Dysplasia of the hip in adolescent patients successfully treated for developmental dysplasia of the hip

Abstract

Background: The purpose of this study was to analyze whether hips treated for developmental dysplasia of the hip (DDH) during infancy, which were clinically and radiologically fully normalized by walking age, may become dysplastic again during later growth.

Materials and methods: A total of 150 patients were randomly selected out of a collective of 386 patients treated for DDH at the Department of Orthopaedics at the University of Zurich between 1993 and 2004. Treatment was started at birth and continued for 6 months. All patients had clinically and radiographically normal hips by walking age. The patients did not suffer from other diseases, in particular, neurological or neuromuscular diseases.

Results: We detected four female subjects among the 150 patients who had been successfully treated for DDH, who had developed dysplastic hips in early adolescence, necessitating acetabular surgery.

Conclusion: The successful treatment of DDH in infancy does not ensure normal hip development; therefore, follow up into maturity may be recommended.

Level of evidence: Level IV.

Keywords: Congenital dysplasia of the hip; Developmental dysplasia of the hip; Pavlik harness.

Fig. 1

a This girl showed a good reduction with symmetrical centred hips at the age of 4 years. b At the age of eight on the x-ray symmetrical centred hips could be confirmed. c At the age of 14 she complaint about pain during exercise and in the x-rays a dysplasia of the right hip could be confirmed, with a CE angle of 25°. On the left side a minor dysplasia could be observed. d When she turned 15, a bernese pelvis osteotomy was performed, the left hip is currently still asymptomatic

Fig. 2

a In this patient at the age of 4 years normal appearing hips could be observed by x-ray. b Also at the age of 8 years the x-ray showed normal hips. c At the age of 13 radiologically an acetabular dysplasia could be confirmed at the right side while a borderline dysplasia on the left side, with a CE angle of 21°. d At the age of 14 also in this patient a bernese pelvic osteotomy was performed

Fig. 3

a The third girl showed a normal x-ray when she was 14 months old with symmetrical hips. b At the age of 10 years she did not complain about any hip problems, and the x-ray of her hips was interpreted as being normal. c At the age of 12 radiologically an acetabular retrovsion could be observed, causing painful impingement symptoms. The CE angle was measured with 15°. Due to the fact that bone growth arrest was not reached until now, we plan to perfom acetabular surgery next year

Fig. 4

a The x-ray at 18 months of age was normal. b She was seen again for a consultation when she was 6 years old, without hip disturbances; pelvic x-ray was normal. c At the age of 12 she developed a hip dysplasia on the right side. The CE angle is 5° (four standard deviation below the mean normal value) but there is significant retroversion of the acetabulum with positive cross over sign. She is scheduled for a triple pelvic osteotomy