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One-stage correction of neglected congenital dislocation of the hip without preoperative traction
1Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
Insights
Preoperative traction is not necessary for treating neglected congenital dislocation of the hip (CDH) in children up to nine years old. One-stage total correction without traction offers a safe and effective treatment option.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
Background:
- Congenital dislocation of the hip (CDH) management is debated, particularly regarding preoperative traction for neglected cases.
- Neglected CDH presents challenges in achieving stable hip reduction and preventing complications.
Purpose of the Study:
- To evaluate the efficacy and safety of one-stage, total correction without preoperative traction for neglected CDH.
- To assess outcomes in pediatric patients with untreated dislocated hips.
Main Methods:
- Retrospective study of 64 patients (74 hips) with neglected CDH treated between 1984 and 1988.
- Surgical techniques included open reduction with Salter's osteotomy, triple osteotomy, and femoral shortening.
- Minimum follow-up of two years.
Main Results:
- Over 95% of hips were well-contained post-operatively.
- Minor complications included two cases of subluxation and one redislocation, all managed successfully.
- Avascular necrosis of the femoral head occurred in three hips.
- Patients without complications showed good function and no significant leg length discrepancy.
Conclusions:
- One-stage total correction without preoperative traction is a safe and effective treatment for neglected CDH in children up to nine years of age.
- This approach leads to good functional outcomes with a low rate of significant complications.
Abstract:
The value of preoperative traction of a neglected congenital dislocation of the hip (CDH) is a controversial issue. A retrospective study was performed to evaluate the effects of one-stage, total correction without traction used in neglected CDH. From April 1984 to November 1988, 64 patients (74 untreated dislocated hips) were operated upon with one-stage total correction without preoperative traction. Their ages ranged from 1 year 2 months to 8 years 6 months. Forty-five patients (53 hips) underwent open reduction and a Salter's osteotomy. Ten patients (11 hips) had additional femoral shortening. Nine patients (10 hips) underwent open reduction and a triple osteotomy with femoral shortening. With a minimum of two years of follow-up, all of the hips were well contained, except for two hips with subluxation and one hip with redislocation (reduced after a secondary operation). Avascular necrosis of the femoral head was evident in three hips (one in each group). All of the patients without complications functioned well without significant leg length discrepancy. The other patients also performed well after their complications were treated. In conclusion, neglected CDH in patients up to nine years of age can be safely and effectively treated by one-stage, total correction without preoperative traction.