Congenital dislocation of the Hip: Medial Approach Open Reduction hip (MAOR)
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Medial approach open reduction (MAOR) was first described by Ludloff in 1908. Several variations have been described. This technique is a modification of the original with tenodesis of the ligament teres as described by Torode (JPO 2008). This operation is typically utilised for patients presenting between 6 and 18 months of age.
The indication for MAOR is the dislocated hip that is either irreducible or unstable on attempted closed reduction. The procedure has been utilised from the age of 3 months up to 2 years but typically is used from 6 to 18 months.
Anterior open reduction(AOR) is widely practiced as an alternative to MAOR. AOR has the advantage that reefing of the capsule can be performed to increase stability. In addition AOR can be combined with pelvic osteotomy. Therefore this is the preferred approach for children presenting after 18 months where residual acetabular dysplasia is unlikely to resolve.
MAOR has the advantage that it can be performed through a small incision and it is ideally suited to bilateral cases. The wounds heal with an excellent cosmetic result.
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Author: Mr Christopher Edward Bache (FRCS Tr & Orth)
Institution: The Birmingham Childrens' Hospital, Birmingham, UK.
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