- See:
-
DDH:
-
Impediments to Reduction in DDH:
-
Medial Approach to Hip:
-
Open Reduction
-
Pelvic Osteotomy:
- Treatment Goals:
- goal is to achieve and manitain a concentric reduction of hip joint;
- concave acetabulum cannot develop without concentric force exerted by the reduced femoral head;
- upto age 1 yrs, concentric reduction generally results in normal hip;
- upto age 4 yrs, reduction along w/ operative correction of acetabular dysplasia
or correction of femoral anteversion can lead to normalization of the hip;
- Treatment Based on Age:
- New born (birth to 6 months) and use of Pavlik harness:
- Infants (6 to 20 months of age)
- Age 18 mo to 36 months:
- after 2 years of age, there is increased risk of
AVN & closed reduction is more likely to fail;
-
open reduction thru anterolateral approach is generally preferred;
- thru anterolateral approach consider need for innominate osteotomy;
-
medial approach is advocated by some;
- is of more value in the child younger than 18 months;
- Age > 3 years:
- as with all DDH patients, the goal is mainain a concentric reduction;
- attempts at closed reduction risks
AVN in these children, due to the
adaptive shortening of soft tissues across the hip; (see
impediments to reduction);
- while the data is controversial for pts less than 3 years of age, in children older than age 3 yrs,
femoral shortening yields significantly lower rates of AVN than does preoperative traction;
-
traction is associated w/ 50% incidence of AVN in pts older than 3 yrs;
-
open reduction, femoral shortening, &
acetabular osteotmy may be required simultaneously
to maintain concentric reduction;
- often a
VDRO is performed along with the femoral shortening;
- post operatively these patients need to be placed ina hip spica cast with the hip in more
than 90 deg of flexion and in less than 90 deg of abduciton;
- references:
- One stage treatment of congenital dislocation of the hip in children 3 to 10 years old. Functional and radiographic study.
MG Ryan et al.
JBJS Vol 80-A. No 3. March 1998. p 337.
- Older Child:
- upper age limit after which reduction of the hips is less favorable than natural history
of untreated dislocation is controversial;
- children older than 7 years at the time of treatment are more likely to have residual dysplasia;
- general rule is 8 to 9 years for unilateral dislocation and 5 to 6 years for bilateral dislocation;
- Complications:
-
avascular necrosis:
