One- Stage Correction of Neglected Developmental Dysplasia of the Hip by Open Reduction and Pemberton Osteotomy

Background and purpose: Pemberton osteotomy is commonly used for correction of hip dysplasia. Its application in case of hip dislocation is rarely reported. The purpose of this study was to determine the efficacy of one-stage open reduction and Pemberton osteotomy of the neglected dislocated hips (DDH). Methods: We retrospectively reviewed the clinical and radiographic results of one-stage total correction of 75 patients with neglected DDH (86 hips) from 1984 through 1996. Sixty-nine patients (77 hips), ageed 13 to 76 months (mean, 21.5 months), underwent open reduction , Pemberton osteotomy and hip spica for 8 weeks. Seven patients (9 hips ageed 29 to 73 months (mean, 46.6 months), underwent additional femoral shortening (another hip in one bilaterally involved patient underwent only open reduction and Pemberton osteotomy). Results: acetabular index improved markedly from 40.4°(range, 25-60 °) preoperatively to 16. 2 ° (range, 0-30° ) postoperatively. Complications included redislocation in 4 patients (4 hips) and avascular necrosis in 3 patients (3 hips). Reoperation was performed in 4 patients (4 hips). All patients are followed up at least 3 years. By Severin’s classification, all operated hips had excellent (18) or good (68) final radiographic results. The functional results, evaluated by McKay’scriteria, were also excellent (52 patients /60 hips) and good (23 patients /26 hips). Conclusions: Neglected DDH was safely and effectively treated by open reduction, Pemberton osteotomy and optional femoral shortening with limited complications