Evaluation of Radiological Outcomes Following Open Reduction and Pemberton's Procedure for Pediatric Developmental Dysplasia of Hip
Background: Surgical management is indicated in paediatric patients with developmental dysplasia of the hip with late presentation or failure of nonsurgical care. The goal of surgery is to achieve a stable reduction to facilitate femoral head and acetabulum growth while preventing femoral head osteonecrosis and the need for further surgery. The Pemberton’s procedure for Developmental dysplasia (DDH) of the hip can be a safe and successful method in the treatment of developmental hip dysplasia in older children. The present study was carried out with an objective to assess the radiological outcomes following Pemberton’s procedure.
Methods: A retrospective study was carried out in a tertiary care centre from 2007-2011. About 70 patients with 88 hips who underwent open reduction and Pemberton’s procedure were included in the study. Radiological follow-up was done with X-ray to assess Acetabular index (AI), Shenton’s line (SL), and any signs of early avascular necrosis (AVN) of head of the femur. Data of the radiological indices were entered in excel and analyzed in SPSS 23. Mean, percentages, and appropriate statistical tests such as paired t-test and Kappa Coefficient were applied.
Results: In final 70 patients selected in the study, 57 (81.4%) were females and 13 (18.6%) were males. The AI outcome was studied in the patients for the right and left hip where 94.9%-97.7% within 6 months post-surgery and 92.3% at 2 years post-surgery were converted from abnormal to normal status. SL outcome was studied for the right and left hip where 88.1%-86.1% within 6 months post-surgery and 95.2%-97.7% at 2 years post-surgery were converted from broken to intact status. AVN outcome at 2 years postsurgery for the right and left hip which results 81.1% - 83.3%.
Conclusion: The pediatric patients diagnosed with DDH who underwent open reduction and acetabuloplasty using Pemberton's procedure has shown significant improvement in the studied radiological orthopedic outcomes.