DDH presenting at walking age is not uncommon, particularly in developing countries. This study was done in patients who presented between 12 and 36 months of age to assess the following: 1) percentages of hips amenable for successful CR, 2) failure rate after CR and OR in walking age DDH and 3) the need for secondary procedures to address subluxation and residual dysplasia within first 2 years. All patients (Jan 2009- Jan 2019) who had their index intervention between 12 and 36 months of age and have completed years of follow-up were included and all those with associated congenital anomalies/syndromes were excluded. We identified 142 patients, of which 65 patients with 84 hips formed the study cohort. We divided the patients in three groups: Group I - CR, Group II –OR, and Group III - OR with an additional bony procedure -femoral and/or pelvic osteotomy. We had 10(11.9%) hips in group I, 39(46.4%) hips in group II and 35(41.6%) hips in group III. The mean follow-up was 44.8 months (24 to 132 months). The mean final AI was 24.6 ̊in Group I, 28.2 ̊ in Group II and 26.3 ̊in Group III. There was no significant difference in the final AI between the groups (p>0.05). An attempted closed reduction has a 50% failure rate and we recommend a low threshold for open reduction. About 50% of the hips which did not have a pelvic osteotomy at the time of index procedure fail to remodel and have residual acetabular dysplasia.

Introduction: Developmental dysplasia of the hip (DDH) is a congenital anomaly of the hip socket that can lead to severe disability and pain if not treated correctly. Controversy remains about the most effective type of screening for DDH: clinical exam as the sole screening modality, universal ultrasound screening, or a combined approach with targeted referrals for ultrasound. This study aims to evaluate the cost-effectiveness of expanding the available child health care package with DDH screening for children under the age of 6 months in Egypt. Materials: We developed a generalized framework to calculate the cost-effectiveness of expanding an existing child health care package with a DDH screening program. The framework contains 4 different decision trees for screening: status quo, clinical exam only, clinical examination and targeted ultrasound screening and universal ultrasound screening. Each scenario is further examined with a sensitivity analysis using different types of providers: community health workers, nurses or physicians. Results: Screening by clinical exam combined with targeted ultrasound has the highest sensitivity in the literature (98.74%), while clinical exam alone has the highest specificity (98-99%). The cost of conservative treatment (Pavlik harness or abduction splint) ranges from 13-53 USD, while surgical treatment for DDH ranges from 497-1439 USD in middle-income countries. The cost of ultrasound screening is estimated at 30-40 USD per child. Conclusions: Determination of the cost-effectiveness of the 4 proposed pathways for DDH screening in Egypt is currently ongoing. We aim to finalize the model and the calculations by the end of May.

Initially considered as a vestige, which supplied blood supply to the femoral head during the early years of life, ligamentum teres (LT) is now being recognized as a source of mechanical stability to the hip. It is one of the crucial factors providing stability to the ball and socket joint. Reports have shown increased instability when associated with LT tears. Lately, a lot of studies have focused on improving the outcomes of developmental dysplasia of the hip (DDH), with a major focus on preserving the LT. LT is believed to have various mechanical & Biological roles hence procedures that involve sacrificing the LT should be carefully considered. Various methods of reconstruction of ligamentum teres have been described. Recently, techniques have been devised to reconstruct and preserve thereby strengthening LT which can be technically challenging. In this report, we describe a simple technique of preserving/reconstructing Ligamentum teres which is safe, simple, effective, and easily reproducible.