scholarly journals Developmental dysplasia of the hip: update of management

2019 ◽  
Vol 4 (9) ◽  
pp. 548-556 ◽  
Author(s):  
Alfonso Vaquero-Picado ◽  
Gaspar González-Morán ◽  
Enrique Gil Garay ◽  
Luis Moraleda
Keyword(s):  
Physical Examination ◽  
Open Reduction ◽  
Acetabular Dysplasia ◽  
Wide Spectrum ◽  
Positive Family History ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Spontaneous Correction ◽  
Hip Reduction ◽  
Dysplasia Of The Hip

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

Developmental Dysplasia of the Hip

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 201-208
Author(s):  
David D. Aronsson ◽  
Michael J. Goldberg ◽  
Thomas F. Kling ◽  
Dennis R. Roy
Keyword(s):  
Early Detection ◽  
Physical Examination ◽  
Wide Spectrum ◽  
Developmental Dysplasia ◽  
Health Examination ◽  
Screening Examination ◽  
Neonatal Hip ◽  
Associated Risk Factors ◽  
Dysplasia Of The Hip ◽  
Pelvis Radiograph

Objective. The definition and early treatment of congenital dysplasia of the hip are controversial. The purpose of this study was to discuss the reasons for changing the acronym to developmental dysplasia of the hip (DDH) and to address its early detection and treatment. Design. This multicenter study was designed to provide an updated assessment of the definition, pathologic anatomy, prevalence, etiology, natural history, early detection, and treatment of DDH. Results. DDH more accurately describes the condition previously termed congenital dysplasia of the hip. The disorder is not always present at birth (congenital) and an infant may have a normal neonatal hip screening examination and subsequently develop a dysplastic or dislocated hip. Developmental dysplasia encompasses the wide spectrum of hip problems seen in infants and children. Physicians should understand that a normal neonatal screening examination does not assure normal hip development. The diagnosis of developmental dysplasia is made by physical examination. The Ortolani and Barlow maneuvers were designed to detect a subluxatable, dislocatable, or dislocated hip in the neonatal period. In the older child, limited abduction becomes a more reliable sign. The examination is variable depending on the type of dysplasia and changes with growth. The ultrasound is proving to be a sensitive tool in confirming the diagnosis in newborns and infants from birth to 4 months of age. The ultrasound is also valuable in older infants in terms of documenting that the dysplasia is responding to treatment. However, the ultrasound depends on an experienced sonographer and, in some cases, may be too sensitive, resulting in overtreatment. After 3 to 4 months of age, an anteroposterior pelvis radiograph can confirm the diagnosis. Conclusions. All newborns should have a neonatal hip screening physical examination. After screening, the hips should be re-examined during health examination visits at 2 weeks, 2 months, 4 months, 6 months, 9 months, and 1 year of age. If any question arises during these visits or if there are associated risk factors, we recommend an ultrasound if the infant is <4 months of age or an anteroposterior pelvis radiograph if >4 months of age.

CONGENITAL HIP DYSPLASIA HIGHLIGHTS OF AVASCULAR NECROSIS INCIDENCE AFTER OPEN REDUCTION FOR DEVELOPMENTAL DYSPLASIA OF THE HIP IN NAJAF (IRAQ)

2020 ◽  
Vol 1 (8(77)) ◽  
pp. 4-6
Author(s):  
M. A. Al-juifari ◽  
E.S. Samoshkina ◽  
M.J. Alwash
Keyword(s):  
Family History ◽  
Avascular Necrosis ◽  
Open Reduction ◽  
Wide Spectrum ◽  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Normal Vaginal Delivery ◽  
Female Group ◽  
Cross Sectional ◽  
Dysplasia Of The Hip

