Congenital dislocation of the hip. A re-appraisal of the upper age limit for treatment

J Bone Joint Surg Br. 2006 Aug;88(8):1076-81. doi: 10.1302/0301-620X.88B8.17592.


Difficulties posed in managing developmental dysplasia of the hip diagnosed late include 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 a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay's criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision. One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.

MeSH terms

  • Age Factors
  • Bone Diseases, Developmental / congenital*
  • Bone Diseases, Developmental / diagnostic imaging
  • Bone Diseases, Developmental / surgery
  • Child
  • Child, Preschool
  • Female
  • Femur / surgery
  • Femur Head Necrosis / etiology
  • Hip Dislocation, Congenital / diagnostic imaging
  • Hip Dislocation, Congenital / physiopathology
  • Hip Dislocation, Congenital / surgery*
  • Hip Joint / diagnostic imaging
  • Hip Joint / physiopathology
  • Hip Joint / surgery
  • Humans
  • Male
  • Orthopedic Procedures / methods
  • Postoperative Complications
  • Radiography
  • Range of Motion, Articular
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome