Developmental Dysplasia of the Hip: Pathophysiology and Surgical Indications in the First Two Years of Life

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The hip joint is fully developed at the eleventh gestational week. This is the earliest time at which dislocation can occur because only a concentrically congruent femoral head in the acetabulum can lead to development of a normal hip joint. If normal development does not occur, treatment is required as soon as possible. In the first months of life, simple means of physiologic abduction should be used. If maintenance of reduction is impossible by these means, gentle closed reduction should be performed. Open reduction of the hip joint is reserved for hips in which obstacles to gentle closed reduction exist or hips that do not respond to conservative treatment. Open reduction is recommended from age 6 months; after age 18 months, subtrochanteric varus derotational or Salter's innominate osteotomy should be performed, according to the bony changes on the femoral or pelvic side of the hip joint.

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