Manasse H, Poiri A, Moullac D, Rasamoelina MB, Daoulas T, Solofomalala GD. Challenges in the management of hip dislocation disease in Madagascar. World J Orthop 2025; 16(10): 112086 [DOI: 10.5312/wjo.v16.i10.112086]
Corresponding Author of This Article
Herijaona Manasse, MD, Service de Chirurgie Orthopédique et Traumatologique, CHU Anosiala, 6C3C+QF4 Alakamisy, Ambohidratrimo 105, Madagascar. herijaona.mrakotoherisoa@gmail.com
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Surgery
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 18, 2025 (publication date) through Oct 26, 2025
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Manasse H, Poiri A, Moullac D, Rasamoelina MB, Daoulas T, Solofomalala GD. Challenges in the management of hip dislocation disease in Madagascar. World J Orthop 2025; 16(10): 112086 [DOI: 10.5312/wjo.v16.i10.112086]
World J Orthop. Oct 18, 2025; 16(10): 112086 Published online Oct 18, 2025. doi: 10.5312/wjo.v16.i10.112086
Challenges in the management of hip dislocation disease in Madagascar
Herijaona Manasse, Arthur Poiri, Dylan Moullac, Mamisoa Bodohasina Rasamoelina, Thomas Daoulas, Gaëtan Duval Solofomalala
Herijaona Manasse, Mamisoa Bodohasina Rasamoelina, Gaëtan Duval Solofomalala, Service de Chirurgie Orthopédique et Traumatologique, CHU Anosiala, Alakamisy, Ambohidratrimo 105, Madagascar
Arthur Poiri, Service de Chirurgie Pédiatrique, CHU Brest, Brest 29200, Bretagne, France
Dylan Moullac, Thomas Daoulas, Service de Chirurgie Orthopédique et Traumatologique, CHU Brest, Brest 29200, France
Co-first authors: Herijaona Manasse and Arthur Poiri.
Author contributions: Manasse H, Poiri A and Daoulas T designed and conducted the study and wrote the paper; Rasamoelina MB to the analysis; Solofomalala GD and Moullac D supervised the study.
Institutional review board statement: The study followed the ethical protocols of Helsinki’s Declaration, 2013 revision. Anonymity of the participants was ensured.
Informed consent statement: Informed consents were taken from the patients for inclusion in the study as well as including their photographs in the study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Herijaona Manasse, MD, Service de Chirurgie Orthopédique et Traumatologique, CHU Anosiala, 6C3C+QF4 Alakamisy, Ambohidratrimo 105, Madagascar. herijaona.mrakotoherisoa@gmail.com
Received: July 17, 2025 Revised: August 7, 2025 Accepted: September 11, 2025 Published online: October 18, 2025 Processing time: 91 Days and 19.7 Hours
Abstract
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.
Core Tip: Developmental dysplasia of the hip management in resource-limited settings faces delays and severe cases at diagnosis. Appropriate treatment yields good outcomes despite prolonged traction and equipment challenges.
