A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation.
Step 1: Surgical Approach
A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage.
Step 2: Explore the Hip Joint
Make sure to find the true acetabulum and remove all obstacles to femoral head reduction.
Step 3: Femoral Head Reducibility
Check the reducibility of the femoral head in different positions through a full range of hip motion.
Step 4: First Femoral Osteotomy
Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy.
Step 5: Hip Joint Stability
Check femoral head reduction stability with the proximal end of the osteotomized femur.
Step 6: Femoral Shortening
Decide the amount of shortening and rotation for the best femoral head reduction.
Step 7: Pemberton Acetabuloplasty
In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy.
Step 8: Postoperative Management
Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace.
The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).
Pitfalls & Challenges