Analysis of the Effectiveness and Functional Outcome of Klisic Procedure in Neglected Developmental Dysplasia of Hip in Children more than Three Years Old

Manimaran, K P (2006) Analysis of the Effectiveness and Functional Outcome of Klisic Procedure in Neglected Developmental Dysplasia of Hip in Children more than Three Years Old. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Developmental dysplasia of hip (DDH) is a spectrum of disorders of the developing hip that present in different forms at different ages. This developmental disorder of hip evolves over a period of time during childhood. The structures that make-up the hip are normal during embryogenesis and it gradually become abnormal for a variety of reasons mainly foetal position and presentation at birth. The older term congenital dislocation of the hip has gradually been replaced by developmental dysplasia. Klisic in 1989 recommended, the use of the term “developmental dysplasia of hip” to indicate a dynamic disorder potentially capable of getting better or worse as the child grows. The term developmental dysplasia is used to denote both dislocation and dysplasia of hip. AIM: The aim of this study is to analyse the effectiveness and functional outcome in neglected developmental dysplasia of hip at three year and above, by one stage correction procedure (Klisic) that consists of Open reduction of the hip joint, Capsulorrhaphy, Femoral shortening and varization, Pelvic osteotomy. MATERIALS AND METHODS: In this study we have taken 12 hips in 10 patients, who were operated for neglected developmental dysplasia of hip. This study was conducted in Institute of Child Health and Government General Hospital, Madras Medical College. All the patients under went one stage correction procedure (ie) Klisic procedure which consist of Open reduction of dislocated hip joint, Primary femoral shortening, varization and derotation, Capsulorrhaphy, Pelvic osteotomy namely salter or Dega for acetabular dysplasia. There were 8 female and 2 male children with the female preponderance of developmental dysplasia of hip. All the patients were more than 3 yrs old. The lowest age in 3 yrs and the highest age is 15 yrs. The mean average of the age is 7 yrs. There were 7 left sided hips of 5 right sided hips which include 2 bilateral hips. Four patients had previous unsuccessful surgical attempts, one patient had bilateral congential talipes equinovarus, another patient had secondary valgus deformity of the knee due to stiff hip. The period of study in from 2003 – 2004. The longest follow-up is 2 yrs 10 months of the shortest follow-up is 1 yr 7 months. RESULTS: All the patients are evaluated clinically and radiologically. Clinical Evaluation - Post operatively after the period of immobilization (6 – 8weeks) the patients were evaluated with the following criteria: Pain in the hip joint while at rest, standing and walking, - Stability of the hip. Range of movement of the hip joint, Trendelenburg sign. Radiological Evaluation - Post operatively all the patients were evaluated radiologically with Severin’s classification. The Serevin classification includes the following criteria: Deformity of the femoral head, Deformity of the femoral neck, Deformity or dysplasia of acetabulum, Articulation of the femoral head, Centre edge angle, Age, Post operative and acetabular index is measured. CONCLUSION: The one stage correction procedure can be safely and effectively performed in neglected developmental dysplasia of hip in patients who were more than three years old. Open reduction for the dislocated hip, femoral shortening, derotation and varization for relatively long femur and valgus malallingement of upper femur and pelvic aesteotomy for acetabular dysplasia can give satisfactory clinical and radiological results. If the procedure is done in relatively younger children the functional out come is satisfactory poor results in older children. This procedure has the advantage of decreasing the need for subsequent surgeries in multistage procedure and eliminating the need for prolonged post operative immobilization. In pelvic osteotomy Salter method has a disadvantage of secondary posterior subluxation of hip because of the posteriorly deficient acetabulum. Dega osteotomy can be formed without that complication for acetabular dysplasia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional Outcome ; Klisic Procedure ; Neglected Developmental Dysplasia ; Hip ; Children more than Three Years Old.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 01:46
Last Modified: 14 Sep 2017 01:46
URI: http://repository-tnmgrmu.ac.in/id/eprint/3071

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