Derotational femoral shortening for developmental dislocation of the hip: special indications and results in the child younger than 2 years.

Combining derotational femoral shortening osteotomy with open reduction to reduce the incidence of redislocation and avascular necrosis (AVN) in developmental dislocation of the hip (DDH) was first used only for older children. In special circumstances (teratologic dislocation, syndrome-related DDH, difficult home environment), we have combined femoral shortening with open reduction in 15 children (20 hips) ranging in age from 5 to 23 months old. Fourteen hips required concurrent pelvic osteotomy. Complications included partial AVN in two hips, residual subluxation requiring acetabular osteotomy in two hips, and residual dysplasia in two hips. Radiographic evaluation by the Severin method revealed 15 good or excellent hips and five hips rated fair or less. Hips reduced without pelvic osteotomy produced better radiographic results than those treated with a concomitant augmentation acetabuloplasty (Albee). This procedure can injure the growth centers of the acetabular rim in a very young child. Derotational femoral shortening can be used in special circumstances to achieve reduction in DDH in children younger than 2 years. The surgery is technically demanding, and the surgeon should have extensive prior experience using this method in older children.