Congenital dislocation of the hip: Development of the joint after closed reduction

Abstract

Background Although it is often diffi cult to predict long term outcomes with reasonable certainty in children with orthopaedic conditions, it is important to attempt to do so. Erik Severin predicted the outcome in developmental dysplasia of the hip. His work was the continuation of that of his well known professor Henning Waldenstron and was initially published in Swedish in 1941 [ 1[ and summarized in this selected paper. Methods A case series of 115 patients with congenital dislocation of the hip (CDH), 38 of which were bilateral and 39 were unilateral, all treated by closed reduction between 1937 and 1940. All were under 5 years of age and all had one or more hip arthrograms in the course of treatment. Full clinical and radiological details were available for 72 patients with a minimum of 5 years follow up. Results Functional outcome was very good with 90 % did not have any complains. However, children have an extraordinary ability to compensate and accommodate for hip deformities and functional outcomes may not be the best indicator for overall outcome. This was acknowledged and there was more focus on anatomical (radiological) abnormalities. The anatomical outcomes were put in fi ve groups based on several radiological markers. Table 150.1 summarises these groups: Conclusions The author's conclusion was (1) closed reduction was the method of choice in CDH and open reduction should be preserved for the very few cases in which closed reduction was unsuccessful, (2) there was soft tissue interposition in the majority of the cases of complete CDH; however, the soft tissue barrier was gradually overcome if the hip was kept against the acetabulum and it had no bearing on the outcome.