Open reduction for developmental dysplasia of the hip (DDH) is an operation to place a dislocated hip back into the socket in a child when closed (non-operative) reduction has been unsuccessful or is not appropriate.
An incision is made over the front of the hip (anterior approach). Soft tissue obstructions preventing reduction are removed, including a tight psoas tendon and thickened ligamentum teres. The femoral head is placed back into the acetabulum. A hip spica cast (a body cast from the chest to the knees) is applied to hold the hip in place while it stabilises. The operation takes one to two hours.
Open reduction is needed when DDH is diagnosed late (after six months), when closed reduction under anaesthesia has failed, or when the hip cannot be maintained in a reduced position.
Pavlik harness (for infants under six months), closed reduction under anaesthesia, and hip spica casting. These are tried first when age-appropriate.
MRI or arthrogram to assess the hip. The child needs to be fit for a general anaesthetic and prepared for six to twelve weeks in a hip spica cast.
Successful relocation of the hip, allowing normal hip development. Earlier treatment gives better outcomes. Most children go on to have a well-functioning hip, though long-term monitoring is essential.
Skin irritation, cast breakage, and difficulty with hygiene and care.
Temporary hip stiffness after cast removal.
Loss of blood supply to the femoral head, potentially causing growth disturbance. Risk approximately 5-10%.
The hip may dislocate again, requiring further surgery.
The socket may remain shallow, requiring later osteotomy.
Wound infection.
Damage to the growth plate affecting leg length.
General anaesthesia. Care with positioning in the hip spica.
Hip spica cast for six to twelve weeks. Cast changes may be needed. After cast removal, the child gradually returns to normal activity. Physiotherapy is rarely needed — children adapt quickly. Long-term X-ray monitoring until skeletal maturity to watch for dysplasia or AVN.
Regular X-rays and clinical reviews throughout childhood to monitor hip development.
Typically six to twelve weeks. The cast holds the hip in the correct position while the soft tissues tighten around it.
Most children treated successfully walk normally. Earlier treatment gives better outcomes.
Some children need further procedures (such as pelvic or femoral osteotomy) if the socket remains shallow as they grow.