The Protective Effect of Adding Valgus Osteotomy to the Femoral Shortening in Prevention of Avascular Necrosis of Femoral Head in Treatment of Developmental Dysplasia of the Hip

Abstract

Femoral shortening during reduction is one of the effective methods to reduce the risk of AVN, especially in older children, which causes good reduction of the femoral head without high pressure on the femoral head. Osteotomies performed for femoral shortening should be accompanied by a varus osteotomy in older children, if needed. According to intraoperative observations, during hip abduction, the retinal arteries are compressed, which can be reduced by valgus osteotomy. Therefore, our aim in this study was to evaluate the rate of avascular necrosis of the femoral head, hip joint instability and the need for reoperation in children with DDH who have been treated with two femoral shortening methods alone or with valgus osteotomy. Materials and Methods: In this study, patients with DDH who underwent open reduction surgery (via anterior hip approach), plow osteotomy, femoral shortening, and spica capsule surgery (one and a half) in cases where postoperative examination Retinal collar vascular implantation ostomy was evident at the edge of the acetabulum. Femoral shortening was performed in conjunction with valgus stotomy. The level of AVN was assessed by radiography, and a physical examination was performed to assess the instability of the hip joint to determine if the hip was stable, and radiography was used to determine the need for reoperation Results: Among the cases for which osteotomy was performed, six cases (two cases of left DDH and four cases of right DDH) developed AVN; The prevalence of this complication in this group was 9.5%. The number of cases for which osteotomy was not used and developed avascular complication was 21 cases (nine cases of left DDH and 12 cases of right DDH); The prevalence of this complication in this group was 33.33% (P = 0.001). The relationship between age and avascular necrosis incidence in patients who underwent surgery without valgus osteotomy showed a statistically significant relationship (P = 0.014), while between age and avascular necrosis incidence in patients undergoing valgus osteotomy. There was no statistically significant relationship (P = 0.054). The study of the relationship between the type of avascular complication and age in cases without valgus osteotomy showed that with age, the type of avascular necrosis incidence worsens.