Post-Operative Management After Open Reduction of Hip Dysplasia

Immediate Post-Operative Care and Immobilization

Parents should receive written instructions on cast care and positioning, as the American Academy of Orthopaedic Surgeons recommends, to ensure proper healing and minimize complications 1, 2

The American College of Radiology recommends that radiographs should be obtained at each follow-up visit to assess concentric reduction and detect avascular necrosis (AVN) of the femoral head, with the first follow-up typically occurring within 2-4 weeks post-operatively 3
Ultrasound is not the preferred modality after open reduction in older infants, as radiographs provide better assessment of bony acetabular development and femoral head position, according to the Journal of the American College of Radiology 4, 5
Radiographic surveillance should be continued at regular intervals, typically every 3-6 months initially, then annually, to monitor acetabular development and detect late complications, as recommended by the American Academy of Orthopaedic Surgeons 6

Normal walking age is 12-15 months, but children after open reduction typically walk much later, with expected walking age depending on the age at surgery and duration of immobilization, according to the American Academy of Orthopaedic Surgeons 3

The American Academy of Orthopaedic Surgeons recommends that no formal physical therapy is indicated during the immediate post-operative period, but may have a role later, with written home exercise instructions typically sufficient after cast removal 1, 2
Physical therapy may be considered if significant muscle weakness or gait abnormalities persist beyond the expected recovery period, but this is not routinely prescribed, as stated by the American Academy of Orthopaedic Surgeons 1, 2

The American Academy of Orthopaedic Surgeons recommends that follow-up radiographs should be obtained at age 1 and 4 years to assess acetabular development, and clinical hip examinations should be continued at all well-child visits through age 5 6

Untreated or inadequately treated developmental dysplasia of the hip (DDH) leads to early degenerative joint disease, with DDH causing up to one-third of total hip arthroplasties in patients under 60 years, according to the American Academy of Orthopaedic Surgeons 6