Growth Stimulating Minimal Acetabuloplasty, Alongside Hip Open Reduction: A Simpler One-stop Operative Treatment for Developmental Dysplasia of the Hip

BACKGROUND: This paper describes a pelvic procedure that is technically simpler, quicker to perform, and equally effective as all existing pelvic osteotomies. It is used alongside hip open reduction for the treatment of the associated acetabular dysplasia. It is a minimal additional procedure that is intended to ignite the growth of the dysplastic acetabulum. METHODS: A total of 167 hips (in 154 infants) treated with open reduction and growth-stimulating minimal acetabuloplasty, all with follow-up between 4 and 16 years postoperatively, are reported. The surgical technique is described. Sequential radiographs were analyzed through to final follow-up, which for 21% is to skeletal maturity. Patient demographics, preoperative and sequential postoperative indices, and outcomes are recorded. RESULTS: Preoperative IHDI position was grade IV dislocation in 77% and grade III in 33%. Mean starting acetabular index (AI) was 41.3 degrees (range 30 to 54 degrees) and median age at operation was 13 months (range from 1 to 2.5years). At final follow-up, 98.2% of hips have a Severin 1 (excellent) or 2 (good) outcome, with the AI normalized. These are all IHDI grade 1 and have a mean center-edge-angle of 35.7 degrees. Only 6 of these (3.6%) have warranted a subsequent pelvic osteotomy for residual acetabular dysplasia. CONCLUSIONS: The growth-stimulating minimal acetabular procedure is technically straightforward. It is simpler than standard existing pelvic osteotomies, yet it is shown to be at least as effective. With up to 16 years follow-up, we can highly commend its routine use alongside hip open reduction in infants aged 1 to 2.5 years old. LEVEL OF EVIDENCE: Level III-case-control study.