The functional and radiographic results of closed reduction in 152
congenitally dislocated hips of 119 patients who had been managed between
1938 and 1969 were reviewed retrospectively. The average age of the
patients at the time of the reduction was twenty-one months (range, one to
ninety-six months). At the time of the latest follow-up evaluation, the
average age was thirty-one years (range, sixteen to fifty-six years). The
average duration of follow-up was thirty years (range, fifteen to
fifty-three years). At the latest follow-up evaluation, the Iowa hip rating
averaged 91 points (range, 38 to 100 points) and the Harris hip score
averaged 90 points (range, 33 to 100 points). Thirty-five hips were rated
Severin Class I; thirty-five, Class II; twenty-eight, Class III;
fifty-three, Class IV; and one, Class VI. Disturbance of growth in the
proximal end of the femur occurred in ninety-one hips (60 per cent). Eight
contralateral hips that had appeared normal also demonstrated disturbance
of proximal femoral growth. In many hips, partial physeal arrest could not
be determined for ten to twelve years after the reduction. Seventeen hips
(twelve patients) had a total replacement when the patients were an average
age of thirty-six years (range, nineteen to fifty-three years). Sixty-five
hips (43 per cent) had radiographic evidence of degenerative joint disease.
Patients who did not have a growth disturbance of the proximal end of the
femur or evidence of subluxation tended to function extremely well for many
years despite a radiographic result that was less than anatomical. Function
tended to deteriorate with time, even in the absence of disturbance of
growth in the proximal end of the femur. Despite generally good function at
the latest follow-up evaluation, the prognosis for these patients remained
guarded.