Abstract
Introduction: Difficulties posed in managing late diagnosed CDH are a high placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is now well-established practice. Femoral shortening prevents excessive pressures on the enlocated femoral head which can predispose to avascular necrosis. Instability due to a co-existing dysplastic shallow acetabulum is frequent and so a pelvic osteotomy is performed to achieve stable and concentric hip reduction.
Theoretical advantages of a one stage open reduction includes shortened hospital stay, avoidance of prolonged repeated immobilization and decreased joint stiffness. This study reports the results of single stage combined procedure for late presenting congenital dislocation of the hip in children aged 4 years and above.
Methods: We retrospectively reviewed 15 patients (total 18 hips) presenting with CDH age 4 years and above who were treated by one stage combined procedure performed by the senior most author. The average age at surgery was 5 years and 9 months (range 4 years to 11 years). The average follow up was 6 years 2 months (range 2 years to 8 years 6 months). All patients were followed up clinically and radiologically in accordance with McKay criteria and modified Severin classification.
Results: According to the McKay criteria12 hips performed excellently whilst 6 did good. All patients had full range of movement except for one. There was an average 1 cm limb length discrepancy in 8 patients. All were Trendlenburg negative. Modified Severin classification demonstrated 4 hips of grade1a, 6 were 1b, 8 were grade 2. 1 patient had AVN and 1 had subluxation requiring revision surgery.
Conclusions: In conclusion, one stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in short to medium term follow.
Mr James Robb – BSCOS Honorary Secretary, Mr Geoffrey Mill – Host of the meeting, Mr Robin Paton – Editorial Secretary. Correspondence should be sent to BSCOS, c/o Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London, WC2A 3PN.
