The Journal of Bone and Joint Surgery, Vol 75, Issue 9 1334-1345, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Open reduction through a medial approach for congenital dislocation of the hip. A critical review of the Ludloff approach in sixty-six hips
MG Mankey, GT Arntz and LT Staheli
Children's Hospital and Medical Center, Seattle, Washington 98105.
We reviewed the results of open reduction through the medial approach of
Ludloff, done for congenital dislocation in sixty-six hips (sixty-three
children). The mean age at the time of the operation was twelve months
(range, two to sixty-three months), and the mean duration of follow-up was
six years (range, two to thirteen years). Avascular necrosis was evident
preoperatively in two hips (3 per cent) and was noted postoperatively in
another seven hips (11 per cent). There was a correlation between the age
of the patient at the time of the operation and postoperative avascular
necrosis, with an increased prevalence of the complication in patients who
had been managed with the open reduction after the age of twenty-four
months. One redislocation and two subluxations were noted at the time of
the first changing of the cast, four weeks postoperatively. Although the
acetabular index decreased from a mean of 38 degrees preoperatively to a
mean of 16 degrees at the time of follow-up, acetabular dysplasia did not
resolve in 33 per cent of the hips and pelvic osteotomy was performed. We
consider the Ludloff approach to be a safe and effective method for the
treatment of congenital dislocation of the hip in infants who are less than
the age of twenty-four months and in whom a concentric reduction with less
than 60 degrees of abduction was not achieved following closed reduction.
The advantages of this approach include direct access to the iliopsoas, the
transverse acetabular ligament, and the constricted capsule; minimum loss
of blood; and a cosmetically acceptable scar.
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