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Safe Use of Arthroscopy in Children with Hip Dysplasia

This is the first report on the use of hip arthroscopy to diagnose and then treat hip dysplasia in children. In the past, hip arthroscopy was difficult to do and its use was very limited in children. Newer methods and better equipment have changed the picture.

Three young children with hip dysplasia were included in the study. All had failed conservative care with a Pavlik harness. The Pavlik harness is a soft brace that holds the child's hip in a flexed and abducted position (out to the side away from the body).

Closed reduction surgery also failed. In this operation, while under the relaxing effects of anesthesia, the dislocated hip is put back into its correct position. But the hips did not stay in the socket and dislocated again.

With arthroscopic surgery, while the arthroscope was in place, traction was applied manually to the leg. The amount of force needed to reduce the hip was minimal with this technique. The children were put in a spica (hip to foot) cast to hold the hip in place.

The surgeries were done on an outpatient basis. After the cast was removed, the hips were stable and no further dislocations occurred. The authors conclude that arthroscopy can be used in children to treat hip dysplasia and to avoid a more invasive operation.

More studies are needed before this method can be recommended for all children with hip dysplasia. Short-term complications and long-term problems need to be assessed. The risk of avascular necrosis (loss of blood supply to the hip) and the need for further surgeries must be determined.

References: James J. McCarthy, MD and G. Dean MacEwen, MD: Hip Arthroscopy for the Treatment of Children with Hip Dysplasia: A Preliminary Report. In Orthopedics. April 2007. Vol. 30. No. 4. Pp. 262-264.

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