After the age of 18 months almost all dislocated hips will require surgery to relocate the femoral head into the socket. In addition most hips will have a shallow socket that is unlikely to spontaneously improve even if the hip is relocated. Although this shallow (dysplastic) socket will not cause symptoms in childhood it is likely to lead to arthritis in adult life. The degree of shallowness can be measured on an X ray. If a dislocated hip is found to have an excessively shallow socket, after the age of 18 months Mr Bache prefers to correct both problems at the same time.
The hip joint can be operated on from several directions. After the age of 18 months the hip is usually approached from the front. This is called an anterior approach. The incision is along the iliac crest. This bone is what people often refer to as the hip bone although in reality the hip joint is below this and what we are feeling is the pelvis (iliac bone). The incision is often called ‘bikini line’ since underwear will cover the scar. Tight tendons and the joint capsule are opened as for MAOR. The incision is larger than that used for MAOR but it does have the advantage that the pelvic bone can be accessed at the same time so that the shallow hip socket can be corrected (see below). After surgery a hip spica will be required for 6-10 weeks.