Congenital Dislocation of the Hip: Recent Advances and Current Problems.
BENNETT, JAMES T. M.D. *,**; MACEWEN, G. DEAN M.D. **,+
Clinical Orthopaedics & Related Research.
247:15-21, October 1989.
(Format: HTML, PDF)
This article reviews changes that have occurred in the understanding and treatment of congenital dislocation of the hip (CDH). It is now recognized that CDH is a spectrum of diseases with differing etiologies, pathologies, and natural histories that, as a result, require different treatment approaches. The etiology of CDH involves genetic, hormonal, mechanical, and environmental influences. This recognition of mechanical factors that predispose to CDH has allowed the identification of high-risk patients. Screening for CDH in the newborn has resulted in many more patients being diagnosed earlier. Ultrasonography has added a new dimension to CDH diagnosis, since it has demonstrated abnormal hips in otherwise normal children. In the newborn, the use of ultrasonography may be the single most important recent contribution to the study of this disease. The natural history of CDH is well-known: The disease often can lead to early coxarthrosis. However, avascular necrosis is a complication of treatment and results in a hip that may be worse than one not treated at all. Treatment of CDH includes gentle closed reduction in the majority of patients. In patients under six months of age, this can usually be achieved with the Pavlik harness. Up to the age of three years, gentle manipulative closed reduction after traction is successful in the majority of patients. The trend toward the use of home traction and away from inpatient skeletal traction has been documented by many centers to be successful. Open reduction is becoming infrequently required and has specific indications. Still, this reduction must be gentle and may follow traction in the younger patient or femoral shortening in the older patient if it is not possible or desirable to lower the femoral head to the level of the acetabulum. Secondary procedures, including the Salter or Pem-berton osteotomies, are indicated in the older patient for persistent dysplasia or subluxation when the acetabulum fails to respond to the concentric reduction of the femoral head into the acetabulum. The Chiari or shelf salvage procedures are indicated when a stable concentric reduction cannot be achieved.
(C) Lippincott-Raven Publishers.