One-stage surgical procedure for congenital dislocation of the hip in older children. Long-term results

The one-stage procedure described in this article, which has been used in children older than three years of age, is the method of choice in the treatment of late-diagnosed congenital dislocation of the hip. The present authors and their patients have been more than satisfied with the results of this procedure. With femoral shortening as the fundamental step, this method can be applied in high dislocations, as well as in cases of subluxation in which a pelvic osteotomy is indicated, to restore the depth of the acetabulum and to prevent undue pressure on the femoral head, which is the main cause of avascular necrosis, joint stiffness, and failures. Evaluation of the results is confusing but should rely on resistance of the hip in daily function, clinical appearance, range of hip motion, and the patient's opinion. Roentgenologic evaluation seems to be even more difficult, because numerous parameters need to be taken into consideration and correlated with the preoperative appearance of the hip. Certainly, it is reasonable to expect the majority of patients to develop osteoarthritic changes eventually, but nearly all patients can live a normal or satisfactory life for a number of years. The present authors are convinced that many patients will remain symptom-free for a long period.