# One-Stage Surgical Outcomes for Bilateral Developmental Dysplasia of the Hip in Walking Children: A Retrospective Case Series Study From the Post-war Era in a Tertiary Care Hospital at Kabul, Afghanistan

## TL;DR

This study evaluates the effectiveness of one-stage surgery for hip dysplasia in walking children in Afghanistan, showing mostly positive outcomes.

## Contribution

The study provides clinical evidence for one-stage surgical management of bilateral hip dysplasia in post-war Afghanistan.

## Key findings

- 72% of cases showed excellent functional outcomes using modified McKay's scoring.
- Mean acetabular index reduction was 13.78° for right hips and 17.29° for left hips.
- 83.3% of hips had no postoperative complications, though some had subluxation or avascular necrosis.

## Abstract

Purpose

Bilateral surgery for developmental dysplasia of the hip in a single stage represents a significant surgical challenge. The present study, therefore, aimed to evaluate the clinical and radiographic outcomes of one-stage surgical management of bilateral developmental dysplasia of the hip in children after the onset of independent walking.

Materials and methods

This retrospective case series was conducted between 2020 and 2024 at the French Medical Institute for Mothers and Children in Kabul, Afghanistan. The study included 36 patients with a mean age of 32 months (range: 18-54 months), all diagnosed with bilateral developmental dysplasia of the hip, accounting for a total of 72 affected hips. Postoperative functional outcomes were assessed using the modified McKay's scoring system, while radiographic evaluation was performed by measuring the acetabular index. The mean follow-up duration was 9.6 months.

Results

In this study, functional outcomes assessed by the modified McKay's criteria demonstrated excellent results in 26 cases (72%), good results in six cases (16.7%), fair results in three cases (8.3%), and poor results in one case (3%). The mean reduction in the acetabular index between preoperative and postoperative evaluations was 13.78±3.5° for the right hips and 17.29±5° for the left hips. With respect to postoperative complications, the majority of hips (60, 83.3%) showed no adverse effects; however, subluxation occurred in three hips (4.2%), avascular necrosis of the femoral head in four hips (5.5%), and acetabular dysplasia in five hips (7%).

Conclusion

A one-stage open reduction combined with Salter's osteotomy, with femoral shortening when indicated, is recommended as an effective management strategy for bilateral developmental dysplasia of the hip in children aged 1.5-4.5 years.