CONGENITAL DISLOCATION OF THE HIP IN OLDER SUBJECTS

Based on A Study of Sixty-Six Open Operations

In summarizing these cases one may say that the age is largely a factor in determining the type of operation employed, but that usually in any type employed with children between three and ten years of age the patient should be given preliminary treatment. A thorough stretching of the muscles about the hip, tenotomy of the adductors, and traction have been found of value. The reaming type will insure stability but in general very little mobility. The osteoplastic buttress type usually prevents further upward displacement of the femur but, unless care is taken to restore the backward position of the dislocation, the characteristic gait is only partially corrected. However, it is an operation that usually assures stability and a satisfactory degree of mobility. In the frankly irreducible case, the Lorenz bifurcation is a most valuable procedure. It renders the hip stable and gives a surprising degree of mobility. It is of particular value in the adult bilateral case with pain. In the unilateral case it has the disadvantage of shortening an already short extremity, even though the characteristic lurch and lordosis become less.

The last method presented—that of preserving the natural synovial sac over the head of the femur, and transplanting it into a reamed-out acetabulum at or near the original acetabulum—is an attempt to assure a genuine reduction of the dislocation, plus the preservation of stability and mobility. To date four hips have been operated upon by this method and the results have been encouraging.

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