Osteonecrosis and femoro-acetabular impingement: sequelae of developmental dysplasia of the hip

Abstract

SummaryA 2-year-old girl with developmental dysplasia of the right hip underwent open reduction and capsulorrhaphy via the anterior approach with hip spica casting in an internally rotated position. During her 26 years of follow-up, she was found to have osteonecrosis and subsequently cam-type femoro-acetabular impingement at 28 years of age. She was treated with surgical dislocation of the hip and osteochondroplasty to recreate the normal contour of the head and neck offset.

Femoral Neck Bony Prominence Working as a False Head in Neglected Developmental Hip Dysplasia

“…With resultant avascular necrosis of the dislocated femoral head. 1 This highlights the value of early recognition and reduction of developmental hip dysplasia, and the value of early reduction to achieve satisfactory and stable opposition of the femoral head with the acetabulum to avoid late surgical intervention which may carry higher rates of complications. Closed reduction remains a very effective modality of treatment for developmental hip dysplasia; the choice between closed or open methods of reduction is then better decided on an individual case by case basis.…”

“…A closed reduction approach of dislocated hips in developmental hip dysplasia is associated with multiple complications that include the risk of failed reduction, avascular necrosis of the femoral head or femoral nerve impingement. 1 Some of those complications can be reduced with ensuring a concentric reduction without excessive flexion or excessive abduction. In 12%-43% of cases a closed reduction attempt fails to produce a stable concentric reduction of the hip.…”