Role of Proximal Femoral Osteotomy in the Management of Developmental Dysplasia of Hip
Volume 6 | Issue 2 | May-August 2020 | Page: 33-38 | Prateek Behera
Authors: Prateek Behera 
 Department of Orthopedics, All India Institute of Medical Sciences, Bhopal, 462020 India
Address of Correspondence
Dr. Prateek Behera,
Department of Orthopedics, All India Institute of Medical Sciences,
Bhopal, 462020 India
E-mail: email@example.com , firstname.lastname@example.org
Proximal femoral osteotomy as a component of the treatment of developmental dysplasia of hip (DDH) has been used for almost a century now, after being described by Hey-Groves in 1928. Over the years, understanding of its role has evolved alongside our improved knowledge on the pathoanatomy and biomechanics of DDH. It has come a long way from being used exclusively in older walking children; being used as the only other concomitant procedure with open reduction of hip and being used with pre-determined values to be achieved on table, to its present state of being an indispensable component of the a la carte approach of the treatment of DDH. A femoral osteotomy is used for shortening, decreasing the femoral anteversion, or for producing a varus at the proximal femur. The surgical technique has remained largely unchanged over the years although proximal femoral locking plates are increasingly employed in addition to the traditional options such as angle blade plate, DCP, or one-third tubular plates. This review aims to analyze and summarize the current understanding of the role played by a proximal femoral osteotomy in the management of DDH.
Keywords: Developmental dysplasia of hip; Proximal femoral osteotomy; Varus derotation osteotomy; Avascular necrosis of femoral head.
1. Murphy RF, Kim YJ. Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 2016;24:615-24.
2. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part I. Instr Course Lect 2004;53:523-30.
3. Herring JA. Congenital coxa vara. In: Tachdjian’s Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 483-579.
4. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.
5. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 1998;80:711-9.
6. Doudoulakis JK, Cavadias A. Open reduction of CDH before one year of age. 69 hips followed for 13 (10-19) years. Acta Orthop Scand 1993;64:188-92.
7. Weinstein SL. Developmental hip dysplasia and dislocation. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s Pediatric Orthopaedics. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2014. p. 983-1111.
8. Forlin E, Munhoz da Cunha LA, Figueiredo DC. Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy. Orthop Clin North Am 2006;37:149-60.
9. Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Relat Res 1976;119:60-9.
10. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part II. Instr Course Lect 2004;53:531-42.
11. Moseley CF. Open reduction of a congenital dislocated hip and salter innominate osteotomy. In: Tolo VT, Skaggs DL, editors. Master Techniques in Orthopaedic Surgery: Pediatrics. 1st ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p. 120-35.
12. Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 2000;82:17-27.
13. Weinstein SL, Dolan LA, Morcuende JA. The 2018 Nicholas Andry Award: The evidence base for the treatment of developmental dysplasia of the hip: The Iowa contribution. Clin Orthop Relat Res 2018;476:1043-51.
14. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876-88.
15. Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion. AJR Am J Roentgenol 1981;137:97-101.
16. Sankar WN, Neubuerger CO, Moseley CF. Femoral anteversion in developmental dysplasia of the hip. J Pediatr Orthop 2009;29:885-8.
17. Sarban S, Ozturk A, Tabur H, Isikan UE. Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip. J Pediatr Orthop B 2005;14:410-4.
18. Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91:2622-36.
19. Galpin RD, Roach JW, Wenger DR, Herring JA, Birch JG. One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. J Bone Joint Surg Am 1989;71:734-41.
20. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: Special indications and results in the child younger than 2 years. J Pediatr Orthop 1995;15:768-79.
21. Wenger DR, Weinstein SL. Operative Treatment of Developmental Dysplasia of the Hip with Open Reduction and Salter Osteotomy. Available from: https://www.vjortho.com/2000/12/operative-treatment-of-ddh-with-open-reduction-and-salters-osteotomy.
22. Kelly DM. Congenital and developmental abnormalities of the hip and pelvis. In: Azar FM, Beaty JH, Canale ST, editors. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier Saunders; 2017. p. 1118-54.
23. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Post reduction computed tomography in developmental dislocation of the hip: Part I: Analysis of measurement reliability. J Pediatr Orthop 1997;17:626-30.
24. Sangavi SM, Szöke G, Murray DW, Benson MK. Femoral remodelling after subtrochanteric osteotomy for developmental dysplasia of the hip. J Bone Joint Surg Br 1996;78:917-23.
|How to Cite this Article: Behera P | Role of Proximal Femoral Osteotomy in the Management of
Developmental Dysplasia of Hip | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 27-32.
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