Degenerative Knee Joint Disease Research Articles

A Pilot Study of the Clinical Effectiveness of a Single Intra-Articular Injection of Stanozolol in Canines with Knee Degenerative Joint Disease and Its Correlation with Serum Interleukin-1β Levels.

Stanozolol shows promise as an anabolic and anti-catabolic agent for treating degenerative joint disease (DJD). This study assessed the clinical efficacy of a single intra-articular stanozolol injection in canine knees with DJD and its correlation with serum IL-1β levels. Thirty dogs (n = 30) were divided into a control group (CG, n = 10) and a study group (SG, n = 20) with DJD. Pain levels were assessed using the Brown query, and radiographs were taken at T0 and T3. IL-1β levels were quantified via ELISA. Apart from 2 patients, all showed reduced pain intensity, with 15 patients showing improvement at T1 and 3 patients at T2. A positive correlation (r = 0.84; p < 0.01) was found between pain level and IL-1β in 15 patients. No systemic effects were observed. Most patients (18/20) experienced reduced pain. This pilot study suggests stanozolol's potential in managing DJD in dogs. Further research is warranted to validate these findings and understand stanozolol's mechanism in DJD treatment.

Novel triple therapy in osteoarthritis of knee joint

Background: Regenerative medicine may be defined as the process of replacing or regenerating human tissues or cells of humans to restore or to get very near to normal function of human life. Biological tissues found in humans such as blood, fat, bone marrow are the main resources of regenerative medicine which help in natural process of healing of soft tissue. Extracorporeal shock wave therapy (ESWT) is a physical modality that helps in enhancing healing process of soft tissues. Osteoarthritis of the knee joint is a gradually progressive degenerative condition with the loss of articular cartilage. The early stages of disease are managed conservatively with the aim of retarding the rate of cartilage destruction. Methods: A total of 80 patients underwent the novel triple therapy. The objective is to find out the potential of combination therapy in early degenerative disease of knee with the aim of reduction of inflammation. A protocol was developed which involved three injections of platelet rich plasma (PRP), six sessions of combined ESWT and physiotherapy. Results: Evaluation was mainly based on WOMAC/KSS/VAS scores. Patients in stage 1 and 2 (55+15=70) had excellent results for 36 months, patients in stage 3 (10 cases) had satisfactory outcome at 24 months. Conclusions: Triple therapy is an alternative treatment or in few cases a definitive treatment in degenerative disease of knee joint where medical and surgical management has minimal or no role. Triple therapy in mild to moderate osteoarthritis of knee joint has better outcome.

Thermal Oscillation Changes the Liquid-Form Autologous Platelet-Rich Plasma into Paste-Like Form.

Objectives The texture of the autologous platelet-rich plasma (PRP) that is used in treating degenerative joint diseases such as knee osteoarthritis (OA) is usually in liquid form. However, the turnover rate of protein metabolism in the knee synovial fluid (SF) is less than one hour. This study examined the feasibility of the thermal oscillation technique in converting the liquid-form PRP into an injectable viscous paste-like PRP that may delay the degradation of PRP and continuously release growth factors in the knee joint for a longer period of time. Methods This study was conducted in the rehabilitation department of a tertiary hospital. A total of 10 elderly patients with an average age of greater than 65 years and diagnosed with moderate degree of knee OA were recruited. The RegenPRP (RegenLab, Le Mont-sur-Lausanne, Switzerland) test tube chamber was used for PRP generation. A total of 60 milliliters (mL) of blood was drawn from each patient. 10 mL of blood was injected into each PRP test tube chamber. As a result, a total of 6 test tube chambers were obtained and each chamber was centrifuged for 15 minutes. Approximately 5 mL of PRP supernatant (the liquid-form end product) was aspirated and sent for thermal oscillation treatment. Five temperatures were tested: 55, 65, 75, 85, and 95 degrees Celsius. Oscillation was set at 200 revolutions per minute (rpm) for 15 minutes. The enzyme-linked immunosorbent assay (ELISA) was applied in measuring the concentration of platelet-derived growth factor (PDGF) in picogram/milliliter (pg/mL). Repeated measures ANOVA followed by the Bonferroni post hoc test was used to compare the PDGF concentrations between each testing condition. Results Under 75 degrees Celsius of heating, the resultant paste-like PRP end product had the highest concentration of PDGF in picograms per milliliter (pg/mL) as compared with other heating conditions (p < 0.05). The viscosity of the paste-like PRP was measured to be 70,000 centipoise (cP), which is similar to the viscosity of a toothpaste. The paste-like PRP end product was able to release PDGF continuously for about 14 days, with the highest concentration achieved on the 8th day with an average of 35646 ± 2499 pg/mL. In nonthermally treated liquid-form PRP sample, the highest number of PRP was observed on the 4th day with an average value of 8444 ± 831 pg/mL. Under the heating conditions of 55 and 95 degrees Celsius, the highest concentration of PDGF was observed on the 5th day (13346 ± 764 pg/mL and 3440 ± 303 pg/mL, respectively). Under the heating conditions of 65 and 85 degrees Celsius, the highest concentration of PDGF was observed on the 7th day (15468 ± 744 pg/mL and 20432 ± 1118 pg/mL, respectively). Conclusion Through thermal oscillation, liquid-form PRP can be converted to paste-like PRP end product with a viscosity similar to that of a toothpaste. The best heating condition was discovered to be 75 degrees Celsius. The paste-like PRP was able to release PDGF continuously for about 2 weeks, with the highest concentration obtained on the 8th day. The findings in this study suggested that paste-like PRP may be a viable option in treating degenerative knee joint diseases.

