Congenital dislocation of the hip joint—Problems in diagnosis and treatment

Abstract

The most significant advance in congenital dislocation of the hip joint (CDH) was the introduction of early diagnosis and treatment as proposed by Ortolani,’ and Palm&n” and von Rosen3 in their pioneer studies published between 1937 and 1961. As long ago as in 1879, Roser4 had stated : ‘Early treatment of hip joint dislocation is the main prerequisite of successful correction. I believe that many of these cases could be restored to normal if the condition were diagnosed neonatally and immediately treated with abduction braces’. Not until 33 years later was the first report on systematic clinical examination of newborn infants with hip instability presented by Le Damany. When using a new clinical test, which he described in detail, for assessment of whether the hip joints in new-born infants were displaceable-‘hanches subluxables’he found 20 babies with unstable hips among 1722 newborn infants (12 cases per 1000 live births). At the beginning of this century there was still, however, controversy over what age treatment was to be commenced. Lorenz6 of Vienna, to whom we are indebted for pointing out that maintenance of reduction is as essential as reduction when treating dislocated hips in children, stated that treatment by closed reduction should not normally be undertaken before the 2nd year of life. He believed that the displacement developed gradually during the 1 st year of life and that not until the 2nd year of life was diagnosis usually reliable. Severin’ in 1941 believed, however, that diagnosis could be established before the 2nd year of life and in his extensive reexamination of 306 cases of CDH treated by closed reduction at the age of 1 year or later he concluded that the best way to