Surgical treatment of late congenital dislocation of the hip (after 4 years of age).

The goal of the surgical treatment in previously untreated juvenile hip displacement is to achieve a stable and concentric reduction of the femoral head with the best range of motion and without severe complications related to avascular necrosis (AVN) and stiffness of hip joint. In this paper the authors describe their approach in the treatment of the patients affected by neglected high dislocation of the hip joint observed after 4 years of age, when all of them had been ambulant for several years. They point out, on the basis of their experience, the importance of avoiding damage to the vessel supply of the dislocated femoral head, respecting the soft tissue and the use of different surgical techniques to perform acetabuloplasty in relation to skeletal age, in order to obtain good hip stability and congruency, good range of motion for 20 years at least, and to prepare the hip joint for further surgical intervention in the best way possible when inevitable osteoarthritis occurs.