Developmental dysplasia of the hip in the newborn: A systematic review

Abstract

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index (DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeDamany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.

Developmental Dysplasia of Hip

“…1,2 Earlier detection of DDH leads to better prognosis with nonsurgical intervention. DDH represents a wide variety of pathologic conditions, ranging from fine acetabular dysplasia to irreducible hip dislocation with proximal femoral displacement.…”

Retracted: Joined at the hip? A paleoepidemiological study of developmental dysplasia of the hip and its relation to swaddling practices among indigenous peoples of North America

“…Misalignment can be the result of trauma or congenital abnormalities in the joint which increase the likelihood of further damage (Aufderheide and Rodriguez-Martin, 1997;Ortner, 2003). In the past, this condition was called congenital dysplasia/dislocation of the hip, referring to complete dislocation at birth, however a higher frequency of DDH cases begin with only a slight abnormality of the acetabulum and develop over the life of the individual into more severe forms, taking tissue growth and differentiation into consideration, hence the clinical appropriateness of the name change recognizing it as a developing pathology (Gulati et al, 2013;Harcke, 1999).…”

CORR Insights ® : Higher Pavlik Harness Treatment Failure Is Seen in Graf Type IV Ortolani-Positive Hips in Males

“…Previous systematic reviews [3,7] have looked at the factors that predict the outcome of Pavlik harness treatment. The existing data could be further explored to see if it is of sufficient quality to be able to stratify these risk factors.…”