The Dega Osteotomy in the Treatment of Developmental and Neuromuscular Hip Pathology. Is it a Versatile Osteotomy?

Abstract Background: The management of developmental dysplasia of the hip (DDH) in walking children is difficult. Although much confusion still surrounds the actual procedure of the Dega osteotomy, it is one of the most commonly used osteot-omies in the management of DDH. Aim of Study: The aim of this study was to evaluate the use of the Dega osteotomy in the treatment of hip pathology resulting from both developmental dysplasia (DDH) and neuromuscular disease (NM). Patients and Methods: The cases were operated in Abo-El-Reesh Hospital in Cairo and Kafr El-Shiekh El Aam hospital from September 2013 to November 2015. The follow-up period ranged from 18 to 24 months. Patients were divided into two groups. Dega osteotomy in DDH cases (group I) was performed in 26 hips in twenty one patients. Dega osteotomy in CP cases (group II) was performed in twenty four hips in twenty patients. The Dega was customized at the time of surgery to provide more anterior or posterior coverage de-pending on the needs of the individual hip. Patients were assessed for age, sex, and relevant medical and surgical history (e.g. open or closed reduction of a dislocated hip, adductor tenotomy, psoas lengthening, and femoral osteotomy). Clinical notes were obtained for range of motion, and evidence of discomfort or activity restriction. The acetabular index and center-edge angle, migration percentage were measured pre-operatively and postoperatively on X-ray. CT scan was used to determine the defect in the acetabulum either posteriorly or anteriorly in selected cases. Results: Younger age was significantly associated with better results. Males got slightly better results than females. However, it was was statistically insignificant. from 24 hips of CP group, insignificant difference was found between affection of the right and the left sides. Significant effect on the final end results was found as regarding the type of CP, where results were better for diplegic than quadriplegic patients. (p-value 0.0423).
Conclusion: The Dega osteotomy works well for dysplasia in both DDH and NM populations, and can easily and safely be combined with associated procedures for single-stage correction of acetabular dysplasia. Dega is a versatile osteot-omy which can be used well to cover the femoral head in the presence of any acetabular defect whether anterior, postero-lateral or even posterior defect in both DDH and NM popula-tions without affecting the acetabular volume.