One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results.
We reviewed the results of operative treatment of congenital dislocation of the hip in eighteen children (twenty-five hips) whose average age at the time of the index operation was six years and four months (range, three years to nine years and eleven months). None of the patients had had previous treatment of the dislocation. Preliminary traction was used for five patients (six hips), and open reduction and femoral shortening was performed in all hips. The functional result was assessed, according to the Iowa hip-rating system, after an average duration of follow-up of ten years and six months (range, six years and two months to sixteen years and ten months). Sixteen hips had an excellent result; seven, a good result; and two, a fair result. The average limb-length discrepancy was 0.8 centimeter (range, zero to four centimeters), and the average foot-progression angle was 11 degrees (range, 0 to 30 degrees) of external rotation. According to Severin's classification of the radiographic appearance, seven hips had an excellent result; eleven, a good result; four, a fair result; and three, a poor result. Four of eleven hips that had evidence of osteonecrosis of the proximal part of the femur had a severe deformity, and one patient had radiographic evidence of moderate degenerative osteoarthrosis when she was sixteen years old. On the basis of this review, we suggest that a one-stage operative procedure consisting of open reduction, femoral shortening, and pelvic osteotomy (if necessary) for previously untreated congenital dislocation of the hip in children who are three to ten years old can result in remodeling of the acetabulum and a functional hip.