Revising Treatment Guidelines for Congenital Hip Dislocation: Evaluating the Efficacy of Open Reduction in Children Over 18 Months in Conflict-Affected and Low-Resource Settings

Abstract Background: Developmental dysplasia of the hip (DDH) remains a significant cause of childhood disability worldwide. While early diagnosis and closed reduction remain the gold standard in high-resource settings, children in conflict-affected and low-resource regions often present late, beyond the optimal treatment window. Current international guidelines provide limited evidence-based recommendations for the management of late-presenting DDH in such environments. Objective: To critically evaluate the role and efficacy of open reduction in children over 18 months with congenital hip dislocation, with particular focus on surgical feasibility, outcomes, and risks in low-resource and conflict-affected contexts. Methods: A narrative systematic analysis was conducted of published cohort studies, case series, and guideline statements between 2000–2024, supplemented by field reports from humanitarian organizations. Primary outcomes included hip stability, avascular necrosis (AVN), functional mobility, and complication rates. Contextual variables such as resource limitations, anesthesia safety, and rehabilitation capacity were integrated into the evaluation. Results: Open reduction in children >18 months achieved high rates of hip stability (75–92%) across multiple series, but with increased risk of AVN (15–25%). In resource-limited contexts, lack of postoperative physiotherapy and inconsistent access to anesthesia specialists amplified complication risks. Delayed diagnosis due to disrupted health systems in conflict zones led to a 3–5× higher incidence of neglected DDH. Modified protocols—such as staged traction before reduction, use of anterior approaches, and simplified postoperative immobilization—were reported to improve outcomes where imaging and physiotherapy services are scarce. Conclusion: Current treatment guidelines inadequately address late-presenting DDH in low-resource or conflict-affected settings. Open reduction remains a viable and often necessary intervention beyond 18 months, but outcomes are contingent upon adapting surgical and rehabilitative strategies to contextual limitations. A revision of guidelines to incorporate pragmatic, resource-sensitive protocols is urgently warranted.