What is the role of open reduction in the treatment of developmental dysplasia of the hip (DDH)?

Updated: Feb 26, 2018
  • Author: Junichi Tamai, MD; Chief Editor: William L Jaffe, MD  more...
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Answer

Open reduction is the treatment of choice for DDH in children who are older than 2 years at the time of the initial diagnosis or in whom attempts at closed reduction have failed. In children with teratologic hips, with failure at a much younger age, open reduction can be performed via a medial approach. The medial approach has a number of advantages, as follows:

  • Both hips can be reduced at the same time (in a patient with bilateral DDH)
  • Obstacles to reduction (eg, psoas tendon) are easily identified
  • The adductor longus can be sectioned through the same incision
  • Because the hip abductor muscles are not at risk for injury, residual weakness is unlikely to occur
  • The iliac apophysis is not at risk for injury
  • The incision has a very good cosmetic result

Problems with this approach include the following:

  • Potentially increased rates of avascular necrosis
  • The possibility that the surgeon may be unfamiliar with this approach
  • The inability to perform capsular plication (capsulorrhaphy) or a pelvic procedure through this incision

With the use of a medial approach, the cast plays a much more important role.


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