Introduction: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal disorders among newborns. Failure to identify or treat early may result in hip dysfunction and early arthritis. The purpose of this study is to evaluate the radiographic and functional results of one-stage treatment (open reduction, femoral shortening, and San Diego pelvic osteotomy) of DDH in older children. 

Patients and Methods: In this prospective case-series comprising 24 patients (28 hips) underwent the triple procedure of open reduction, femoral shortening and San Diego pelvic osteotomy, at new Kasr-al-aini University Hospital and Souad Kafafi University hospital between January 2015 and March 2021. The mean age of patients at presentation was 7.14 (from 5.6 to 8.8) years and the average follow-up were 20.2 months. Patients were classified pre-operatively according to the Tonnis classification. Postoperative functional evaluation was performed using Modified MacKay clinical evaluation system to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip movement. Radiographic assessment using Severin's scoring method was made.

 

Results: According to MacKay score, 20 hips were excellent to good (71%), while eight hips (29%) were fair to poor. Radiographically, according to the Severin's modified criteria, 22 hips (78%) were excellent to good and six hips (22%) were fair to poor. There was Limb length discrepancy ranged from 0.5 to 2.1 cm.

Conclusion: The triple procedure of open reduction, femoral shortening and San Diego pelvic osteotomy gives satisfactory results in older children regarding that adequate shortening with derotation if needed is performed, together with appropriate acetabular reconstruction and capsulorrhaphy.

Assem Bastawisy Ahmed, MD, is an esteemed orthopedic surgeon with 29 years of experience. He currently serves as an assistant professor in orthopedics & trauma surgery at the Faculty of Medicine, Misr University for Science & Technology, a position he has held since July 2014. Dr. Ahmed completed his medical education at Cairo University, earning his MD in orthopedics & trauma surgery in 2009. His extensive career includes significant roles in various hospitals, including Military Hospitals, Haram Hospital, and New Kasr el-Aini Teaching Hospital. He has also gained international experience through fellowships and visiting doctor positions in Austria, Switzerland, Italy, and Germany. Dr. Ahmed has specialized in areas such as limb lengthening, correction of bone deformities, and management of postoperative infections. He has contributed to the field through numerous publications and presentations at international conferences, covering topics like rheumatoid arthritis, pediatric femoral fractures, and minimally invasive surgical techniques. Ahmed is fluent in Arabic, English, and German, reflecting his broad international engagement in the field of orthopedics.