Ludloff’s medial approach has been described as a simple procedure for open reduction of developmental dysplasia of the hip
(DDH) requiring minimal dissection and tissue disruption. Many patients undergo subsequent reconstruction of the acetabulum
after skeletal maturity for residual dysplasia. Femoral head deformity reportedly influences the long-term outcome of these
osteotomies. The literature suggests this deformity may be related to the patient’s age at the time of a medial approach.
We therefore asked whether femoral head deformity (roundness index, femoral head enlargement) at skeletal maturity correlates
with patient age at surgery. We assessed the radiographs of 40 patients (42 hips). Their mean age at surgery was 14.3 months
(range, 6–31 months); the minimum followup was 10 years (mean, 15.8 years; range, 10–27 years). The mean roundness index at
skeletal maturity correlated with increased age at the time of the operation (mean index, 58.3; range, 47–79) while enlargement
did not. Using a medial approach for correction of DDH in older patients increases the risk of femoral head deformity at skeletal
maturity.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation
and that all investigations were conducted in conformity with ethical principles of research.