ddh Deformity Correction and Limb lengthening Pediatric Orthopedics

DDH Revision Surgery – The Arthrogram Advantage

DDH is a challenging Pediatric Orthopedic problem. The earlier the treatment is started better the result generally..

In many cases even with early care and even surgery the hip still tends to deviate away from acetabulum. This results in persistent Dysplasia.

When we attempt reconstruction one of the problems we face is whether to do the osteotomy of femur and acetabulum or wait and watch for acetabulum to remodel when child is young.

Arthrogram is an excellent tool to evaluate the state of cartilage over the lateral aspect and superolateral aspect of femoral head and then decide whether we want to do the acetabular osteotomy at the same sitting or defer it.

Illustrating below a case whether the Derotation osteotomy was done first and the we decided the acetabular osteotomy based on the cartilage cover on arthrogram.

This is useful in a child younger than 2 and half years as acetabulum has good remodelling potential at that age. In older children we will need to combine the procedures.

The state of hip before the osteotomy. Open reduction was done elsewhere about a year ago. Persistent hip dysplasia was observed.
The Derotation osteotomy improved the coverage but we still have to decide about the acetabular procedure.
An arthrogram reveals a large cartilage cover on superolateral acetabulum. The cartilage bump is pointed to by the forceps.
The C Arm image is superimposed and an artist’s impression is drawn showing what the cartilage would look like in 3D. This offers an excellent teaching tool and a 3D orientation for young surgeons and pediatric orthopedic trainees to decide whether an acetabular osteotomy is needed

The surgeon would then discuss with parents and opt to continue an acetabular procedure of take a staged approach