[Open reduction after failure of conservative treatment for congenital dislocation of the hip initiated before the age of six months].
OBJECTIVE
The aim of this study was to present the indications, technique and results of open reduction for congenital hip dislocation performed after failure of conservative treatment.


METHODS
Criteria of inclusion in the series were: congenital dislocation of the hip treated conservatively before the age of six months requiring open reduction for failure of initial treatment between 1978 and 1998. During this period, 3000 hips sustained conservative treatment. The series counted 33 hips in 29 children. Mean number of different conservative methods used for one hip was 2.6. One-third of the hips had had previous surgery. Avascular necrosis was noticed in 17 cases (51.5%). Mean age at open reduction was 2 years. Pelvic (61%) and/or femoral (79%) osteotomies were combined with open reduction.


RESULTS
Mean follow-up was 9.5 years. Among the complications, minor avascular necrosis was noticed in five hips without preoperative lesions. Hip joint congruency was excellent or good in 80.7% of the cases. There were no recurrent dislocations. Ten hips (32.3%) were free of avascular necrosis but 4 presented severe avascular necrosis (13%).


CONCLUSIONS
Indications for open reduction are exceptional, attesting to the efficacy of conservative treatment. This salvage procedure achieves good results in the hands of experienced surgeons. The quality of the reduction depends not only on the intra- and extra-articular excision, but also on the stability achieved with peri-articular osteotomies. The main factor of prognosis is avascular necrosis induced by previous treatment.
Wicart
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P
Service de Chirurgie Orthopédique Pédiatrique, Université René-Descartes (Paris V), Hôpital Saint-Vincent-de-Paul, 74-82, avenue Denfert-Rochereau, 75674 Paris Cedex 14. philippe.wicart@free.fr
Ghanem
I
I
Seringe
R
R
D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D005271:Femur Head Necrosis / Q000209:etiology; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular; D012008:Recurrence; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D017211:Treatment Failure