for prolonged
post-operative immobilization.