Hip Procedure Essentially Unchanged for 50 Years

MONDAY, Oct. 6 (HealthDay News) -- The surgical technique for open reduction and innominate osteotomy for developmental hip dislocation -- which has essentially remained unchanged in the 50 years since it was introduced -- is the focus of an article published in a supplement to the October issue of the Journal of Bone & Joint Surgery.

John H. Wedge, M.D., of the Hospital for Sick Children in Toronto, Ontario, Canada, and colleagues write that these procedures are indicated in children older than 18 months, and innominate osteotomy and open reduction are best performed simultaneously. After the age of 3 years, children generally require a femoral shortening osteotomy to prevent osteonecrosis of the femoral head due to excess pressure.

According to the authors, points of concern include failure to create concentric reduction, which can lead to dislocation or chronic subluxation following the procedure; using excessive force in reducing the hip, which can lead to osteonecrosis; and tying the capsulorrhaphy sutures before finishing the innominate osteotomy, which can make an intraoperative redislocation more difficult to recognize.

"Modern imaging (computed tomography or MRI) with cross-sectional cuts to confirm the concentricity of the reduction postoperatively now provides us with greater certainty than can be achieved with use of plain radiographs. Such imaging can be performed on the first postoperative day and at subsequent times if necessary without general anesthetic or sedation while the child remains immobilized in the hip spica cast," the authors write.

At least one author has had a financial relationship with Physicians Services Inc.

Abstract
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