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Advancing Surgical Care for Pediatric Hip Dysplasia

Advancing Surgical Care for Pediatric Hip Dysplasia 1024 575 Pam Georgiana

A novel technique demonstrates safety, stability and reduced casting needs.

For children with developmental dysplasia of the hip, open reduction surgery reliably restores the hip to the socket. However, recurrent instability, iatrogenic complications, residual dysplasia and prolonged casting can limit favorable outcomes. To improve these results, orthopedic surgeons at Nationwide Children’s Hospital have developed a new technique that incorporates ligamentum teres reconstruction into standard open reduction.

This novel approach uses a low-profile suture-button device to recreate the stabilizing function of the native ligament and provide immediate internal support once the hip is positioned correctly. The results of the first clinical series were recently published in The Journal of Pediatric Orthopaedics.

“We developed this procedure to provide the hip better stability without increasing iatrogenic risk,” says Kevin E. Klingele, MD, chief of orthopaedic surgery and director of the Center for Hip Preservation at Nationwide Children’s. “If we can stabilize the hip internally, we can reduce the chance of it slipping out again, avoid weeks of casting, and hopefully improve the hips remodeling capability.”

The prospective study evaluated 49 patients (61 hips) who underwent open reduction with ligamentum teres reconstruction between 2020 and 2024. A single surgeon performed all procedures. After excluding revision surgeries, procedures using nonstandard implants and patients without at least one year of follow-up, 33 patients (41 hips) remained for analysis. Eighteen patients (21 hips) had idiopathic dysplasia and 15 patients (20 hips) had neuromuscular or syndromic conditions.

During open reduction surgery, the surgeon threads a suture-button device through a tunnel in the proximal femur, anchoring it inside the pelvis and creating a new stabilizing structure that augments standard open reduction techniques. This additional stability removes the need for postoperative cast immobilization. Instead, patients are placed in custom braces postoperatively for 4-6 weeks. “If we can avoid casting without compromising stability, it is better for the child and the family,” Dr. Klingele says.

Dr. Klingele also notes that the team intentionally chose a device long used in sports medicine. “The idea was to utilize something strong, low profile and familiar to orthopedic surgeons,” he says. “We have studied and verified the surgical technique and hope to someday restore a normal ligamentum teres and therefore restore normal hip function and remodeling potential.”

Short-term outcomes are encouraging. Follow-up averaged 27.6 months for idiopathic cases and 21.9 months for nonidiopathic cases. In the idiopathic group, all hips were severely dysplastic (grade III or IV). Yet none lost reduction and no hardware failures occurred. Minor complications were observed in 5% of the cases. In the nonidiopathic group, only one hip (5%) lost reduction.

This publication marks the first formal introduction of the technique to the orthopedic community. Nationwide Children’s is currently the only hospital performing the procedure. Dr. Klingele’s team has already expanded its use to older children with neuromuscular conditions such as cerebral palsy, Down syndrome and muscular dystrophies to support longer-term hip stability. Potential future applications may include select hip trauma and sports medicine cases.

Dr. Klingele notes that the current device requires removal about one year postoperatively. Efforts are underway to develop a resorbable or biologic implant.

“These early results show that ligamentum teres reconstruction can safely augment open reduction and improve stability across a range of patients,” Dr. Klingele says. “We are encouraged by the outcomes and committed to refining this technique to help more children with challenging hip conditions have a better quality of life.”

 

Reference:

Englert G, Mansour A, Strub D, Badowski E, Tulchin-Francis K, Kadado A, Smith C, Klingele K. Open Reduction With Ligamentum Teres Reconstruction-Preliminary Results of a Novel Technique for the Management of Pediatric Developmental Dysplasia of Hip. Journal of Pediatric Orthopaedics. Published online July 23, 2025. doi:10.1097/BPO.0000000000003051

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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