Treatment of failed open reduction for congenital dislocation of the hip

Twenty-three patients with 25 involved hips underwent repeat open reduction after previous unsuccessful attempts at open reduction for congenital dislocation of the hip (CDH). All hips ultimately were reduced at a mean age of 2 years 10 months (range 10 months to 7 years 3 months). On review, we noted that 15 of the hips were never concentrically reduced at the first procedure, and seven of these hips had undergone simultaneous Salter osteotomy. The most common cause of failure was improper exposure and release of the tight inferior capsule and transverse acetabular ligament, which blocked complete reduction. A vascular necrosis was documented in 44% of the hips, with a lateral physeal growth disturbance in four hips, a central physeal growth arrest in four hips, and complete femoral head necrosis in three hips.