Developmental dysplasia of the hip (DDH) is a one of the most common congenital abnormalities. It presents with the wide spectrum of anatomical features due to the mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur head and irreducible hip dislocation. It present with an estimated incidence ranging from 1.4 to 35.0 per 1000 newborns with higher prevalence in Asian, Mediterranean, Caucasian, and American populations with a sex-ratio of girls to boys as 4-10:1. The risk of complications after treatment is associated with the type of reduction and also depends of previous treatment and immobilization, degree of dislocation, patient’s age at surgery. This study is a cross-sectional study with DDH patients born between January 2018 and December 2019, in the city of Al Najaf, Iraq. Ethnicity, gender, fetal presentation, time of diagnosis, affected side of the hip, family history and avascular necrosis of the femoral head (AVN) complications were considered. Post-operative clinical and radiological evaluation was preformed depending on McKay’s criteria and Severin’s classification. A total of 49 DDH patients were identified with female:male ratio of 7,2:1. Among girls, the time of diagnosis was 2,68 ±1,14 years, in the group of boys this indicator was 3,4 ±1,02 years, р=0,231. In both gender group the bilateral process was most common (66,7% in male group and 58,9% in female group). In 30% patient the family history was positive. Normal vaginal delivery was in 69,4% cases (67,4 and 83,3% girls and boys). Breech presentation was observed exclusively in female group. In 14% cases a combination of DDH with other malformations was revealed, in most cases it was joint laxity, less common minor congenital malformations. In 30% patients the closed bilateral reduction was performed. 46 patients were undergoing open reduction. Complications of DDH were detected in 29% cases. Most common was avascular necrosis in varying degrees (35%), 14% patients had early osteoarthritis, 21% local infections. The post-operative clinical McKay’s criteria showed prevalence of excellent and good results. Findings of the post-operative radiographic assessment (Severins grade method) were excellent in 21 hips, good in 14 hips. Сonsequently, late diagnosis of DDH leads worth outcomes, requires surgical interventions and causes increasing frequency of complications.

scholarly journals Ultrasound of the neonatal hip as a screening tool for DDH: how to screen and differences in screening programs between European countries

2021 ◽  
Vol 21 (85) ◽  
pp. e147-e153
Author(s):  
Iris Kilsdonk ◽  
◽  
Melinda Witbreuk ◽  
Henk-Jan Van Der Woude ◽  
◽  
...  
Keyword(s):  
Imaging Modality ◽  
Positive Family History ◽  
Newborn Infants ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Ultrasound Technique ◽  
Screening Programs ◽  
Dynamic Ultrasound ◽  
The Uk ◽  
Dysplasia Of The Hip

Developmental dysplasia of the hip comprises a broad spectrum of abnormalities in hip development, of variable severity. Besides physical examination, ultrasound is the preferred imaging modality for screening for developmental dysplasia of the hip in children aged younger than six months. The Graf method is the most widely used ultrasound technique for infant hips; a stepwise approach will be shown in this article. Furthermore, the process of dynamic ultrasound imaging will be explained as well as the use of transinguinal ultrasound in infants wearing a spica cast. There is no consensus on the best way to screen for developmental dysplasia of the hip, which is probably the reason why different screening programs exist throughout Europe, as will be discussed in this article. The use of universal versus selective ultrasound remains a controversy, as does the timing. Is it better to perform sonography in all newborn infants like in Germany and Austria? Or should we examine only the infants with clinical hip instability or risk factors (breech position, positive family history), like in the UK and the Netherlands? This article reviews the epidemiology, static and dynamic ultrasound techniques in screening for developmental dysplasia of the hip, and differences in screening programs throughout Europe. Set aside the uncertainties about whom and when to screen, it needs to be emphasized that ultrasound screening for developmental dysplasia of the hip is important, since the disease is initially occult and easier to treat when identified early. In this way, the radiologist can aid in preventing serious disability of the hip.

scholarly journals CONGENITAL HIP DYSPLASIA HIGHLIGHTS OF AVASCULAR NECROSIS INCIDENCE AFTER OPEN REDUCTION FOR DEVELOPMENTAL DYSPLASIA OF THE HIP IN NAJAF (IRAQ)

