Proximal versus distal tenotomy of the iliopsoas tendon in the surgical treatment of developmental dysplasia of the hip: a randomized clinical trial

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Abstract
Purpose This study aimed to compare the release of the iliopsoas tendon at two levels: proximally at the pelvic brim and distally near the lesser trochanter. Methods The study was a randomized clinical trial. It was done to check the equivalence between two parallel groups of patients with DDH of grade 2 or more who underwent open reduction operations for their hips: Group 1, division of the iliopsoas tendon at the pelvic brim, and Group 2, division of the tendon at the lesser trochanter level. All the operations were done through the anterior approach. Results Thirty-eight patients (24 females and 14 males) with 54 hips (cases) operated, 27 cases in each group. The mean follow-up period of the cases was 2.4 years (SD 0.6). In the third month postoperatively, children of both groups had grade 2 hip flexion strength. Later, a statistically significant difference (p-value 0.007) occurred between them in the 24th month (Group 1 reached grade 5 and Group 1 to grade 4). More complications, 13 out of 27 (48.2%%), were recorded in Group 2. The complications were active bleeding due to injury to medial circumflex femoral vessels (5 cases) and avascular necrosis of the femoral epiphysis (8 cases). Group 1 had only four cases of avascular necrosis of the femoral epiphysis. Conclusion Patients who underwent a DDH operation with a division of the iliopsoas tendon proximally at the pelvic brim regained hip flexion strength earlier and achieved a better grade with fewer complications.

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