Patients at walking age are generally brought to the clinic because of the recognition of limping and limb length discrepancy by their families. Reasons for late presentation are thought to be inadequate knowledge of the primary care physicians and pediatricians on developmental dysplasia of the hip (DDH), as well as the poor socio-economical and educational level of the family.
The purpose of treatment in developmental dysplasia of the hip is to ensure reduction of the hip joint as soon as possible, in order to provide an adequate environment for development of acetabulum and the proximal femur. The later the diagnosis is made, the less the acetabular and proximal femoral remodeling potential remains and the more complicated the required treatment becomes; besides, the risk of development of degenerative joint disease increases.
Because joint capsule is elongated superiorly after 18 months, the preferred method of open reduction is generally anterior open reduction with adequate capsulorrhaphy. Pelvic osteotomy is generally added to open reduction considering the relatively less potential remained for acetabular remodelling. Rotational pelvic osteotomies and acetabuloplasty procedures have advantages and disadvantages compared to each other. In children younger than two years old, some surgeons prefer to follow acetabular development after open reduction by radiography and reserve the pelvic osteotomy for later. After two years, generally femoral shortening is added to open reduction and concomitant pelvic osteotomy. The purpose of femoral shortening is to decrease the contact pressure on the femoral head and thus reduce the risk of avascular necrosis. Although some surgeons prefer long period of traction before open reduction, femoral shortening is proven to be more effective for the prevention of avascular necrosis.
Early diagnosis is the key for diagnosis and treatment of DDH. Early management achieves 95% success rate and low complication risk. One should remember that the first treating surgeon has a higher chance of acquiring a healthy hip.