The Journal of Bone and Joint Surgery, Vol 74, Issue 8 1140-1152, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Prognostic factors in congenital dislocation of the hip treated with closed reduction. The importance of arthrographic evaluation
E Forlin, IH Choi, JT Guille, JR Bowen and J Glutting
Alfred I. duPont Institute, Wilmington, Delaware 19899.
We reviewed the clinical records, arthrograms, and roentgenograms of
sixty-one children who had seventy-two congenitally dislocated hips in an
effort to identify factors that can be used to predict the outcome of
treatment. Only patients who had been followed clinically and
roentgenographically for a minimum of two years after the initial closed
reduction were included in the study. The mean age at the time of closed
reduction was thirteen months (range, three to forty-one months). The mean
age at the time of the most recent follow-up was six years (range, two to
fifteen years). The mean duration of follow-up after the initial closed
reduction was five years (range, two to thirteen years). There was no
statistical difference between the good, fair, and poor-result groups with
regard to sex, the age at the initial reduction, the traction station, the
side of involvement, the initial acetabular index, the initial grade of
displacement, the effect of adductor tenotomy, and several of the
arthrographic measurements. The medialization ratio (the percentage of the
horizontal radius of the cartilaginous femoral head that lay medial to the
Perkins line), measured at the time of the reduction, was significantly
different (p < 0.04) between the hips for which the result was good or
fair and those for which the result was poor. The medialization ratio
averaged 75 per cent in the hips for which the result was good, 66 per cent
in those for which the result was fair, and 57 per cent in those for which
the result was poor. Limbus shapes 5 through 8 were associated with
avascular necrosis (p < 0.05) and a poor result (p < 0.03).
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