Background: The goal of operative treatment of hip dysplasia or subluxation in children is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. In theory, intervention in early childhood, when the remodeling potential is greater, should provide the best opportunity for the development of a normal joint.
Methods: To determine the efficacy of early surgical intervention in restoring the normal morphology of the hip, according to radiographic criteria, we reviewed the cases of thirty-six children (fifty hips) with residual dysplasia or subluxation who were managed with either a femoral and/or a pelvic osteotomy when they were between two and eight years old (Group I). The average age at the time of surgery was 3.7 years, and the average duration of follow-up was 4.3 years. We compared these results with those achieved in fourteen patients (eighteen hips) with residual hip dysplasia or subluxation who were treated surgically at an older age, between eight and eighteen years old (Group II). The outcome was assessed with use of clinical as well as multiple radiographic criteria. We believe that a normal relationship between the acetabulum and the femoral head was established when there was an acetabular index of <20° or a Sharp angle of <42°, a center-edge angle of >20°, and an intact Shenton's line.
Results: At the time of the latest follow-up, sixteen of the seventeen hips with residual dysplasia that had been treated with pelvic osteotomy alone in Group I and three of four such hips in Group II had a normal relationship between the acetabulum and the femoral head. Normal radiographic findings were noted in fifteen of the seventeen hips with residual subluxation that had been treated with combined femoral and pelvic osteotomies in Group I compared with four of eight such hips in Group II.
Conclusions: We found that residual hip dysplasia or subluxation could be more predictably corrected, with normal radiographic results and with less morbidity and fewer complications, in children who were between two and eight years old than in those who were between eight and eighteen years old. Long-term follow-up is required to confirm whether the improved anatomy and function of the hip that resulted from early correction of residual dysplasia or subluxation lasts into adulthood.
François D. Lalonde, MD; Dennis R. Wenger, MD ; Division of Orthopedic Surgery, Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123
Steven L. Frick, MD; Department of Orthopaedic Surgery, Carolinas Medical Center, 1001 Blythe Boulevard, Suite 602, Charlotte, NC 28232