- See:
- DDH
- Impediments to Reduction in DDH
- Medial Approach to Hip
- Open Reduction
- Pelvic Osteotomy
- Treatment Goals:
- goal is to achieve and manitain a concentric reduction of hip joint;
- concave acetabulum cannot develop without concentric force exerted by the reduced femoral head;
- up to age 1 yrs, concentric reduction generally results in normal hip;
- up to age 4 yrs, reduction along w/ operative correction of acetabular dysplasia or correction of femoral anteversion can lead to
normalization of the hip;
- Treatment Based on Age:
- New born (birth to 6 months) and use of Pavlik harness:
- Infants (6 to 20 months of age)
- Age 18 mo to 36 months:
- after 2 years of age, there is increased risk of AVN & closed reduction is more likely to fail;
- open reduction thru anterolateral approach is generally preferred;
- through anterolateral approach consider need for innominate osteotomy;
- medial approach is advocated by some;
- is of more value in the child younger than 18 months;
- Age > 3 years:
- as with all DDH patients, the goal is mainain a concentric reduction;
- attempts at closed reduction risks AVN in these children, due to the adaptive shortening of soft tissues across the hip;
(see impediments to reduction);
- while the data is controversial for pts less than 3 years of age, in children older than age 3 yrs, femoral shortening yields
significantly lower rates of AVN than does preoperative traction;
- traction is associated w/ 50% incidence of AVN in pts older than 3 yrs;
- open reduction, femoral shortening, & acetabular osteotmy may be required simultaneously to maintain concentric reduction;
- often a VDRO is performed along with the femoral shortening;
- post operatively these patients need to be placed ina hip spica cast with the hip in more than 90 deg of flexion and in less
than 90 deg of abduction;
- references:
- One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results.
- Older Child:
- upper age limit after which reduction of the hips is less favorable than natural history of untreated dislocation is controversial;
- children older than 7 years at the time of treatment are more likely to have residual dysplasia;
- general rule is 8 to 9 years for unilateral dislocation and 5 to 6 years for bilateral dislocation
- Complications:
- avascular necrosis