Surgical treatment of congenital dislocation of the hip

The results of two collective studies on congenital dislocation of the hip (CDH) from a number of hospitals are reported here, including general trends in the Federal Republic of Germany and the author's personal methods and preferences. In the first collective study group, the rate of ischemic necrosis in open reductions was 8.2% for anterolateral approaches, 9.6% for inguinal, 16.7% for Ludloff's operation, and only 5.5% when shortening osteotomy was combined with open reduction. A simultaneous Salter osteotomy or acetabuloplasty increased the rate to 10.3% and a concomitant varus osteotomy to 22.2%. The author prefers an inguinal approach to the hip joint, first laterally and then medially of the iliopsoas muscle and femoral nerve, for optimal visualization of the acetabulum. Stability of the joint is increased by a girdle-like flap from the dorsolateral capsule, which is drawn anteriorly and prevents dorsal redislocation. Acetabuloplasty should also be used, even during the first year of life, in joints in which stability may only be guaranteed by extreme abduction and internal rotation. Salter's and Pemberton's osteotomies are used in Germany with good results. However, the author prefers a lateral Albee-Lance acetabuloplasty modified to a complete osteotomy for lateral levering of the acetabular roof. Long-term results show measurements between 82% and 93% of normal and slightly pathologic values. Simultaneous or single varus osteotomies lead to subcapital coxa valga and should no longer be used routinely. In adolescents and adults up to 45 years of age, as long as osteoarthritis is not too advanced and the femoral head is not too deformed, triple pelvic osteotomy with the author's type of modification has a number of advantages.