Open reduction surgery for congenital hip dislocation is the procedure used to reduce the femoral head (i.e., reposition it in the correct position) in cases where non-surgical attempts have failed.
It is a delicate procedure that must be performed by expert teams and can be performed using various approaches, from traditional to minimally invasive.
Open reduction for congenital hip dislocation: an experienced center in Bologna (Italy)
Our center has world-class experience in the surgical treatment of congenital hip dislocation.
Dr. Lampasi has been practicing congenital hip dislocation surgery for years, due to extensive experience gained from his years at the Rizzoli Orthopedic Institute, integrated with international experience and innovative techniques.
He was Head of Pediatric Orthopedics at Meyer Hospital in Florence, where he performed (the first in that hospital) many surgical operations in this field.
He has been called as a consultant to various public and private Italian Hospitals to perform hip dislocation surgeries (open reduction, pelvic osteotomies, etc.), also carrying out training activities for other pediatric orthopedic surgeons.
He is a recognized member of the International Hip Dysplasia Institute.
For years, he has been carrying out educational and outreach activities online and collaborating with family support groups , gathering experiences from all over Italy.
Open reduction for congenital hip dislocation: why?
In cases of hip dislocation, it is necessary to reposition the femoral head into its correct location, the acetabulum. The first approach is always non-surgical, using braces.
If treatment is carried out early and by expert hands, the dislocation can be resolved in most cases.
If treatment is performed late or incorrectly, or in cases where the dislocation is more severe from the onset, more invasive procedures are necessary.
In some cases, a closed reduction is sufficient : the femoral head is reduced (under anesthesia) and a cast is applied to keep it in position.
In very specific cases, a preliminary application of skin traction lasting a few weeks may be used to reduce existing tension. However, this practice has not been shown to be truly effective in many recent scientific studies, and has therefore been abandoned by many centers, given the significant effort involved for patients and their families.
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Open reduction for congenital hip dislocation: what does it involve?
In cases where non-surgical attempts to reduce the femoral head have failed, a surgical reduction should be planned.
The surgery consists of opening the hip joint, freeing the femoral head from obstacles that prevent it from centering itself in the acetabulum and repositioning it correctly.
Is open reduction better than closed reduction? Is traction necessary?
This is a doubt that many families have, but it is a wrong question.
In reality, it is important to apply the correct method to each individual case. If a dislocation can be corrected non-surgically and without forcing, it is right that it be treated that way.
But in many cases, the obstacles are so stubborn that there is no solution other than surgery. If, in these cases, we persist in trying to reduce the femoral head with noninvasive procedures, casting, or traction, we only increase the risk of failure or damage to the femoral head (necrosis).
Open reduction for congenital hip dislocation: what techniques are available?
Open reduction surgery for congenital hip dislocation can be performed in several ways:
- the classic approach: via the anterior approach
- medial approach: this is a less invasive approach, with less blood loss (less risk of blood transfusion) with the possibility of operating on two hips at the same time and with the possibility of combining other minimally invasive procedures to increase hip stability
Our center is one of the few centers with long experience in the application of both techniques.
This way, it is possible to apply the most suitable procedure depending on the case and avoid more invasive procedures.
Open reduction for congenital hip dislocation: why is minimally invasive important?
The first goal of open reduction is to reposition the femoral head in the correct position, but another goal is also important: to avoid suffering of the femoral head and to spare the local soft tissues.
Hips affected by hip dislocation already have a certain local vulnerability, making the femoral heads at risk of developing necrosis. Therefore, it is important to avoid forced surgical procedures that could increase this risk.
Furthermore, it is important to also consider the soft tissues, especially the muscles, capsules, etc. The more invasive the interventions, the greater the risk of weakness, stiffness, scarring, impaired acetabular development, etc.
Open reduction for congenital hip dislocation: can it be combined with other procedures?
In cases of established hip dislocation, in older patients (generally over 18-24 months of age), it is possible to combine open reduction of the hip with other procedures to also correct the associated bone deformities: femoral osteotomy and/or pelvic osteotomy.
Open reduction for congenital hip dislocation: where should the procedure be performed?
Few centers in Italy perform surgical reduction for congenital hip dislocation in children, and some families travel abroad to have it done.
Ours is one of the very few centers with extensive experience in both the classic and minimally invasive approaches, in bone reconstruction, and in interventions on previously treated but unresolved cases.