Surgical management of the congenital dislocation of the knee and hip in children presented after six months of age

Abstract

PurposeCongenital dislocation of the knee and hip is a rare congenital disorder. The specific aim of the study was to evaluate the clinical and radiological outcomes of the children with congenital dislocation of the knee and hip who presented after six months of age.MethodsAll the consecutive children with congenital dislocation of the knee and hip joints were retrospectively reviewed. We included cases that were treated after six months of age and followed up for a minimum of two years. Twenty-four children with congenital dislocation of the knee and hip (thirteen with ligamentous laxity, eleven children with stiff joints) were included. The knee was dislocated in 45 limbs; the hip was dislocated in 40 instances. The knee joint dislocation was treated with quadricepsplasty in all twenty-four children (45 knees). The hip dislocation (n = 32) was addressed with either closed reduction (n = 8) or open reduction of the hip (n = 24). Eight hip dislocations were not addressed. The outcome of the hip and knee was evaluated.ResultsThe clinical and radiological outcomes were better in children with ligamentous laxity than without laxity. Twenty-two children were community walkers. An orthosis was needed in eight children. The frequency of spontaneous reduction of unreduced dislocation of the hip was noted in three children (5/8 hips).ConclusionOutcome in combined dislocation of knee and hip is good in most cases with surgical interventions. The outcome is better in children with ligamentous laxity. Spontaneous reduction of the dislocated hips might be achieved after gaining knee flexion following knee surgery for congenital the knee in a few cases.