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 treating hip dislocation is rarely re ported. The purpose of this study was to determine the efficacy of one-stag e open reduction and Pemberton osteotomy of neglected developmental dysplas ia of the hip (DDH). Methods: We retrospectively reviewed the clinical and radiographic results of one-stage total correction in 75 patients with neglected DDH (86 hips) f rom 1984 through 1996. Sixty-nine patients (77 hips) aged 13 to 76 months ( mean, 21.5 mo) underwent open reduction, Pemberton osteotomy, and hip spica for 8 weeks. Seven patients (9 hips) aged 29 to 73 months (mean, 46.6 mo) underwent additional femoral shortening (another hip in one bilaterally inv olved patient underwent only open reduction and Pemberton osteotomy). Results: Acetabular index improved markedly from 40.4 degrees (range, 25-60 degrees) preoperatively to 16.2 degrees (range, 0-30 degrees) postoperativ ely. Complications included redislocation in four patients (4 hips) and ava scular necrosis in three patients (3 hips). Reoperation was performed in fo ur patients (4 hips). AH patients were followed up for 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's criteria, were also excellent (52 patients/60 hips) and good (23 patients/2 6 hips). Conclusions: Neglected DDH was safely and effectively treated by open reduc tion, Pemberton osteotomy, and optional femoral shortening with limited com plications.