Intra-articular injection of stromal vascular fraction for knee degenerative joint disease: a concise review of preclinical and clinical evidence.

Autologous fat-derived stromal vascular fraction (SVF) is a mixed cell population that has been used for many years in regenerative plastic surgery. In terms of animal and clinical research, this concise review was performed to evaluate the efficacy of SVF in knee degenerative joint disease (KDJD), which could cause pain, disability and severely affect patients' lives. Thirteen studies retrieved and screened from the databases were included, including six animal studies and seven clinical trials. The meta-analysis of clinical research shows that intra-articular injection of SVF, in combination with adjuvant surgery, could alleviate pain and improve early functional recovery for patients with KDJD at Kellgren-Lawrence (KL) grades II-III.

Efficacy of intra-articular injection of combined platelet-rich plasma and hyaluronic acid in knee degenerative joint disease (182)

Objectives:Osteoarthritis (OA) of the knee is a debilitating disease whose prevalence has increased across the world with aging population. Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) injections appear to be two of the main strategies for conservative treatment of early knee OA. The effectiveness of both treatments, however, is still under debate because contrasting results have been described in the current literature. Some pre-clinical studies evaluated the association of PRP and HA with encouraging results, highlighting the possibility of a synergistic effect between the two compounds and suggesting a possible use through combined intra-articular injections. The aim of this prospective randomized controlled double-blind clinical trial is to evaluate the efficacy of intra-articular injections of PRP and HA for the treatment of early stages of knee degenerative joint disease in improving joint function and reducing pain, compared to the intra-articular injections of PRP and HA alone.Methods:Patients with knee early OA were prospectively enrolled and then double-blinded randomly divided into three groups of fifty-eight subjects each: HA alone, PRP alone and PRP+HA group. Patients received three intra-articular injections with two-week interval period among each dose. Patients clinical outcome was evaluated through five questionnaires [The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner Activity, Visual Analogue Scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form] before the treatment (T0) and after 3, 6 and 12 months from the first injection. Patients’use of paracetamol and supplementary analgesia for knee pain during the study was collected.Results:One hundred and seventy-four patients were enrolled in this study (age, 30-80 years; 108 females and 66 males) and 162 completed the 12-month follow-up. All patients showed significant clinical improvement after treatment. The analysis of covariance (ANCOVA) did not show statistically significant differences among the three groups for all the variables analysed at 6 and 12 months of follow-up (p>0.05).No significant differences were found in terms of adverse events (p=0.49) among the three groups of patients (p=0.92).The demand for paracetamol and supplementary analgesics was generally low and there were no significant differences among the groups (p=0.23 and p=0.56, respectively).Conclusions:Injections treatments for early knee OA are an important conservative therapeutic strategy. To date, the current literature presents many contrasting studies about the effectiveness of PRP or HA, but only a few consider the combined use of PRP and HA as attractive therapeutic option. Our study has not shown any significant difference in clinical and functional outcomes among the three experimental groups, suggesting a substantial equivalence of these three treatments. Thus, cost-effectiveness is in favor of HA injections in the conservative treatment of early OA.