2020 ◽  
Vol 5 (7(76)) ◽  
pp. 17-19
Author(s):  
M. A. Al-juifari ◽  
E.S. Samoshkina ◽  
M.J. Alwash
Keyword(s):  
Family History ◽  
Avascular Necrosis ◽  
Open Reduction ◽  
Wide Spectrum ◽  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Normal Vaginal Delivery ◽  
Female Group ◽  
Cross Sectional ◽  
Dysplasia Of The Hip

Developmental dysplasia of the hip (DDH) is a one of the most common congenital abnormalities. It presents with the wide spectrum of anatomical features due to the mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur head and irreducible hip dislocation. It present with an estimated incidence ranging from 1.4 to 35.0 per 1000 newborns with higher prevalence in Asian, Mediterranean, Caucasian, and American populations with a sex-ratio of girls to boys as 4-10:1. The risk of complications after treatment is associated with the type of reduction and also depends of previous treatment and immobilization, degree of dislocation, patient’s age at surgery. This study is a cross-sectional study with DDH patients born between January 2018 and December 2019, in the city of Al Najaf, Iraq. Ethnicity, gender, fetal presentation, time of diagnosis, affected side of the hip, family history and avascular necrosis of the femoral head (AVN) complications were considered. Post-operative clinical and radiological evaluation was preformed depending on McKay’s criteria and Severin’s classification. A total of 49 DDH patients were identified with female:male ratio of 7,2:1. Among girls, the time of diagnosis was 2,68 ±1,14 years, in the group of boys this indicator was 3,4 ±1,02 years, р=0,231. In both gender group the bilateral process was most common (66,7% in male group and 58,9% in female group). In 30% patient the family history was positive. Normal vaginal delivery was in 69,4% cases (67,4 and 83,3% girls and boys). Breech presentation was observed exclusively in female group. In 14% cases a combination of DDH with other malformations was revealed, in most cases it was joint laxity, less common minor congenital malformations. In 30% patients the closed bilateral reduction was performed. 46 patients were undergoing open reduction. Complications of DDH were detected in 29% cases. Most common was avascular necrosis in varying degrees (35%), 14% patients had early osteoarthritis, 21% local infections. The post-operative clinical McKay’s criteria showed prevalence of excellent and good results. Findings of the post-operative radiographic assessment (Severins grade method) were excellent in 21 hips, good in 14 hips. Сonsequently, late diagnosis of DDH leads worth outcomes, requires surgical interventions and causes increasing frequency of complications.

scholarly journals Closed reduction in late-detected developmental dysplasia of the hip: indications, results and complications

2018 ◽  
Vol 12 (4) ◽  
pp. 317-322 ◽  
Author(s):  
P. Wicart ◽  
R. Seringe ◽  
C. Glorion ◽  
A. Brassac ◽  
V. Rampal
Keyword(s):  
Avascular Necrosis ◽  
Closed Reduction ◽  
Acetabular Dysplasia ◽  
Treatment Options ◽  
Developmental Dysplasia ◽  
Review Of The Literature ◽  
Joint Congruency ◽  
Spontaneous Correction ◽  
Suitable Treatment ◽  
Dysplasia Of The Hip

PurposeThe aim of the study was a review of the literature in order to evaluate the results and complications of closed reduction in late-detected developmental dysplasia of the hip (DDH).MethodsThis study consisted of an analysis of the literature relative to late-detected DDH treatment options considering hip congruency, rates of re-dislocation and of avascular necrosis.ResultsGradual closed reduction (Petit-Morel method) appears to be an effective method concerning joint congruency restitution. Dislocation relapse and avascular necrosis are more efficiently prevented with closed versus open reduction. The tendency for spontaneous correction of acetabular dysplasia decreases if closed reduction is performed after 18 months of age. Patient age at the beginning of traction should be considered for the prognosis, with a lower rate of satisfactory results showing after the age of 3 years.ConclusionIn our opinion, the Petit-Morel method is a suitable treatment option for children aged between six months and three years with idiopathic DDH.

