[Treatment of the dislocated hip in older children]

Between 1976 and 1987, 85 cases of CDH occurring after walking age were followed in the department. Eighteen children aged 5 years or older were reviewed. In 11 children the dislocation was unilateral and in 7 bilateral; out of these 25 hips, 20 were high luxations and 5 occurred at a lower level. Two children, 6 and 13 years old, had a bilateral dislocation. Except for 2 children of 5 years of age who were treated conservatively, surgical treatment was indicated in the other 18 cases usually after tenotomy and derotation. In 13 hips, a surgical repositioning was performed, associated with femoral osteotomies, either shortening osteotomies (7) or derotation osteotomies (3). Pelvic osteotomies were indicated either immediately or later in 15 hips. A triple osteotomy was usually performed (11); a Salter (2) or a Chiari (2) has been rarely used. After a follow-up of 5 years, evaluation according to clinical and radiological criteria showed 14 good and 7 bad results. The latter 7 cases had either a dislocation or an eccentration. Reviewing these series, the authors describe the problems in the treatment of the dislocated hip in the older child: the indications, the therapeutic strategy for those dislocations and the decision for treatment of the bilateral high dislocation in the older child.