Small Noncoding RNAs in Knee Osteoarthritis: The Role of MicroRNAs and tRNA-Derived Fragments.

Knee osteoarthritis (OA) is a degenerative knee joint disease that results from the breakdown of joint cartilage and underlying bone, affecting about 3.3% of the world’s population. As OA is a multifactorial disease, the underlying pathological process is closely associated with genetic changes in articular cartilage and bone. Many studies have focused on the role of small noncoding RNAs in OA and identified numbers of microRNAs that play important roles in regulating bone and cartilage homeostasis. The connection between other types of small noncoding RNAs, especially tRNA-derived fragments and knee osteoarthritis is still elusive. The observation that there is limited information about small RNAs different than miRNAs in knee OA was very surprising to us, especially given the fact that tRNA fragments are known to participate in a plethora of human diseases and a portion of them are even more abundant than miRNAs. Inspired by these findings, in this review we have summarized the possible involvement of microRNAs and tRNA-derived fragments in the pathology of knee osteoarthritis.

Gait parameters and functional performance following multi-factorial treatment among degenerative joint disease patients

Introduction and Aim: Degenerative Joint Disease (DJD) poses a challenge to manage and restore functional capabilities among patients. Incorporation of structured exercises, manual therapy and patient education had a significant impact on clinical and functional status of patients. Past research hasexplored benefits of therapy on functions and gait. Although, such studies did not address the functional restoration. Hence, present study was aimedto address the lacunae.&#x0D; &#x0D; Materials and Methods: 100 patients with mean age and SD; 51.61(5.4) were included. Participants had knee Degenerative Joint Disease (DJD); grade 2 or 3 on Kellgren and Lawrence scale, were allocated to Experimental Group (EG) and Comparative Group (CG). EG received joint mobilization and Muscle Energy Technique (MET). CG received Interferential therapy (carrier frequency 4 kHz; beat frequency 100 Hz; and sweep frequency 150 Hz). Strengthening exercises and patient education were common for both groups. Intervention lasted two weeks, the post-intervention metrics included; stride length, step length, and cadence for gait and knee injury and osteoarthritis outcome score.&#x0D; &#x0D; Results: Data obtained was subjected to statistical analysis. Frequency and percentage were used for categorical variables; mean andstandard deviation (SD) were used for continuous variables. Post-intervention, there was a significant improvement of gait parameters and Knee Injury and Osteoarthritis Outcome Score (KOOS) in both groups. CG had a better improvement in STL, SL, CAD with mean of 39.84(5.68), 20.22(2.84), 97.16(3.75) and EG with mean of 44.36(4.48), 22.30(3.75), 92.82(3.75) and p &lt; .0005. However, it was evident that the proportion of functional improvement among CG was lesser.&#x0D; &#x0D; Conclusion: Inclusion of structured exercises, manual therapy and patient education in intervention would be effective and improve the functional status of DJD patients.&#x0D;

Comparative gait analysis of patients with different design of total knee arthroplasty

Introduction/Objective. The essence of the treatment of degenerative knee joint diseases is pain relief, restoring motion range and stability of knee joints. Methods. In this study, 35 patients participated after having surgery of the knee joint. The patients had a posterior-stabilized (PS) endoprosthesis in one joint, and a posterior cruciate ligament retaining (CR) endoprosthesis in the other. Kinematic data was collected using a 3D optical system for tracking fluorescent markers in time. Based on these data, the following parameters were determined: degree of flexion, mediolateral (ML) translation, lateral gap, medial gap, and the angle of change between the transtibial and transfemoral axes. Results. The results show a more pronounced flexion degree with the PS prosthesis compared to the CR prosthesis. Also, the results show negligible values of the ML translation, lateral gap, and medial gap in both types of prostheses. Using the non-parameter Wilcoxon test, a substantial difference in the angle change between the transtibial and transfemoral axes was confirmed, that is, in the flexion angles on the CR and PS prostheses. Conclusion. This study shows that there is no great difference in the use of the PS or CR designs of endoprostheses. Better behavior and range of motion in the knee joint were established with the implantation of the PS endoprosthesis. This conclusion is confirmed by the substantial difference in the degree of flexion of the knee joint and in the position of the transversal axes of the tibia and femur.

