The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology.

Abstract

BACKGROUND:

The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of hip pathology resulting from both developmental dysplasia (DDH) and neuromuscular disease (NM).

METHODS:

We retrospectively reviewed the results of one surgeon's operative experience with the Dega osteotomy for the treatment of DDH and NM. Forty-four patients (50 hips) with an average length of follow-up of 53 months were identified. The Dega was customized at the time of surgery to provide more anterior or posterior coverage depending on the needs of the individual hip.

RESULTS:

In all cases, there were no intraoperative complications and all hips were well reduced postoperatively. In the DDH group, there were 22 children (26 hips), who underwent surgery at a mean age of 3.1 years. Thirteen hips had a concomitant open reduction and 4 had a femoral osteotomy. There were 5 complications: 2 femoral head lateralizations, 2 avascular necroses (asymptomatic), and 1 traumatic dislocation. One patient (1 hip) had a reoperation. All patients had unlimited physical activity with no limp with an improvement in the acetabular index from 37 degrees preoperatively to 13 degrees at last follow-up. In the NM group, there were 22 children (24 hips), who underwent surgery at a mean age of 6.3 years. Twenty-three hips had concomitant procedures performed. At an average of 56 months postoperatively, all patients were pain-free. There were 5 complications: 1 graft dislodgement, 1 graft collapse, and 3 femoral head lateralizations. Three patients (3 hips) had a reoperation. Acetabular index improved from 36 degrees preoperatively to 14 degrees, and the migration percentage ranged from 84% to 14%.

CONCLUSIONS:

In this series of Dega osteotomies, one of the largest in the English literature, the osteotomy seems safe and effective in the treatment of both DDH and NM hip disease. The Dega osteotomy is utilitarian, as it may provide increased acetabular coverage anteriorly or posteriorly depending on where it is hinged.

LEVEL OF EVIDENCE:

Therapeutic study, clinical case series: level IV.

• Authors: Judson W Karlen, David L Skaggs, Manoj Ramachandran, Robert M Kay
• Journal: Journal of pediatric orthopedics (J Pediatr Orthop) 2009 Oct-Nov Vol. 29 Issue 7 Pg. 676-82 ISSN: 1539-2570 [Electronic] United States
• PMID: 20104144 (Publication Type: Journal Article)

Topics

• Cerebral Palsy
• Child
• Child, Preschool
• Female
• Hip Dislocation, Congenital (surgery)
• Hip Joint (abnormalities, surgery)
• Humans
• Infant
• Male
• Neuromuscular Diseases (congenital, surgery)
• Osteotomy (methods)
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Treatment Outcome