Developmental Dysplasia of the Hip

Excerpt

Developmental dysplasia of the hip occurs due to an abnormal hip development, presenting in infancy or early childhood with a spectrum ranging from dysplasia to dislocation of the hip joint. Developmental dysplasia of the hip encompasses several hip abnormalities, including instability, acetabular dysplasia, subluxation, and dislocation. These issues often occur in children with no other comorbid or underlying conditions. Previously referred to as "congenital dislocation of the hip," the term developmental is preferred since not all are present or are identified at birth.

Presentation varies from minor hip instability to frank dislocation. The exact etiology is still elusive. Multifactorial in nature, a combination of genetic, environmental, and mechanical factors play a role. Many genetic loci have also been identified in familial cases.

Though some types of developmental dysplasia of the hip resolve spontaneously, other cases require early intervention to avoid complications in adulthood. However, clinicians must be able to identify the type of hip disorder present as this determines the management indicated and the expected prognosis.

Diagnosing developmental dysplasia of the hip consists of clinical screening and imaging studies. Clinical screening is generally done in newborns and children with risk factors for hip abnormalities. Clinical examination includes the Ortolani test, the Barlow maneuver, and noting limited hip abduction, asymmetric gluteus folds, or limb-length inequality, which suggest developmental hip dysplasia.

Abnormal findings on clinical screening should be further evaluated with x-ray or ultrasound imaging, depending on the patient's age. Early diagnosis and management will prevent long-term complications like persistent dislocation and early hip osteoarthritis.

Based on the severity of the hip abnormality and the patient's age, management of developmental hip dysplasia consists of conservative treatments (eg, activity modification, physical therapy, and splinting) or surgical interventions. No definitive evidence demonstrates that one surgical approach is more effective than the others; therefore, the management is selected according to the surgeon's preferences and the overall clinical picture.