Variations in developmental dysplasia of the hip – current concepts

Abstract

Developmental dysplasia of the hip (DDH) is one of the most common congenital defects with an incidence of around 2 cases per 1000 births, affecting the development of the acetabulum and the femoral head. Etiopathogenesis remains unclear but certain risk factors have been associated with DDH including the female gender, postmaturity, primiparity, oligohydramnios and breech presentation. If left untreated, hip dysplasia is considered a main cause of early osteoarthritis. Reviewing the literature, the purpose of the current study is to present current evidence regarding the anatomical abnormalities of DDH during infancy, childhood and adulthood. Using the searching tools on the internet, a thorough search, evaluation and selection of recent published articles in reliable international electronic libraries was conducted regarding the anatomical variations in developmental dysplasia of the hip. The results, extracted from these manuscripts, were the basic source of the current study. It was found that hip anatomy is affected in many different ways which range from sole acetabular dysplasia and stability to subluxation and dislocation. Acetabular defects along with femoral head and soft tissue abnormalities are usually present, making surgery a very challenging process. Dominant symptoms in infancy involve length discrepancy and limited abduction while groin pain and abnormal gait appear later in life. In cases of early diagnosis, DDH can be treated efficiently. Therefore, careful examination of all infants should be performed using the Barlow and Ortolani tests along with ultrasound, when there is a high clinical suspicion. It would be advisable though to screen all infants in order to avoid delayed diagnosis. In later life, radiographs are considered the primary diagnostic tool, whereas a considerable advancement to treating adult DDH is the growing use of personalized (custom-made) implants.