THE ADAPTIVE CHANGES IN THE HIP IN CONGENITAL DISLOCATION AND THEIR IMPORTANCE IN TREATMENT

¹ Professor of Orthopaedic Surgery, Harvard University. Chief of Orthopaedic Service, Massachusetts General Hospital. Chief Surgeon, New England Peabody Home for Crippled Children

1. Congenital dislocations of the hip should be reduced at the earliest possible time, for two reasons:

a. The reduction is more easily accomplished.

b. Adaptive changes and injury to the upper femoral epiphysis are increased by function in the unreduced hip.

2. Manipulative reduction in the early years of childhood may be successful. It should be tried first. But force and resultant injury should be avoided if the hip is not easily reduced. Open operation is the better method.

We are dealing, it seems to me, with an embryological defect in congenital dislocation of the hip. We should realize that the hip is not normal at birth and that throughout the individual's life it is to be deformed. In fact, this abnormality of growth may develop into a change in the upper end of the femur which is incompatible with normal hip function. If this be true, and I for one believe it to be true, then success or failure following any operative procedure depends to some degree upon the foreordained changes in the upper femoral region. In other words, reduction of the dislocation does not mean a perfect hip, no matter how reduction is accomplished.

Reduction (and early reduction) does mean, however, the lessening of all the secondary changes which we know follow the faulty mechanics of the unreduced hip. Force of any kind, used either in open operation or manipulative reduction, will add its influence to the development of deformity in the upper end of the femur as growth is accomplished.

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