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. 2013 Apr 18;4(2):32-41.
doi: 10.5312/wjo.v4.i2.32. Print 2013 Apr 18.

Developmental dysplasia of the hip in the newborn: A systematic review

Vivek Gulati  1 , Kelechi Eseonu, Junaid Sayani, Nizar Ismail, Chika Uzoigwe, Muhammed Zaki Choudhury, Pooja Gulati, Adeel Aqil, Saket Tibrewal
Affiliations

Developmental dysplasia of the hip in the newborn: A systematic review

Vivek Gulati et al. World J Orthop. .

Abstract

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index (DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeDamany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.

Keywords: Congenital; Developmental dysplasia of the hip; Pavlik harness; Pelvic osteotomy; Ultrasound screening.

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Figures

Figure 1
Figure 1
Diagram to demonstrate location of Shenton line. Shenton line is disrupted in developmental dysplasia of the hip[5].
Figure 2
Figure 2
The Pavlik harness[31].
Figure 3
Figure 3
Calculation of acetabular index[95].
See this image and copyright information in PMC

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