Application of Core Area Muscle Group Stability Enhancement Combined with Suspension Training in Rehabilitation Treatment of Elderly Patients with Degenerative Knee Joint Disease

Application of Core Area Muscle Group Stability Enhancement Combined with Suspension Training in Rehabilitation Treatment of Elderly Patients with Degenerative Knee Joint Disease

Analysis of Musculoskeletal Ultrasound in the Diagnosis of Middle-aged and Elderly Degenerative Knee Joint Disease and Its Influence on the Coincidence Rate

Analysis of Musculoskeletal Ultrasound in the Diagnosis of Middle-aged and Elderly Degenerative Knee Joint Disease and Its Influence on the Coincidence Rate

AGE PECULIARITIES OF KNEE FUNCTIONALITY AND PHYSICAL PERFORMANCE IN ELDERLY WOMEN

Aim. The aim of this study is to learn the effect of the age on degenerative knee joint disease and physical capability of elderly women. Materials and methods. Three groups of relatively healthy elderly women (G1 – 60–64 years (n = 34), G2 – 65–69 years (n = 31) and G3 – 70–74 years (n = 18)) participated in the study. The functional status of the knee joint (pain, limitation of motion, physical functionality) was estimated with the help of WOMAC index. Physical performance in women was studied with the help of three functional tests. Pain in the knee joint before and after the tests was assessed with the help of the Numeric Pain Rating Scale (NPRS). Statistical data were processed with the help of Statistica 10 and IBM SPSS22. Results. Pain and stiffness in the knee joint in elderly women increased significantly with age while physical functionality decreased (p &lt; 0.01). Correlations were established between “age/pain” – (r = 0.581), “age/stiffness” – (r = 0.565) and “age/physical functionality” – (r = 0.666) indices, p &lt; 0.01. Authentic changes of the pain index were revealed in the knee joint during physical activity. Correlation analysis showed a clearly defined dependence between the level of physical capability in women and their age. Conclusion. The data obtained prove that the age of elderly women is one of the main factors influencing their functional capability. The age also is one of the factors influencing the progression of functional and degenerative disorders in the knee joint.

The Diagnosis and Therapy of Degenerative Knee Joint Disease: Expert Consensus from the Chinese Pain Medicine Panel.

At present, there are many constantly updated guidelines and consensuses on the diagnosis and treatment of osteoarthritis both at home and abroad. The recommendations established using methods of evidence-based medicine has experienced strict research on controlling bias and promoting reproduction rate. As a result, the previous evidence was reevaluated, and a lot of changes were provoked in the diagnosis and treatment concept of osteoarthritis. However, several methods not recommended by foreign guidelines are still in use in the current clinical practice in China. On the one hand, Chinese experts have not reached extensive consensus on whether it is necessary to make changes according to foreign guidelines. On the other hand, almost all the current relevant guidelines are on osteoarthritis, but the lesions around knee joints which, as a whole, bear the largest weight in human body, cannot be ignored. For this purpose, Chinese Association for the Study of Pain (CASP) organized some leading experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of degenerative knee osteoarthritis (DKOA) in combination with the guidelines in foreign countries and the expert experience of clinical practice in China. The consensus, which includes the definition, pathophysiology, epidemiology, clinical manifestation, diagnostic criteria, and treatments of DKOA, is intended to be used by first-line doctors, including pain physicians to manage patients with DKOA.

Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double-blinded Controlled Trial.

