A retrospective review of fifty-three congenitally dislocated hips (in
forty-four patients) in which ischemic necrosis developed was undertaken to
assess patterns of growth disturbance and to establish treatment protocols.
We utilized the Bucholz and Ogden classification of the four
roentgenographic patterns of ischemic necrosis complicating the treatment
of congenital hip disease. Patients with Type-I disease had transient
ischemia with early recovery. Significant growth disturbances requiring
surgical treatment were not observed. Limb-length discrepancy, increased
height of the greater trochanter relative to the femoral neck and head, and
problems with femoral head coverage were more likely to develop in hips
with Type-II or Type-III ischemic necrosis. Equalization of limb lengths,
trochanteric epiphyseodesis, and surgical means of improving femoral head
coverage were also more commonly indicated in these patients. In patients
with Type-IV disease, mild deformities of the femoral head and occasional
limb-length discrepancies developed; other sequelae were uncommon and
surgical intervention was rarely required.