We are adopting a child from another country who has some hip problems. She started out with a hip infection that wasn’t treated. Then the hip dislocated. They said because she was “too old” (three years old) at the time, they couldn’t do surgery. We will definitely have her checked by our pediatrician and an orthopedic surgeon. What should we expect?

Infection of the hip joint that is undiagnosed and therefore untreated can lead to a condition known as septic arthritis. In young children, dislocation of the septic hip can be a challenge.

According to a recent update on the management of septic hip dislocations from India, your adoptive daughter’s care falls well within the recommended protocols for treatment. Here’s a summary of the information provided.

Before a treatment plan can be determined, the surgeon must know for sure whether the child’s hip is truly dislocated or just not fully formed yet with an intact capital femoral epiphysis (area of growth at the top of the femur or thigh bone) still in place. Usually X-rays are not enough to make this determination so MRI, ultrasound, and/or arthrogram are required.

Treatment can range from no reconstructive surgery called closed reduction with full (spica) cast immobilization to open reduction (open incision and relocating or putting the hip back in place). The goals of stabilizing the hip versus restoring normal anatomy depend on knowing whether the capital femoral epiphysis is present or the hip is dislocated.

Treatment decisions are also influenced by the age of the child. For example, children under the age of two may be successfully treated with closed reduction. Open reduction is recommended for children older than that.

Treatment may include preoperative traction to pull the dislocated hip down to the level of the acetabulum (hip socket). Some surgeons prefer to shorten (or lengthen) the femur to accomplish this same alignment. Soft tissue structures may be needed such as lengthening of the psoas (hip flexor) muscle or tendon.

Sometimes the surgeon must do a bony osteotomy (remove a wedge-shaped piece of bone from the femur) to correct a problem with the angle of the hip. A shelf procedure may be needed to extend the bone and form a cover around the femoral head. This keeps it from migrating upward and dislocating again.

Relocation of the hip is not always the best idea. It can result in chronic hip stiffness, leg shortening, and a definite lurch in the gait (walking) pattern. Patients with oddly shaped femoral heads and poor (thin) articular cartilage from the infection often end up with degenerative arthritis and chronic pain even with hip relocation.

Patients should be selected carefully for open reduction and surgical restoration of the hip. A nice, round femoral head of good size is important. Healthy cartilage is a good prognostic factor (meaning surgical treatment is more likely to yield good results). Children older than six years old are not likely to benefit from open reduction. And finally, the patient who does NOT have stiffness before surgery has a better chance of good recovery and positive outcomes.

At age three, your child is at the upper end of ages that can be treated conservatively but she may qualify for surgical reconstruction. You won’t really know what course will be advised until she is evaluated. But this information may give you a picture of the possibilities and expected outcomes.