Open Reduction With Ligamentum Teres Reconstruction-Preliminary Results of a Novel Technique for the Management of Pediatric Developmental Dysplasia of Hip.

Abstract

The primary goal in the management of developmental dysplasia of the hip (DDH) is to obtain and maintain a stable, concentrically reduced hip via closed or open techniques while limiting iatrogenic risk. Recent studies suggest a 7% risk of recurrent instability following open reduction (OR) of idiopathic DDH and even higher rates of recurrent instability and complications with the management of neuromuscular or syndromic DDH. This study describes a novel technique of ligamentum teres reconstruction (LTR) performed during OR of idiopathic and nonidiopathic DDH. This is a prospective cohort study of 49 consecutive patients (61 hips) who underwent LTR with OR as an index procedure via a single surgeon from 2020 to 2024. The procedure combines an anterior and limited lateral approach with the use of a suture button device passed through a femoral tunnel and flipped along the inner table of the pelvis, inferior and posterior to the triradiate physis. Demographics, radiographic severity, and short-term outcomes were analyzed. Exclusion criteria included surgery performed in a revision setting (4 patients/4 hips), nonstandard implant (2 patients/2 hips), and <1 year follow-up (10 patients/14 hips). A total of 33 patients (41 hips) met inclusion criteria-18 patients (21 hips) with idiopathic DDH and 15 patients (20 hips) with nonidiopathic DDH. Average follow-up was 27.6 months for idiopathic and 21.9 months for nonidiopathic patients. In the idiopathic cohort, all patients exhibited grade III or IV DDH. No loss of reduction or hardware failure occurred, and 5% of patients sustained minor complications. In the nonidiopathic cohort, only one loss of reduction was noted (5%). The addition of LTR via a suture button device to OR demonstrates excellent short-term outcomes, including maintenance of reduction and low complication rates. Further studies are warranted to investigate the long-term effect on acetabular remodeling, range of motion, need for postoperative immobilization, and risk of iatrogenic avascular necrosis and future growth disturbance. Level III.