Developmental Dislocation of the Hip: A Clinical Overview

1995 ◽  
Vol 16 (8) ◽  
pp. 299-303
Author(s):  
James F. Mooney ◽  
John B. Emans
Keyword(s):  
Wide Spectrum ◽  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Clear Understanding ◽  
Congenital Dislocation ◽  
Initial Examination ◽  
Walking Age ◽  
Neurologically Normal ◽  
Dysplasia Of The Hip ◽  
Clinical Overview

Introduction The most common musculoskeletal evaluation in the neonatal period and infancy is assessing the child's hips. Treatment of hip dislocation is most successful when begun early, making it imperative that all children undergo repeated, careful hip examinations beginning in infancy until walking age. Those physicians entrusted with the initial examination should have a clear understanding of the etiology, prevalence, and presentation of developmental dysplasia of the hip as well as the appropriate physical examination for this entity. Historically, the term "congenital dislocation/dysplasia of the hip" (CDH) has been used. Reports illustrating cases of late diagnosis of hip abnormalities in patients who previously have had normal clinical and/or radiographic examinations as well as recognition of the wide spectrum of abnormalities from dislocation to dysplasia have led the orthopedic and pediatric communities to adopt the term developmental dislocation/dysplasia of the hip (DDH). This term now is preferred. Definitions and Categorization Hip dislocation can be categorized as "typical" or "teratologic." Teratologic dislocations are uncommon and usually are associated with neuromuscular abnormality, arthrogryposis, or myelomeningocele and typically are high, fixed dislocations. In contrast, "typical" DDH occurs in neurologically normal infants and encompasses a wide spectrum of deformity and presentation. It is important to recognize that previously stable hips may become unstable during infancy, and repeated examinations are needed until the child is of walking 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 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 Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence

2019 ◽  
Vol 4 (10) ◽  
pp. 595-601
Author(s):  
Ioannis Gkiatas ◽  
Anastasia Boptsi ◽  
Dimitra Tserga ◽  
Ioannis Gelalis ◽  
Dimitrios Kosmas ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Hip Dislocation ◽  
Hip Osteoarthritis ◽  
Developmental Dysplasia ◽  
Genetic Components ◽  
Pubmed Database ◽  
Literature Evidence ◽  
Secondary Deformity ◽  
Genetic And Environmental Factors ◽  
Dysplasia Of The Hip

Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and is characterized by mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur and irreducible hip dislocation. It is the leading cause of early hip osteoarthritis in young individuals. Both genetic and environmental factors have been proposed to play an important role in the pathogenesis of DDH. A high prevalence is present in Asian, Caucasian, Mediterranean and American populations, with females being more frequently affected. We evaluated a variety of genetic studies indexed in the PubMed database. Several susceptive genes, including WISP3, PAPPA2, HOXB9, HOXD9, GDF5, TGF Beta 1, CX3CR1, UQCC, COL1A1, TbX4 and ASPN have been identified as being associated with the development of DDH. Moreover, genetic association has also been reported between hip dysplasia and other comorbidities. Even though genetic components are a crucial part in the aetiology of DDH, several DDH susceptibility genes need further investigation. The purpose of this review is to present current literature evidence regarding genes responsible for DDH development. Cite this article: EFORT Open Rev 2019;4:595-601. DOI: 10.1302/2058-5241.4.190006

Developmental Hip Dysplasia

2019 ◽  
pp. 297-300
Author(s):  
Dorothy L. Gilbertson-Dahdal
Keyword(s):  
Risk Factors ◽  
Problem Solving ◽  
Imaging Modality ◽  
Treatment Options ◽  
Hip Dislocation ◽  
Clinical Findings ◽  
Developmental Dysplasia ◽  
Developmental Hip Dysplasia ◽  
Hormonal Factors ◽  
Dysplasia Of The Hip

Chapter 112 focuses on developmental dysplasia of the hip, which includes a spectrum of abnormalities ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Pathophysiology, clinical findings, and screening studies are explored. The pathophysiology is multifactorial including mechanical, genetic and hormonal factors. Imaging strategies, findings, and treatment options are also discussed. Screening US, which is the imaging modality of choice, is performed on infants with predisposing risk factors. Outcome is quite variable with many cases resolving spontaneously without treatment whereas others stabilize with acetabular dysplasia. Treatment options include immobilization and surgery. MRI is used for problem solving in postoperative patients.

