Pediatric update #9. Revision surgery in congenital dislocation of the hip.

Of 759 dislocated hips operated on in our department, 667 received their primary treatment in our hands, while 92 were revised by us after failure of primary surgery. In 71 hips, reconstructive operations were possible, whereas in 21, the joint was destroyed beyond any possibility of repair and a total hip replacement was performed. The reconstructive operations included 16 reopen reductions, five Colonna arthroplasties, six varization derotations, four open reductions and derotations, two valgization osteotomies, and 38 combined procedures. The latter included a shortening varization derotation osteotomy with an open reduction and a Chiari osteotomy of the pelvis. All the revised cases were improved in comparison with their functional status prior to revision. Of the 71 reconstructed joints, the result was good in 59. In the remaining 12, function was improved as compared with the preoperative status, but a total hip replacement will most probably be required in the future. Revision surgery after failure of previous operations for congenital dislocation of the hip can always improve function, but can rarely result in a normal joint. Primary operations should be performed with maximum caution, and it is certainly better to leave limping pain-free children alone than to transform them into limping children in pain.