This investigation examined the validity of the hypothesis that the acetabulum in congenital dislocation of the hip will develop satisfactorily provided accurate congruous and concentric reduction is obtained as early as possible, and is maintained throughout growth. Seventy-two patients with eighty-five hips were studied. The children were more than one year old on admission and over ten years at the time of review. Acetabular development was assessed radiologically by measurement of the acetabular angle. Angles of less than 21 degrees were regarded as normal, and more than 21 degrees as indicating some failure of development. Satisfactory acetabular development occurred in 80 per cent (angles 24 degrees or below), and was unsatisfactory in 20 per cent (angles above 24 degrees). If three errors in management, namely failure to obtain congruity, failure to maintain congruity and ischaemic necrosis secondary to manipulative reductions, are excluded from the analysis, it is found that 95 per cent of acetabula develop satisfactorily. The outcome is largely independent of the age on admission up to four years old, and of bilateral involvement. It is concluded that acetabuloplasty should not be necessary if the patient is admitted under the age of four or congruity is obtained in the functional position under four and a half years.

No abstract

Since 1974, our approach to treatment of teratologic dislocation of the hip in children has been surgical. We retrospectively reviewed 20 teratologic hip dislocations in 13 children with a minimum follow-up of 2 years. Closed treatment failed in most of the hips. At a mean age of 13 months, 11 patients (18 hips) had an open reduction and a one-and-a-half hip spica. It was followed in most of these hips by a femoral varus derotational osteotomy 6 weeks later. Only three hips had an open reduction followed by 3 months of casting. One of these three hips had salmonella infection and a redislocation. Our main complication was avascular necrosis in 20% of hips, two patients (two hips) ending with a leg length discrepancy. There was some limitation of motion in 65% of hips but 76% of patients had a good functional hip score. There was no difference in the results of unilateral versus bilateral dislocation. Poor results were found in three patients and could be explained by trunk hypotonia, marked limitation of motion and severe involvement of upper extremities, multiple deformities and fixed flexion in the lower extremities, generalized weakness and developmental delay. In spite of these difficulties and complications, results are encouraging.