Anisuddin Bhatti.
Outcome of single versus two incision operative approach used for one stage correction of neglected congenital dislocation of the hip joints.
J Pak Orthop Assoc Jan ;21(2):3-18.

Objectives: The primary objectives of study was to evaluate the results of Klisic’s (single incision) versus Wenger’s (two incisions)operative approaches and secondary objective to evaluate the overall results of correction of late presenting neglected Congenital Dislocated Hips (CDH). Methodology: The study includes 60 patients with 73 high riding CDH’s, in age group 3- 8 years. 45 patient (including13 bilateral hip dislocations) were untreated, whereas 15 patients had unsuccessful non-operative treatment in infancy. 19 patients (25 Hips) wereoperated with Klisic approach and 41 patients (48 Hips) were operated with Wengers approach. One stage combined procedure of open reduction, femoral shortening, varus derotation osteotomy, capsuloraphy and reconstruction of acetabulum roof was used in all cases. The patients were evaluated after 3 years minimum followup. McKay’s criteria, Severen’s radiological classification and Klisic overall rating scales were used for clinical and radiological assessment. Results: On overall clinico-radiological assessment (Klisic overall rating scale), 56% hip scored excellent, 34% scored good, 8% scored fair and 2% scored poor (p=0.83). 6.8% (5/73) hips subluxated and 4.5% (4/73) redislocated. Out of these nine redislocated and subluxated hips, 20% (5/25) were among Klisic’s group and 8.3% (4/48) were from Wenger’s group. At the last follow-up after secondary procedures in redislocated & re subluxated hips, 8 out of these 9 hips scored to Klisic type I & II and one hip to Klisic type III. Post operative avascular necrosis (AVN) developed in 6.8% (5/73) hips out of that 4% (1/25) were in Klisic group & 8.3% (4/48) in Wenger group; however all these patients recovered good contour of femoral head in 3 years duration after primary surgery, without requiring another surgery. There was therefore a significant difference of results between two operative approaches (P=0.83, odd Ratio 1.1.2 & 1.1.2). Conclusion: The outcome of surgical approach is indepenent of three assessment criteria, however, the odds of obtaining satisfactory results are increased by Wenger surgical appraoch and the overall results were progressively better in younger than 4 years aged patient compared to older ones.

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