One-stage correction of neglected congenital dislocation of the hip without preoperative traction.

The value of preoperative traction of a neglected congenital dislocation of the hip (CDH) is a controversial issue. A retrospective study was performed to evaluate the effects of one-stage, total correction without traction used in neglected CDH. From April 1984 to November 1988, 64 patients (74 untreated dislocated hips) were operated upon with one-stage total correction without preoperative traction. Their ages ranged from 1 year 2 months to 8 years 6 months. Forty-five patients (53 hips) underwent open reduction and a Salter's osteotomy. Ten patients (11 hips) had additional femoral shortening. Nine patients (10 hips) underwent open reduction and a triple osteotomy with femoral shortening. With a minimum of two years of follow-up, all of the hips were well contained, except for two hips with subluxation and one hip with redislocation (reduced after a secondary operation). Avascular necrosis of the femoral head was evident in three hips (one in each group). All of the patients without complications functioned well without significant leg length discrepancy. The other patients also performed well after their complications were treated. In conclusion, neglected CDH in patients up to nine years of age can be safely and effectively treated by one-stage, total correction without preoperative traction.