EARLY OPEN REDUCFION FOR CONGENITAL DISLOCATION OF THE HIP

We have reviewed 82 children with congenital dislocation of the hip, after freatment by anterior open reduction followed by derotation femoral osteotomy. The clinical and radiological results were significantly better in the group that had open reduction before the appearance of the capital femoral epiphysis; this group also had a lower incidence of avascular necrosis. We conclude that, when it is clearly indicated, the earlier an open reduction is carried out the better the results. The goal of treatment in congenital dislocation of the hip (CDH) is to return the femoral head to within the acetabulum, and to maintain this position until the pathological changes have reversed. Early reduction implies that fewer adaptive changes have taken place, and reduces the time required for the femoral head, acetabulum and capsular structures to return to their normal configuration (Hensinger 1985). It is generally agreed that closed reduction of the dislocated neonatal hip should be attempted first, but this will fail in a proportion of patients ; some due to soft tissue interposition (Leveuf 1948 ; Somerville 1953; Renshaw 1981). Persisting with conservative therapy may then lead to a permanently defective joint. The earliest age at which an open reduction can safely be carried out is contentious (Zionts and MacEwen 1986; Ross, Ford and Evans 1988). Chuinard (1972) stated that Wolf’s law operates across a joint ; if this is true then the