Surgical Technique: Anterior Open Reduction for Developmental Dysplasia of the Hip and Salter Innominate Osteotomy
An open reduction is indicated for those developmental hip dislocations that have failed conservative attempts at reduction including Pavlik harness and closed reduction or for those children who present initially at an older age. The goal of an open reduction is to remove the obstacles blocking the access of the femoral head to the depths of the acetabulum. Achieving a deep and concentric reduction minimizes the risk of re-dislocation and maximizes future remodeling of the hip joint. The anterior approach is the most common technique used to perform an open reduction. This exposure also allows a pelvic osteotomy to be performed (if necessary) to augment coverage and facilitate acetabular remodeling. A concomitant femoral shortening osteotomy may need to be performed if excessive tension is present at the time of open reduction, doing so reduces the risk of avascular necrosis. In addition, femoral version should be assessed to determine the need for femoral derotation.