Dysplacia

Orthopedic Reviews 2010; volume 2:e19

Developmental dysplasia of the hip
Shahryar Noordin, Masood Umer, Kamran Hafeez, Haq Nawaz Section of Orthopedics, Dept. of Surgery, Aga Khan University, Karachi, Pakistan

Abstract
Developmental dysplasia of the hip (DDH) is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with theacetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants havelimited hip abduction on examination, and older children and adolescents present with limping, joint pain, and/or osteoarthritis. Repeated, careful examination of all infants from birth and throughout the first year of life until the child begins walking is important to prevent late cases. Provocative testing includes the Barlow and Ortolani maneuvers. Other signs, such as shorting of the femur withhips and knees flexed (Galeazzi sign), asymmetry of the thigh or gluteal folds, and discrepancy of leg lengths are potential clues. Treatment depends on age at presentation and outcomes are much better when the child is treated early, particularly during the first six months of life.

and the femoral head is able to move within or outside the confines of the acetabulum.2 Subluxation of hip refersto incomplete contact between the articular surfaces of the femoral head and acetabulum. A dislocated hip has no contact between the femoral head and acetabulum. A teratologic dislocation of the hip (TDH) shows very marked and advanced changes in the hip joint at the time of birth and is in a fixed dislocated position. There is an association with other severe malformations, such as spina bifida,arthrogryposis multiplex congenita, lumbosacral agenesis, chromosomal abnormalities, diastrophic dwarfism, Larsen syndrome and other rare syndromes.3

Correspondence: Dr. Masood Umer, Department of Surgery, Aga Khan University, Karachi 74800, Pakistan. E-mail: masood.umer@aku.edu Key words: developmental dysplasia of the hip. Contributions: all authors made substantial contributions to themanuscript. Conflicts of interest: the authors report no conflict of interest. Received for publication: 1 April 2010. Revision received: 31 August 2010. Accepted for publication: 1 September 2010. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0). ©Copyright S. Noordin et al., 2010 Licensee PAGEPress, Italy Orthopedic Reviews 2010; 2:e19 doi:10.4081/or.2010.e19Epidemiology
The exact incidence of DDH is difficult to determine because of a discrepancy in definition of the condition, type of examination used and different levels of skills of clinicians. The incidence ranges from as low as 1 per 1,000 to as high as 34 per 1,000. Higher incidences are reported when ultrasonography is also used in addition to clinical examination.4 Risk factors include firstborn status, female sex, positive family history, breech presentation and oligohydramnios.5 Carter and Wilkinson reported an overall incidence of one per 1,000 live births, with one in 600 girls and one in 4,000 boys having the disorder.6 Other associated factors include ethnic background (e.g. native Americans who use swaddling that forces the hips into extension and adduction), torticollis andlower limb deformity.7

a permanent supine position of newborns which can reduce the risk of sudden infant death seems to increase the risk of DDH.

Natural history
A failed diagnosis of DDH may follow one of four clinical patterns: the hip may reduce spontaneously, it may sublux and maintain partial contact, it can develop frank dislocation, or it can develop dysplastic features whilst...