Treatment concepts for proximal femoral ischemic necrosis complicating congenital hip disease.

A retrospective review of fifty-three congenitally dislocated hips (in forty-four patients) in which ischemic necrosis developed was undertaken to assess patterns of growth disturbance and to establish treatment protocols. We utilized the Bucholz and Ogden classification of the four roentgenographic patterns of ischemic necrosis complicating the treatment of congenital hip disease. Patients with Type-I disease had transient ischemia with early recovery. Significant growth disturbances requiring surgical treatment were not observed. Limb-length discrepancy, increased height of the greater trochanter relative to the femoral neck and head, and problems with femoral head coverage were more likely to develop in hips with Type-II or Type-III ischemic necrosis. Equalization of limb lengths, trochanteric epiphyseodesis, and surgical means of improving femoral head coverage were also more commonly indicated in these patients. In patients with Type-IV disease, mild deformities of the femoral head and occasional limb-length discrepancies developed; other sequelae were uncommon and surgical intervention was rarely required.