Dysplasia, malformation, or deformity? - explanation of the basis of hip development disorders and suggestions for  future diagnostics and treatment

Abstract

This publication focuses on processes which disrupt proper development of the hip. Four pathomechanisms underlying human developmental defects are described in literature, i.e. dysplasia, malformation, disruption, and deformity. In the case of hip development, arguably the greatest challenge involves confusion between dysplasia and deformity, which often leads to misdiagnosis, incorrect nomenclature, and incorrectly chosen treatment. The paper presents a description of hip joint development disorders in the context of their pathomechanisms. An attempt was made to answer the question whether these disorders are rooted in a primary disorder of tissue growth, resulting in its incorrect anatomy, or are the result of anatomical deformation with secondary modifications in tissue structures of a degenerative or adaptive nature, based on Deplesch-Heuter-Volkmann growth and remodeling laws. In addition, emphasis is placed on attention to the presence of the so-called clinically and diagnostically mute cases. The need to augment diagnostic procedures with genetic tests in order to increase the sensitivity of screening has also been suggested. Based on the arguments presented in the paper, a new division of developmental hip disorders has been proposed.