LUDLLOF’S (Medial) Approach Open Reduction of Developmental Dysplasia of the Hip in Children below 16 Months of Age

Abstract

Developmental dysplasia of the hip generally includes subluxation (partial dislocation) of the femoral head, acetabular dysplasia, and complete dislocation of the femoral head from the true acetabulum in addition to teratogenic type. Newborn with true congenital dislocation of the hip, the femoral head can be dislocated and reduced into and out of the true acetabulum. In an older child, the femoral head remains dislocated and secondary adaptive changes in the bony and soft tissue components of the hip. This is a prospective study started from November 2012 to November 2014, done on 90 children ( 25 boys, 65 girls) with (110) developmentally dysplastic hips below age of 16 months in AL Basra General Hospital, all of them were evaluated preoperatively excluding the teratological and neuromuscular causes. Management started by closed reduction with or without adductor tenotomy followed by immediate intraoperative hip arthrogram to assess the outcome in reference to the concentric profile of reduction and its stability in the accepted safe zone. Twenty five patients (29 hips) out of the 90 patients (7 boys, 18 girls) have failed closed reduction as proved by the intraoperative arthrogram and were subjected to immediate open reduction utilizing the medial approach (Ludloff’s). Medial Ludloff’s approach is a good hip approach to be utilized in the open reduction of congenital hip dislocation in the patients younger than one year of age, this represented in the dramatically less operative time comparing to other approaches, with less blood loss, less postoperative pain during hip movements resulted in early improved range of movement, no scarring in the anterolateral region to the hip making it easily to be operated on in the future if required, less risks for postoperative infection, redislocation, and major neurovascular injury. It also have a favorite technical operative advantage in that it create a direct path with the shortest way to attach dealing with a major obstacle of reduction, namely the Iliopsoas tendon. The main drawback is the risk of injuring the Medial circumflex femoral artery with a weighted opportunity for postoperative avascular necrosis of the femoral head. This can be decreased by a careful surgical dissection and manipulation, the operating surgeon must keep the MCFA in his mind all the time, or else its injury could invite a painful failure to both the surgeon and his patient. We recommend more studies to compare between both of the 2 approaches (anterolateral and medial) with a big sample and for a long period of follow-up till beyond bone maturity to assess more confidently the pro and cons of each in dealing with those difficult cases of DDH who require an open reduction for their remedy