Congenital dislocation of the hip. Open reduction by the medial approach

In a retrospective clinical review of patients with congenital dislocation of the hip who underwent open reduction through the Ludloff medial approach, stability of reduction, acetabular development and presence of avascular necrosis were evaluated in 11 patients with 15 dislocated hips. This approach was reserved for patients younger than 18 months of age in whom closed reduction had failed. Ten patients with 14 hips underwent preoperative traction. All 15 hips at follow-up or just prior to subsequent surgery displayed dysplastic and insufficient acetabular development, with persistent subluxation in nine hips. Subsequent surgery to obtain better concentric reduction and acetabular coverage was performed in six hips, and further surgery is being considered in four other hips. Ten hips showed signs of avascular necrosis of the ossific nucleus, with additional involvement of the growth plate in four hips. The medial approach resulted in inadequate concentric reduction, with a high incidence of avascular necrosis. In the majority of patients in this small series, a secondary procedure was needed to improve hip stability and the acetabular dysplasia.