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Abstract
BackgroundThe natural history of hip instability (without subluxation or dislocation) and treatment in infants remain controversial. We performed a retrospective cohort case-only study with blinded, prospectively collected data to assess normalization of the acetabular index in consecutive untreated infant hips with sonography instability.MethodsConsecutive hips meeting inclusion criteria were followed by sonography/radiography and data analyzed using tabular and regression models.ResultsIn 48 hips, acetabular index measured by radiography normalized within 3 years of age without treatment. Normalization by age occurred: 7 months in 35%, 12 months in 67%, 18 months in 75%, 24 months in 81%, and 36 months in 100%. Two patterns of normalization of the acetabular index were observed: group I showed ossification in a physiological range of normal by 7 months of age, and group II had delayed ossification with later normalization of the acetabular index measurement. Breech presentation (p =0.013) and cesarean delivery (p =0.004) statistically directly correlated with a later normalization.ConclusionsThe natural history of infant hip instability (without subluxation or dislocation), which is reduced at rest and unstable with stress as diagnosed by the Harcke method of sonography, has spontaneous normalization of the acetabular index within 3 years of age. We suggest three patterns of acetabular ossification in unstable infants’ hips: (I) normal ossification, (II) delayed ossification with normalization of the acetabular index by age 3 years, and (III) defective secondary centers of ossification with an upward tilt of the lateral acetabular rim in adolescence.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-355) contains supplementary material, which is available to authorized users.
Highlights
IntroductionThe natural history of hip instability (without subluxation or dislocation) and treatment in infants remain controversial
The natural history of hip instability and treatment in infants remain controversial
The aim of our study was to observe a consecutive group of infants who met the criteria of hip instability with stress, whose hips are reduced at rest and which may or may not have acetabular dysplasia by sonography, to determine the natural history of hip instability without treatment
Summary
The natural history of hip instability (without subluxation or dislocation) and treatment in infants remain controversial. Sonography by the Harcke method evaluates the hip joint for soft tissue stability and bone and cartilage abnormality, which are reported as 1) position (being either reduced, subluxated, or dislocated), 2) stability (normal, lax, dislocatable, reducible, or not reducible), and 3) dysplasia (measured as percent of head coverage or acetabular bone inclination, as with the Graf α angle) [2,3,4,5]. The aim of our study was to observe a consecutive group of infants who met the criteria of hip instability with stress, whose hips are reduced at rest and which may or may not have acetabular dysplasia by sonography (measured as percent of head coverage or acetabular bone inclination as with the Graf α angle), to determine the natural history of hip instability without treatment. We hypothesize that the acetabular index (AI) in these hips will normalize
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