Severin, J Bone Joint Surg Am 1950 - Congenital Dislocation of the Hip: Development of the Joint after Closed Reduction

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Congenital Dislocation of the Hip: Development of the Joint after Closed Reduction

Severin·J Bone Joint Surg Am·1950·14 citations·Case series

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A 1950 Swedish case series of 115 children with congenital hip dislocation, all treated by closed reduction between 1937 and 1940. All patients underwent arthrographic monitoring; 72 hips had clinical and radiographic follow-up of 5 years or more. The study asks whether closed reduction achieves durable joint development and whether arthrographic soft-tissue interposition predicts failure.

Key Findings

Two-thirds of hips (Groups I–III) had the femoral head correctly seated in the acetabulum at ≥5-year follow-up — directly refuting Leveuf's claim that closed reduction could never adequately treat true congenital dislocation.
Severin radiographic classification at ≥5-year follow-up (n = 72 hips):
- Group I: Well-developed joint: 33%
- Group II: Moderate deformity, otherwise well-developed: 10%
- Group III: Dysplasia without subluxation: 19.5%
- Group IV: Subluxation: 37.5% (most common poor outcome)
- Group V: Secondary acetabulum articulation: 0%
- Group VI: Redislocation: 0%
Soft-tissue interposition (contrast pool on arthrogram) was present in two-thirds of hips immediately after reduction, yet had no effect on final outcome. Good results occurred just as often with interposition as without. Interposition alone is not an indication for open reduction.
Serial arthrograms showed soft-tissue barriers resolve over weeks to months when the head is held reduced. The head squeezes into the socket within 1–2 weeks; the limbus assumes normal position within a few months.
Functional results exceeded anatomical ones: ~90% of patients had no complaints at follow-up, even with radiographic abnormalities present.

Board PearlSeverin graded hips ≥5 years after closed reduction into six radiographic groups (I well developed to VI redislocation); soft tissue interposed after closed reduction does not in itself indicate open reduction.

Congenital Dislocation of the Hip: Development of the Joint after Closed Reduction

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Congenital Dislocation of the Hip: Development of the Joint after Closed Reduction

Severin·J Bone Joint Surg Am·1950·14 citations·Case series

|

A 1950 Swedish case series of 115 children with congenital hip dislocation, all treated by closed reduction between 1937 and 1940. All patients underwent arthrographic monitoring; 72 hips had clinical and radiographic follow-up of 5 years or more. The study asks whether closed reduction achieves durable joint development and whether arthrographic soft-tissue interposition predicts failure.

Key Findings

Two-thirds of hips (Groups I–III) had the femoral head correctly seated in the acetabulum at ≥5-year follow-up — directly refuting Leveuf's claim that closed reduction could never adequately treat true congenital dislocation.
Severin radiographic classification at ≥5-year follow-up (n = 72 hips):
- Group I: Well-developed joint: 33%
- Group II: Moderate deformity, otherwise well-developed: 10%
- Group III: Dysplasia without subluxation: 19.5%
- Group IV: Subluxation: 37.5% (most common poor outcome)
- Group V: Secondary acetabulum articulation: 0%
- Group VI: Redislocation: 0%
Soft-tissue interposition (contrast pool on arthrogram) was present in two-thirds of hips immediately after reduction, yet had no effect on final outcome. Good results occurred just as often with interposition as without. Interposition alone is not an indication for open reduction.
Serial arthrograms showed soft-tissue barriers resolve over weeks to months when the head is held reduced. The head squeezes into the socket within 1–2 weeks; the limbus assumes normal position within a few months.
Functional results exceeded anatomical ones: ~90% of patients had no complaints at follow-up, even with radiographic abnormalities present.

Board PearlSeverin graded hips ≥5 years after closed reduction into six radiographic groups (I well developed to VI redislocation); soft tissue interposed after closed reduction does not in itself indicate open reduction.

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