The treatment of congenital hip dislocation between the ages of 1 and 3
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L Valdiserri1, J G Campagnaro, R Urso
1Divisione di Ortopedia e Traumatologia Infantile, Istituto Ortopedico Rizzoli, Bologna.
Insights
Non-surgical reduction for congenital hip dislocation in young children yields excellent clinical results in 75% of cases. Surgical intervention is best reserved for cases where conservative methods fail, offering a higher success rate.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Developmental Biology
Background:
- Congenital hip dislocation (CHD) is a common developmental anomaly requiring timely intervention.
- Early treatment is crucial for optimal outcomes and preventing long-term complications.
Purpose of the Study:
- To evaluate the long-term clinical and radiographic outcomes of non-surgical versus surgical treatment for congenital hip dislocation in patients aged 1-3 years.
- To determine the optimal treatment strategy for this patient cohort.
Main Methods:
- Retrospective review of 81 patients (103 hips) treated for congenital hip dislocation between 1-3 years of age.
- Initial treatment involved adhesive band traction followed by gentle non-surgical reduction under general anesthesia and plaster immobilization.
- Surgical reduction was performed in cases where non-surgical methods failed or for residual subluxation, with 91 associated procedures noted.
Main Results:
- Non-surgical reduction achieved excellent clinical results in 75% of cases.
- Radiographically, 48% of hips showed normal aspects, while 42% had residual dysplasia or deformity.
- Avascular necrosis occurred in 16% of non-surgically treated hips and 30% of surgically treated hips, with higher rates in severe dislocations.
Conclusions:
- Non-surgical reduction is the preferred initial treatment for congenital hip dislocation in the 1-3 year age group.
- Surgical intervention should be considered for persistent cases or residual subluxation after conservative management.
- Early diagnosis and appropriate treatment are vital for minimizing long-term hip deformities and avascular necrosis.
Abstract:
A total of 81 patients (103 hips) with a diagnosis of congenital hip dislocation were reviewed, who had been treated between one and three years of age. All of the patients were initially treated with adhesive band traction prior to non-surgical reduction, which was performed under general anesthesia using gentle reduction maneuvers followed by immobilization in plaster. Non-surgical reduction was performed in 69 hips (67%), surgical in the remaining 34 (33%). A total of 91 associated surgical procedures were performed for the treatment of residual subluxation. Average follow-up was 12 years (minimum 5, maximum 19). The clinical results of the non-surgical reductions were excellent in 75% of the cases. Radiographically, 48% are hips which have a normal aspect, while 42% have a moderate degree of residual dysplasia or deformity of the femoral epiphysis and of the acetabulum. Hips that were initially classified as grade III dislocations show fair results. Hips treated non-surgically included 11 cases of avascular necrosis (16%); recovery was adequate. Hips treated surgically included 14 cases of avascular necrosis (30%), which was more accentuated in those hips that had initially been treated elsewhere, and in those classified as grade III. The clinical and radiographic results obtained for the hips treated surgically demonstrate poor results in 17% of the cases (6 out of 34), as a consequence of types III and IV osteochondrosis. It may be concluded that in this age group congenital hip dislocation is best treated by non-surgical reduction, possibly followed by surgery of the femur and acetabulum. Surgical reduction was only indicated when conservative methods failed.