We have reviewed 17 patients (18 hips) who required repeated open reduction for recurrent or\npersistent dislocation after a previous attempt at zigzag osteotomy combined with fibular allowgraft\nfor developmental dysplasia of the hip (DDH). The purposes of this study were to examine\npredictors of redislocation and to evaluate the long-term outcomes after revision surgery.\nThe mean age at primary open reduction was 24 months (13 to 36). The median time to the\nrecognition of failure was 4.6 months. The second reduction was performed at a mean age of\n26.3 months (17 to 42) and the mean age at final follow-up was 79.7 months (58 to 105) and the\nmean time follow-up was 42.4 months (37 to 76). We treated the hips with a new open reduction\nthrough an anteromedial approach. A constricted anteromedial capsule was always found as the\nmain factor; all had an intact anteromedial capsule, and there was an inverted transverse ligament\nin five cases and a very tight psoas tendon in another four cases, eversion of the limbus in\nsix cases, densing anterior capsule in five cases. We perform with the condition that all hips\nwere cleared of scar tissue; five hips had adductor tenotomy; four hips required release of the\npsoas tendon, five eversion of the limbus. Release of the transverse ligament was required in\nfive cases each. All hips with Kirschner wire through the femoral head into the acetabulum.\nThree hips required femoral shortening (average of 1.5 cm); a derotation varus osteotomy was\nperformed in two hips from ten and twelve weeks after repeated open reduction. Postoperative\nresults according to modified McKay criteria for clinical: excellent: 3 of 18 hips (16.7%); good: 8\nof 18 hips (44.4%); fair: 6 of 18 hips (33.3%); and poor: 1 of 18 hips (5.6%). We suggest that\ntechnical failure is usually the cause for redislocation with all that has an intact anteromedial\ncapsule. There was an inverted transverse ligament, tight psoas tendon, eversion of the limbus,\nand densing anterior capsule. We believe that abnormal femoral version and femoral head dysplasia\nare also important factors for redislocation too.
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