The Journal of Bone and Joint Surgery, Vol 71, Issue 5 734-741, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening
RD Galpin, JW Roach, DR Wenger, JA Herring and JG Birch
Texas Scottish Rite Hospital for Crippled Children, Dallas.
We reviewed the results of primary operative treatment in twenty-five
patients (thirty-three hips) who were two years or older and had congenital
dislocation of the hip. None of the patients had had previous treatment for
the dislocation. Preliminary traction was not used in any patient. Femoral
shortening and, in twenty-one hips, pelvic osteotomy were performed at the
time of open reduction. At the most recent follow-up (average, three years
and seven months), according to the radiographic classification system of
Severin, there were seven excellent, seventeen good, and eight fair
results; one hip had a poor result. Avascular necrosis developed in three
of the thirty-three hips. At follow-up, these hips had a radiographic
result of excellent, good, and fair, respectively. Twenty-one patients
(twenty-eight hips) were reviewed with respect to range of motion and
recovery from limb-length discrepancy. According to the rating system of
Ferguson and Howorth, there were seventeen excellent, seven good, and three
fair results; one hip had a poor result. It was concluded that children who
are two years or older and who have a congenital dislocation of the hip can
safely be treated with an extensive one-stage operation consisting of open
reduction combined with femoral shortening and, often, pelvic osteotomy,
without increasing the risk of avascular necrosis. The limb-length
discrepancy that is produced by the shortening does not appear to cause a
clinical problem.
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