Related Experiment Video
Updated: Apr 17, 2026
In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
Published on: July 2, 2021
Arthroscopic Anatomy of the Dislocated Hip in Infants and Obstacles Preventing Reduction
Oliver Eberhardt1, Thomas Wirth1, Francisco F Fernandez1
1Orthopaedic Department, Olgahospital Stuttgart, Stuttgart, Germany.
Insights
This study used pediatric hip arthroscopy to identify obstacles in reducing dislocated hips in young children. Capsular constriction and the teres ligament were the primary blocks to reduction, treatable with arthroscopic release.
Area of Science:
- Pediatric Orthopedics
- Arthroscopic Surgery
- Developmental Dysplasia of the Hip
Background:
- Developmental dysplasia of the hip (DDH) is a common condition in infants and young children.
- Accurate identification of intra-articular obstacles is crucial for successful hip reduction.
- Arthroscopic techniques offer a minimally invasive approach to evaluate and treat DDH.
Purpose of the Study:
- To arthroscopically describe the anatomy of developmentally dislocated hips in young children.
- To elucidate the role of the acetabular labrum in hip luxation and reduction.
- To determine the primary impediments to hip reduction in infants and young children.
Main Methods:
- A specialized pediatric medial hip arthroscopy approach was utilized in 25 hip joints of 21 patients under 4 years of age.
- A 2.7-mm cannulated instrument and a 70° arthroscope with subadductor and anterolateral portals were employed.
- Anatomic structures including the femoral head, ligaments, acetabulum, and labrum were examined, and obstacles to reduction were resected.
Main Results:
- Arthroscopic reduction was successful in all 25 hip joints.
- A hypertrophic teres ligament was observed in 23 hips, and capsular constriction was the main obstacle in 22 hips.
- The acetabular labrum was not inverted and did not impede reduction; secondary changes to the acetabular roof were noted in 10 hips.
Conclusions:
- Pediatric hip arthroscopy via the subadductor portal is a safe and effective method for evaluating DDH.
- The primary obstacles to hip reduction are capsular constriction and the teres ligament, which can be addressed with arthroscopic release.
- The limbus and neolimbus were not found to be significant factors preventing reduction in this series.
Purpose:
The purpose of this study was to describe the anatomy as seen arthroscopically, the role of the labrum and its relevance in luxation and reduction procedures, and secondary changes to the cartilaginous acetabular roof and to determine the main obstacles preventing reduction of dislocated hips in infants and young children.
Methods:
A specialized pediatric medial approach to hip arthroscopy was performed on 25 hip joints in 21 patients younger than 4 years of age. The arthroscopic procedure was conducted using a 2.7-mm cannulated instrument. A subadductor portal was used for the 70° arthroscope, and a high anterolateral portal served as a working portal. The anatomic findings of the individual hip joints were recorded. We examined the femoral head, the teres ligament, the transverse ligament, the acetabulum, and the acetabular labrum. The obstacles preventing reduction were successively resected.
Results:
An arthroscopic investigation of all major structures and arthroscopic reduction was possible in 25 hip joints. A hypertrophic teres ligament was present in 23 of the 25 hips. Capsular constriction prevented reduction in 22 of the 25 hips. The acetabular labrum was not inverted in any of the examined hip joints and was also never an obstacle to reduction. Secondary changes to the cartilaginous preformed acetabular roof were present in 10 hips.
Conclusions:
We have shown that arthroscopy of a developmentally dislocated hip can be safely performed using the subadductor portal. Through this arthroscopic approach, we were able to identify the previously described pathologic structures-the limbus, neolimbus, pulvinar, hypertrophic teres ligament, and capsular constriction. The capsule was the most common block to reduction, followed by the teres ligament. Successful reduction can be achieved by removal of intra-articular tissues, the pulvinar, and the teres ligament, and nearly always a capsular release. The limbus and neolimbus were not factors in achieving reduction in our series.
Level Of Evidence:
Level IV, case series.
More Related Videos
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
08:40Author Spotlight: A Novel 3D-Printed Titanium Implant for Minimally Invasive Treatment of Hip Dysplasia in Young Dogs
Published on: April 19, 2024