Innominate osteotomy and varus derotational osteotomy in the treatment of congenital dysplasia of the hip.
The long-term functional and radiographic outcome of congenital hip dysplasia in patients previously diagnosed and nonoperatively treated, who subsequently underwent operative treatment after walking age was retrospectively reviewed in 94 patients (87% return). Innominate osteotomy (75 hips, 15.2 years mean follow up) yielded satisfactory late radiographic results in 33% of the subluxated hips and 50% of the dislocated hips, despite more encouraging results at one year (56% and 63.6% respectively). Varus derotational femoral osteotomy (35 hips, 10.8 years mean follow up) yielded a satisfactory radiographic outcome in 55.6% of the subluxated hips and 38.5% of the dislocated hips, with little change from the results at one year. Late diagnosis, late operative treatment, and complications of treatment, particularly ischemic necrosis of the femoral head, were predictive of poor outcome. Combined procedures (10 hips, 12 years mean follow up) or secondary open procedures were ineffective. Although Severin radiographic grade varied with time, functional status remained virtually the same throughout individual follow up. Those patients followed beyond skeletal maturity who developed gross articular incongruity or osteoarthritis, showed a decline in functional status.