Journal of Pediatric Orthopaedics - 2026-04-16 - Journal Article
Growth Stimulating Minimal Acetabuloplasty, Alongside Hip Open Reduction: A Simpler One-stop Operative Treatment for Developmental Dysplasia of the Hip.
Aarvold A, Uren N, Rhodes A, Elliott KG, Lindisfarne EA, Carsi B, Clarke NMP
Topics
Key Takeaway
Growth-stimulating minimal acetabuloplasty combined with open reduction achieved Severin 1 or 2 outcomes in 98.2% of 167 hips at up to 16 years follow-up, with only 3.6% requiring subsequent pelvic osteotomy for residual dysplasia.
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Summary
This study evaluated a novel growth-stimulating minimal acetabuloplasty performed concurrently with open reduction in infants aged 1–2.5 years with DDH (77% IHDI grade IV, mean AI 41.3°). At final follow-up, 98.2% achieved Severin 1 or 2 outcomes with normalized AI and mean CEA of 35.7°. Only 6 hips (3.6%) required secondary pelvic osteotomy for residual acetabular dysplasia.
Key Limitation
No concurrent control group receiving a standard pelvic osteotomy makes it impossible to attribute the 98.2% Severin 1/2 rate to the acetabuloplasty versus open reduction alone or natural acetabular remodeling.
Original Abstract
BACKGROUND
This paper describes a pelvic procedure that is technically simpler, quicker to perform, and equally effective as all existing pelvic osteotomies. It is used alongside hip open reduction for the treatment of the associated acetabular dysplasia. It is a minimal additional procedure that is intended to ignite the growth of the dysplastic acetabulum.
METHODS
A total of 167 hips (in 154 infants) treated with open reduction and growth-stimulating minimal acetabuloplasty, all with follow-up between 4 and 16 years postoperatively, are reported. The surgical technique is described. Sequential radiographs were analyzed through to final follow-up, which for 21% is to skeletal maturity. Patient demographics, preoperative and sequential postoperative indices, and outcomes are recorded.
RESULTS
Preoperative IHDI position was grade IV dislocation in 77% and grade III in 33%. Mean starting acetabular index (AI) was 41.3 degrees (range 30 to 54 degrees) and median age at operation was 13 months (range from 1 to 2.5years). At final follow-up, 98.2% of hips have a Severin 1 (excellent) or 2 (good) outcome, with the AI normalized. These are all IHDI grade 1 and have a mean center-edge-angle of 35.7 degrees. Only 6 of these (3.6%) have warranted a subsequent pelvic osteotomy for residual acetabular dysplasia.
CONCLUSIONS
The growth-stimulating minimal acetabular procedure is technically straightforward. It is simpler than standard existing pelvic osteotomies, yet it is shown to be at least as effective. With up to 16 years follow-up, we can highly commend its routine use alongside hip open reduction in infants aged 1 to 2.5 years old.
LEVEL OF EVIDENCE
Level III-case-control study.