Unstable Hip in a Child with Down Syndrome

Abstract

Hip instability in Down syndrome (trisomy 21) is a spectrum of disease that presents with characteristic features at specific ages. Well-defined treatment options exist for each manifestation of hip instability. The final common pathway for the untreated unstable hip is painful degenerative hip disease with significant functional limitations. Traditionally, the results of treatment of hip instability were poor in this population; however, an improved understanding of the pathoanatomy and the development of contemporary algorithms for hip reconstruction have led to improved outcomes. Habitual dislocation of the hip presenting before age 8 years of age is treated with proximal femoral varus derotational osteotomy (VDRO). Older children who have developed secondary acetabular dysplasia are managed with an acetabular reorientation osteotomy with or without a femoral osteotomy. Individuals with evidence of degenerative arthritis, with or without fixed hip dislocation, are not suitable for hip preservation surgery but have been shown to be good candidates for total hip arthroplasty.