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The Journal of Bone and Joint Surgery, Vol 68, Issue 6 829-846, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Treatment of congenital dislocation of the hip in children between the ages of one and three years
LE Zionts and GD MacEwen
The results in fifty-one congenitally dislocated hips in forty-two children
who were between one and three years old when treatment was begun have been
reviewed. Thirty-eight hips (75 per cent) were treated by traction prior to
reduction, gentle closed reduction under anesthesia, selective adductor
tenotomy, and immobilization in a hip-spica cast. Thirteen hips (25 per
cent) required an open reduction when stable closed reduction could not be
achieved. Secondary femoral or acetabular procedures were performed after
either form of treatment if subluxation became apparent after the child had
resumed walking. At an average twelve-year follow-up (range, five to
twenty-two years), thirty-six hips (71 per cent) were rated as Class I;
six, as Class II; eight, as Class III; and one, as Class IV, according to
the classification system of Severin. Significant avascular necrosis
developed in three hips. We think that in this age group congenital
dislocation of the hip is best treated by closed reduction, followed by
femoral or acetabular procedures as needed. Open reduction should be done
only in those hips that cannot be reduced by closed methods.
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