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Minimally invasive Dega acetabuloplasty for the treatment of neuromuscular hip dysplasia

Kappa, Jason E. MDa; Shore, Benjamin J. MD, MPH, FRCSCb; Allar, Benjamin G. BSb; Bruce, Robert W. Jr MDc; Fletcher, Nicholas D. MDc

doi: 10.1097/BCO.0000000000000649
SPECIAL FOCUS: Resident Research Award
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Background: Dega acetabuloplasty is used in the management of neuromuscular hip dysplasia. A minimally invasive technique may decrease perioperative morbidity while allowing for adequate reduction and ensuring stability. We sought to determine the impact of a minimally invasive Dega acetabuloplasty (MID) on hip stability after neuromuscular hip reconstructions.

Methods: A retrospective review was performed of consecutive patients with cerebral palsy (GMFCS IV/V) and neuromuscular hip dysplasia undergoing bony reconstruction including a varus derotational osteotomy (VDRO) of the femur and a Dega acetabuloplasty. Clinical records were reviewed to evaluate preoperative comordibities and clinical complications. Review of pelvic radiographs preoperatively and at follow-up evaluated correction of acetabular index, migration percentage, and the presence of an intact Shenton’s arc.

Results: Forty-two patients (45 hips) underwent MID surgery as part of a reconstructive approach for neuromuscular hip subluxation or dislocation. Preoperative migration percentage averaged 61.1±4.0% (range, 39-100%). In addition to bony reconstructions, 91.4% of hips had soft-tissue balancing. Patients had an average estimated blood loss of 102±69.9 cc, mean operative time of 165±44 min, and an average length of stay of 3.2±1.3 days. No patient required reoperation. Operative intervention resulted in a mean migration percentage of 12.1%±2.5 and residual acetabular index of 16.0±8.7 degrees with 84.4% (38 of 45) of hips having an intact Shenton’s arc at 1-year of follow-up.

Conclusions: The MID provides acceptable rates of postoperative hip stability at 1 yr with low blood loss, surgical time, length of stay, and postoperative medical complications.

Level of Evidence: Level IV.

aGeorge Washington University Department of Orthopaedics, Washington, DC

bChildren’s Hospital of Boston, Boston, MA

cEmory University Department of Orthopaedics, Atlanta, GA

Financial Disclosure: Dr. Fletcher discloses a financial relationship with the Harrison Foundation, Orthopaediatrics, Medtronic, Biomet/Zimmer, and POSNA. Dr. Bruce discloses a financial relationship with the Harrison Foundation. The other authors has no disclosures. The authors report no conflicts of interest.

Correspondence to Nicholas D. Fletcher, MD, Emory University Department of Orthopaedics, 59 Executive Park South NE, Atlanta, GA 30329 Tel: +404-778-3831; fax: +404-778-7016; e-mail: Nicholas.d.fletcher@emory.edu.

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