{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:05:53Z","timestamp":1777633553074,"version":"3.51.4"},"reference-count":36,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"3","license":[{"start":{"date-parts":[[2014,3,1]],"date-time":"2014-03-01T00:00:00Z","timestamp":1393632000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:p>The medial approach for the treatment of children with developmental dysplasia of the hip (DDH) in whom closed reduction has failed requires minimal access with negligible blood loss. In the United Kingdom, there is a preference for these children to be treated using an anterolateral approach after the appearance of the ossific nucleus. In this study we compared these two protocols, primarily for the risk of osteonecrosis.<\/jats:p><jats:p>Data were gathered prospectively for protocols involving the medial approach (26 hips in 22\u00a0children) and the anterolateral approach (22 hips in 21 children) in children aged &lt; \u00a024\u00a0months at the time of surgery. Osteonecrosis of the femoral head was assessed with validated scores. The acetabular index (AI) and centre\u2013edge angle (CEA) were also measured.<\/jats:p><jats:p>The mean age of the children at the time of surgery was 11 months (3 to 24) for the medial approach group and 18 months (12 to 24) for the anterolateral group, and the combined mean follow-up was 70 months (26 to 228). Osteonecrosis of the femoral head was evident or asphericity predicted in three of 26 hips (12%) in the medial approach group and four of 22 (18%) in the anterolateral group (p = 0.52). The mean improvement in AI was 8.8\u00b0 (4\u00b0 to 12\u00b0) and 7.9\u00b0 (6\u00b0 to 10\u00b0), respectively, at two years post-operatively (p = 0.18). There was no significant difference in CEA values of affected hips between the two groups.<\/jats:p><jats:p>Children treated using an early medial approach did not have a higher risk of developing osteonecrosis at early to mid-term follow-up than those treated using a delayed anterolateral approach. The rates of acetabular remodelling were similar for both protocols.<\/jats:p><jats:p>Cite this article: Bone Joint J 2014;96-B:406\u201313.<\/jats:p>","DOI":"10.1302\/0301-620x.96b3.32616","type":"journal-article","created":{"date-parts":[[2014,3,3]],"date-time":"2014-03-03T16:28:58Z","timestamp":1393864138000},"page":"406-413","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["The medial approach for the treatment of children with developmental dysplasia of the hip"],"prefix":"10.1302","volume":"96-B","author":[{"given":"P.","family":"Tarassoli","sequence":"first","affiliation":[{"name":"Bristol Royal Hospital for Children, Bristol Royal Hospital for Children, Paul O\u2019Gorman Building, Upper Maudlin Street, Bristol Avon BS2 8BJ, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. F.","family":"Gargan","sequence":"additional","affiliation":[{"name":"Bristol Royal Hospital for Children, Bristol Royal Hospital for Children, Paul O\u2019Gorman Building, Upper Maudlin Street, Bristol Avon BS2 8BJ, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. G.","family":"Atherton","sequence":"additional","affiliation":[{"name":"Bristol Royal Hospital for Children, Bristol Royal Hospital for Children, Paul O\u2019Gorman Building, Upper Maudlin Street, Bristol Avon BS2 8BJ, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. R. Y. W.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Bristol Royal Hospital for Children, Bristol Royal Hospital for Children, Paul O\u2019Gorman Building, Upper Maudlin Street, Bristol Avon BS2 8BJ, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"r1","first-page":"438","volume":"2","author":"Ludloff K","year":"1913","journal-title":"J Bone Joint Surg [Am]"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197961060-00020"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197961010-00021"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199703000-00008"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199309000-00008"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-198805000-00007"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200409000-00008"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200301000-00001"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.87B3.14663"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B1.21429"},{"key":"r11","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00003086-198209000-00016","volume":"169","author":"Kalamchi A","year":"1982","journal-title":"Clin Orthop Relat Res"},{"key":"r12","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.78B6.0780924"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198062060-00002"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199706000-00002"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-009-0800-7"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e31822e0276"},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e318184202c"},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00652"},{"key":"r19","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00954"},{"key":"r20","doi-asserted-by":"crossref","unstructured":"Shenton EWH.Disease in bone and its detection by the X-rays. 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