We examined the results of medial approach open reduction without preliminary traction or attempt at closed reduction for congenital dislocation of the hip (CDH) in children aged <1 year prospectively. In all children, a trial of conservative treatment with Pavlik harness failed. Twenty-three hips in 19 children were treated. Follow-up ranged from 5 to 10 years (average 8 years). None of the hips redislocated. Osteonecrosis of the femoral head occurred in one patient with coxa magna. Two children subsequently underwent Salter innominate osteotomy for hip dysplasia. Early detection and treatment with Pavlik harness is our preferred approach to treatment of CDH. In children who have failed initial harness management, medial approach open reduction without preliminary traction affords a safe, effective, and relatively simple alternative to other methods of treatment.