Historical Aspects of DDH.

Abstract

Little was known about developmental dysplasia of the hip (DDH) in the early historical era. Symptoms such as limping were caused by a variety of disease processes, many of which were life threatening. It was not until the discovery of X-ray in 1896 that clear understanding of childhood hip conditions, including DDH, could evolve. We reviewed available literature and distilled it into this summary of the history of our understanding of DDH. The development of non-operative methods relied on plaster of Paris cast reductions and later splints and harness systems leading to the Pavlik harness (1950's). The development of ultrasound as a diagnostic technique made early diagnosis and treatment possible. Surgical approaches to DDH treatment required several key discoveries: invention of general anesthesia (1840s); development of sterilization techniques (1860-1880); discovery of X-ray (1890s); development of stainless steel (1920s); and the discovery of antibiotics (1930s). These surgical advances allowed the development of a remarkable variety of operations to treat DDH including open reduction techniques, and osteotomies of the acetabulum and proximal femur. The path to accurate diagnosis and predictable treatment of DDH parallels the many advances that application of the scientific method has allowed in the specialty of orthopedic surgery. The development of academic centers that focus on research and education in childhood hip disorders, as well as a growing number of centers that focus on hip problems in adolescents and young adults, assure a continuous and changing "history" of this common childhood hip condition.