Results of universal ultrasound screening for developmental dysplasia of the hip

2018 ◽  
Vol 100-B (10) ◽  
pp. 1399-1404 ◽  
Author(s):  
R. Biedermann ◽  
J. Riccabona ◽  
J. M. Giesinger ◽  
A. Brunner ◽  
M. Liebensteiner ◽  
...  
Keyword(s):  
Open Reduction ◽  
Open Surgery ◽  
Developmental Dysplasia ◽  
Consecutive Series ◽  
Type I ◽  
Ultrasound Screening ◽  
Treatment Rate ◽  
Cumulative Rate ◽  
Graf Method ◽  
Dysplasia Of The Hip

Aims The purpose of this study was to analyze the incidence of the different ultrasound phenotypes of developmental dysplasia of the hip (DDH), and to determine their subsequent course. Patients and Methods A consecutive series of 28 092 neonates was screened and classified according to the Graf method as part of a nationwide surveillance programme, and then followed prospectively. Abnormal hips were followed until they became normal (Graf type I). Type IIb hips and higher grades were treated by abduction in a Tübinger orthosis until normal. Dislocated hips underwent closed or open reduction. Results Overall, 90.2% of hips were normal at birth. Type IIa hips (8.9%) became normal at a median of six weeks (interquartile range (IQR) 6 to 9). Type IIc and IId hips (0.67%) became normal after ten weeks (IQR 7 to 13). There were 19 type lll and eight type lV hips at baseline. There were 24 closed reductions and one open reduction. No late presentations of DDH were detected within the first five years of life. Conclusion The incidence of DDH was eight per 1000 live births. The treatment rate was 1% (n = 273). The rate of first operations on the newborn hip was 0.86, and rate of open surgery was 0.04. The cumulative rate of open surgery was 0.07. The authors take the view that early identification and treatment in abduction of all dysplastic hips in early childhood reduces the rate of open reduction and secondary DDH-related surgery later in life. Cite this article: Bone Joint J 2018;100-B:1399–1404.

scholarly journals Prediction of the requirement of open reduction for developmental dysplasia of the hip

2017 ◽  
Vol 46 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Nabil Alassaf
Keyword(s):  
Open Reduction ◽  
Area Under The Curve ◽  
Internal Validity ◽  
Developmental Dysplasia ◽  
Estimation Model ◽  
Cross Sectional ◽  
Noninvasive Treatment ◽  
Dysplasia Of The Hip ◽  
Logistic Regression Equation ◽  
Objective Tool

Objective Closed reduction (CR) is a noninvasive treatment for developmental dysplasia of the hip (DDH), and this treatment is confirmed intraoperatively. This study aimed to develop a preoperative estimation model of the probability of requiring open reduction (OR) for DDH. Methods The study design was cross-sectional by screening all patients younger than 2 years who had attempted CR between October 2012 and July 2016 by a single surgeon. Potential diagnostic determinants were sex, age, side, bilaterality, International Hip Dysplasia Institute (IHDI) grade, and acetabular index (AI). An intraoperative arthrogram was the reference standard. A logistic regression equation was built from a reduced model. Bootstrapping was performed for internal validity. Results A total of 164 hips in 104 patients who met the inclusion criteria were analysed. The prevalence of CR was 72.2%. Independent factors for OR were older age, higher IHDI grade, and lower AI. The probability of OR = 1/[1 + exp − (−2.753 + 0.112 × age (months) + 1.965 × IHDI grade III (0 or 1) + 3.515 × IHDI grade IV (0 or 1) − 0.058 × AI (degrees)]. The area under the curve was 0.79. Conclusion This equation is an objective tool that can be used to estimate the requirement for OR.

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