Challenges in the management of hip dislocation disease in Madagascar.

BACKGROUND: Developmental dysplasia of the hip (DDH) remains a significant public health challenge, particularly in developing countries where cultural factors and limited access to appropriate medical equipment complicate optimal management. AIM: To evaluate the difficulties encountered in the management of DDH in our healthcare setting. METHODS: A retrospective, single-center study was conducted over nine years (2015-2023), including 20 patients (26 hips) with idiopathic DDH. Patients with post-traumatic or post-infectious hip dislocations were excluded. Data collected included age at diagnosis, laterality, Tönnis classification, duration of traction, and surgical interventions. RESULTS: The mean age at diagnosis was 35.6 months (4 months to 10.8 years). Dislocation was unilateral in 70% of cases; 69.2% were classified as Tönnis stage 3 or 4. The average traction duration was 57.5 days. Surgery was performed in 8 hips. Among 16 patients with regular follow-up, 10 showed good outcomes, 3 excellent, and 3 fair according to the McKay score. Older age at treatment (> 1 year), bilateral dislocation, and higher severity (Tönnis stages 3 and 4) were associated with worse functional outcomes. No significant correlation was found between functional and radiological results. Residual dysplasia occurred in 3 patients, and 1 re-dislocation was noted. CONCLUSION: Delayed diagnosis and advanced severity at presentation are key challenges in managing DDH in our context. Nevertheless, appropriate management can achieve generally favorable outcomes, despite complications linked to prolonged treatment and resource limitations.