critical analysis of the protocol for the conservative treatment of developmental dysplasia of the hip in Kuwait

ABSTRACT

To evaluate the results of conservative t reatment of developmental dysplasia of the hip to determine which is the most effective treatment in terms of rates of complications as well as from an economical point of view, to prevent unnecessarily long hospital stays. The results of conservative treatment for developmental dysplasia of the hip are evaluated after an average follow-up of four years in 69 patients and 99 hips [31 bilateral, 23 left side, and 14 right side]. All patients were treated at Kuwait's Al-Razi Hospital between January 1995 and December 1996. There were 59 females and 10 males, aged between 5 and 24 months [median 12 months]. The treatment consisted of traction for 1 to 2 weeks followed by manipulation in 36 hips; manipulation with adductor longus tenotomy in 45 hips; and with adductor longus and psoas tenotomy in 18 hips. Avascular necrosis of the femoral head developed in 16 hips [16%]; 14 hips on the affected side and two hips on the unaffected side. Persistent acetabular dysplasia was present in 13 hips, subluxation in nine hips and dislocation in 13 hips. Open reduction was later required in five hips, open reduction and innominate osteotomy in eight hips, and hip extracapsular innominate osteotomy in one hip. The results were evaluated according to the age groups with highest rate of complications after the age of 15 months. The treatment protocol was changed to limit conservative treatment until the age of 14 months. In cases without high dislocation, no traction as preparation for manipulation was used