Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

Abstract

Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. It may result in structural modifications, which may lead to early coxarthrosis. Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. Neonatal screening, along with physical examination and ultrasound, is critical for the early diagnosis of DDH to prevent the occurrence of early coxarthrosis. This review summarizes the currently practised strategies for the detection and treatment of DDH, focusing particularly on current practices for managing residual acetabular dysplasia (AD). AD may persist even after a successful hip reduction. Pelvic osteotomy is required in cases of persistent AD. It could also be undertaken simultaneously with an open hip reduction. Evaluation of the residual dysplasia (RD) of the hip and its management is still a highly active area of discussion. Recent research has opened the door to discussion on this issue and suggested treatment options for AD. But there is still room for more research to assist in managing AD.

Keywords: congenital dislocation of the hip; developmental dysplasia of the hip; hip dysplasia review; hip subluxation; osteotomy.

Figure 1. Tests for hip instability or dislocation in the newborn infant: (A) Ortolani's test; (B) Barlow's provocative test

Figure 2. Reference lines and angles used to evaluate in DDH

Figure 3. Two different measuring reference points. Novais et al. used the lateral edge of the weight-bearing sourcil (point A), while Tonnis used the lateral bony edge (point B). H indicates Hilgenreiner's line.

Figure 4. Treatment algorithm for DDH according to age

DDH: Developmental dysplasia of the hip

Figure 5. Treatment algorithm for residual AD

AD: Acetabular dysplasia

Figure 6. Redirection osteotomies

(a) Salter’s osteotomy; (b) TIO; (c) periacetabular osteotomy; (d) evolution of the TIO, modification of ischial cuts, southerland (green dotted line); Carlioz (orange lines in pubic and ischial bones ); Steel’s (blue line); and Tonnis TIO (black lines) Bernes TIO (red line) TIO: Triple innominate osteotomy

Figure 7. Reshaping osteotomies

(a) Pemberton; (b) Dega; (c) San Diego osteotomies as viewed from the outer surfaces of the ilium

Figure 8. Schematic illustration

(a) a dysplastic acetabulum with deficient superior coverage; (b) the Chiari osteotomy; (c) shelf acetabuloplasty both improves superior coverage