Developmental dysplasia of the hip: What has changed in the last 20 years?

Abstract

Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.

Keywords: Children; Developmental dysplasia; Developmental dysplasia of the hip; Hip; Infant; Newborn.

Figure 1

Magnetic resonance imaging of a two-year-old girl with developmental dysplasia of the hip.

Figure 2

One-year-old girl with developmental dysplasia of the hip on the left side.

Figure 3

Hip reconstruction. A, B: Female patient, diagnosed with bilateral developmental dysplasia of the hip at the age of 2.5 years; C, D: On presentation left hip reconstruction, that included open reduction, Salter osteotomy and femoral derotational osteotomy with shortening, was performed. Post-operative X-rays after removal of the internal fixation devices are shown; E, F: Due to persistent mild hip dysplasia on the right side, a Salter osteotomy was performed at the age of 4 years.

Figure 4

Acetabuloplasty. A female patient was diagnosed with DDH of the left hip at the age of 6 mo using sonography. She was treated with a spica cast. AVN of the left femoral head was seen on follow-up radiographs at the age of 3 years (A,B); C, D: Acetabuloplasty of the left hip with femoral derotational osteotomy was performed at the age of 5 years; E, F: Follow-up X-rays at the age of 8 years. DDH: Developmental dysplasia of the hip; AVN: Avascular necrosis.

Figure 5

Female patient with developmental dysplasia of the hip that was diagnosed in early adolescence. A, B: X-rays at the time of diagnosis of DDH at the age of 13 years; C, D: X-rays taken two years after Ganz osteotomy on the left side. DDH: Developmental dysplasia of the hip.

Figure 6

Summary of the main changes in the field of developmental dysplasia of the hip during the last 20 years. MRI: Magnetic resonance imaging; DDH: Developmental dysplasia of the hip; CT: Computed tomography.