Physical examination

2006 ◽  
pp. 142-163
Author(s):  
David M. B. Hall ◽  
David Elliman
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Physical Examination ◽  
Developmental Dysplasia ◽  
Congenital Dislocation ◽  
Undescended Testes ◽  
Dysplasia Of The Hip ◽  
Dislocation Of The Hip

Chapter 7 covers the neonatal and 6–8 week examinations, the school entrant examination, and screening by physical examination for developmental dysplasia of the hip (DDH) (previously known as congenital dislocation of the hip), heart disease including hypertrophic cardiomyopathy (HCM), hypertension, asthma, and undescended testes and other genital abnormalities.

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

scholarly journals Developmental Dysplasia of Hip: Perspectives in Genetic Screening

2019 ◽  
Vol 7 (4) ◽  
pp. 59 ◽  
Author(s):  
Zamborsky ◽  
Kokavec ◽  
Harsanyi ◽  
Attia ◽  
Danisovic
Keyword(s):  
Psychological Health ◽  
Screening Program ◽  
Wide Spectrum ◽  
Association Studies ◽  
Modern Medicine ◽  
Developmental Dysplasia ◽  
Developmental Dysplasia Of Hip ◽  
Lack Of Information ◽  
Genome Wide ◽  
Dysplasia Of The Hip

Development dysplasia of the hip (DDH) is a complex developmental disorder despite being a relatively common condition mainly caused by incompatibility of the femoral head and the abnormal joint socket. Development dysplasia of the hip describes a wide spectrum of disorders ranging from minor acetabular dysplasia to irreducible dislocation of the hip. Modern medicine still suffers from lack of information about screening and precise genetic examination. Genome wide linkage and association studies have brought significant progress to DDH diagnosis. Association studies managed to identify many candidate (susceptible) genes, such as PAPPA2, COL2A1, HOXD9, GDF-5, and TGFB1, which play a considerable role in the pathogenesis of DDH. Early detection of DDH has a big chance to help in preventing further disability and improve the psychological health and quality of life in those children. This emphasizes the importance to establish a universal screening program along with the genetic counseling.

scholarly journals Total Hip Arthroplasty after Treatment of Pseudojoint Infection in a Patient with a Highly Dislocated Hip

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Kyung-Soon Park ◽  
Jong-Keun Seon ◽  
Seon-Yoon Nah ◽  
Taek-Rim Yoon
Keyword(s):  
Total Hip Arthroplasty ◽  
Infection Control ◽  
Hip Arthroplasty ◽  
English Literature ◽  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Hip Pain ◽  
Total Hip ◽  
Thorough Debridement ◽  
Dysplasia Of The Hip

Infection at the pseudoacetabulum in a patient with a high hip dislocation has not been reported previously in the English literature. We report a case of total hip arthroplasty in a 28-year-old female who presented to us with hip pain following debridement of the infected pseudojoint in a case of neglected developmental dysplasia of the hip. The infection was treated with thorough debridement and drainage. However, even after achieving complete infection control, this patient complained of disabling right hip joint pain. Total hip arthroplasty with subtrochanteric osteotomy was performed to relieve the pain and improve gait. After surgery, the patient's symptoms were relieved. We consider that in this case of acute pseudojoint infection simple arthrotomy and debridement combined with irrigation and drainage provide effective treatment. But muscle weakness and more increased joint laxity can cause hip pain even after infection control. So total hip arthroplasty is likely to be necessary after the infection has been controlled in a patient with a highly dislocated hip.

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