CORR Insights®: Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup.

Abstract

T he Ludloff medial approach to the hip for the treatment of pediatric developmental hip dysplasia is popular in some centers with reports of equivalent clinical outcomes and lower avascular necrosis (AVN) rates. Some surgeons may be unfamiliar or lacking confidence in this approach. Therefore, it is only reasonable to believe that surgeons who are unfamiliar with the Ludloff approach will likely prefer traditional anterior access. The current study by Farsetti and colleagues involves 71 hips treated by medial open reduction with followup to skeletal maturity. The authors are commended for their thoughtful preoperative program (including 4 weeks of preoperative traction), for their long-term followup efforts, and for their thorough assessment of the patients involved. The benefit of preoperative traction remains controversial and warrants well-designed and controlled trials. A similar recent Level III paper by Hoellwarth et al. [3] also compared medial and anterior approaches, with 19 in each matched group, and found no differences in AVN rates or need for further surgery. They reported no protective benefit of a preoperative ossific nucleus. The current study by Farsetti and colleaguies reports a lower AVN rate in children without ossification of the femoral head at the time of surgery—22 of their 71 patients did not have ossified heads. This remains a topic of debate however, with mixed reports.