Treatment of congenital dislocation of the hip in children between the ages of one and three years.

The results in fifty-one congenitally dislocated hips in forty-two children who were between one and three years old when treatment was begun have been reviewed. Thirty-eight hips (75 per cent) were treated by traction prior to reduction, gentle closed reduction under anesthesia, selective adductor tenotomy, and immobilization in a hip-spica cast. Thirteen hips (25 per cent) required an open reduction when stable closed reduction could not be achieved. Secondary femoral or acetabular procedures were performed after either form of treatment if subluxation became apparent after the child had resumed walking. At an average twelve-year follow-up (range, five to twenty-two years), thirty-six hips (71 per cent) were rated as Class I; six, as Class II; eight, as Class III; and one, as Class IV, according to the classification system of Severin. Significant avascular necrosis developed in three hips. We think that in this age group congenital dislocation of the hip is best treated by closed reduction, followed by femoral or acetabular procedures as needed. Open reduction should be done only in those hips that cannot be reduced by closed methods.