Total knee arthroplasty (TKA) is an established surgical technique and is the standard treatment for degenerative knee joint diseases. However, severe pain after TKA makes it difficult for many patients to perform early postoperative rehabilitation and functional exercise, which might result in subsequent unsatisfactory recovery of knee joint function and great reduction in patients' satisfaction and quality of life. Orthopaedic surgeons have tried a large variety of analgesics and analgesic modes to relieve patients' pain after TKA. There are many analgesic regimens available in clinical practice but all have some deficiencies. Parecoxib sodium, a highly selective inhibitor of cyclooxygenase-2 (COX-2), can reduce the synthesis of peripheral prostaglandin to exert the effect of analgesia, and relieve inflammation and prevent central sensitization through inhibition of peripheral and central COX-2 expression. In addition, it can be used as a preemptive analgesic without affecting platelet aggregation. However, there does seem to be conflicting evidence in the current research as to whether parecoxib sodium can be used successfully as a preemptive analgesic; the effect of preemptive analgesia with parecoxib sodium in multimodal analgesia is still controversial. This research investigated the effects of parecoxib sodium in a preemptive multimodal analgesic regimen. Eighty-eight patients were randomized into two groups. The experimental group received parecoxib (46 patients) and the control group received saline (42 patients), administered 30 min before the initiation of the surgical procedure. A patient-controlled analgesia (PCA) pump was applied within 48 h after surgery. The visual analogue scale (VAS), drug consumption through the PCA pump, use of salvaging analgesia, range of motion (ROM) of the knee joints, and postoperative complications were observed. The VAS score in the post-anesthesia care unit (PACU) of the parecoxib group was significantly lower than that of the control group (P = 0.039). There was no significant difference in the demographic profiles, duration of operation, hemorrhage in surgery, postoperative hemorrhage, postoperative drainage, VAS at different time points, function of knee joints, length of hospital stay, use of salvaging analgesia, and postoperative drug consumption through the PCA between the two groups (P > 0.05). In preemptive multimodal analgesia regimens, parecoxib sodium can significantly decrease the VAS score in the short term, relieve pain shortly after surgery, and does not increase the incidence of complications. Parecoxib sodium is a safe and effective drug in the perioperative analgesic management for TKA.

Mid -Term Results of Total Knee Replacement in Under Age of 65 Years Patients with Rheumatoid Arthritis

Background:Total knee arthroplasty in patients with rheumatoid arthritis is associated with some problems, and yet is an effective method for management of knee ailments in these patients. The aim of this cross-sectional study was to evaluate the results of this procedure in a series of patients with rheumatoid arthritis. Methods:Twelve patients (15 knees) with rheumatoid arthritis who underwent knee arthroplasty(Figure-1) and under 65 age were recruited. Clinical and radiographic results including functional score and knee score, radiographic score, the amount of deformity correction, the length of recovery time and complications were evaluated. Results:Eleven patients were female and one patient is male , with mean age of 58.8 years and were followed for an average of 28.2 months. Average knee range of motion had increased from 82 degrees to 106 degrees postoperatively (p=0.002). The mean knee and functional score were 91 (4.44 SD) and 71 (27.92 SD), respectively. None of the patients had radiographic signs of loosening. Conclusion: Total knee arthroplasty performed in degenerative knee joint diseases with severe deformity significantly improves rheumatoid arthritis patients’ complaints and functional results

Degenerative disease of knee joint: a clinico-radiological correlation

Background: This study was done from January 2014 to July 2016, in 128 patients of knee joint osteoarthritis. We assessed epidemiology of osteoarthritis of knee and various MRI findings.Methods: In all the 128 patients radiographs (anteroposterior) were taken in extended and weight bearing position. Staging of osteoarthritis of knee was done using Kellgren-Lawrence scoring system and then we performed magnetic resonance imaging of the knee. All these patients were then interviewed about their clinical symptoms and osteoarthritis of knee was graded by WOMAC scale.Results: Osteoarthritis has a positive correlation with age, female sex and BMI. However occupation of the patient was not associated with any statistical significance. No association was seen between cartilage defects, bone marrow edema, sub chondral cysts, subchondral sclerosis, Baker’s cysts subluxations of tibia and synovitis with clinical features. The patellofemoral compartment of knee joint mostly contributed to the clinical symptoms of the patients in our study population though not being statistically significant (P &gt;0. 05). In tibiofemoral compartment a statistically significant correlation was seen between most of the MRI findings and KL score, however in patellofemoral compartment this correlation is poor.Conclusions: Clinical findings and plain radiographs are still important in evaluating osteoarthritis of knee, MRI plays an important role in imaging the bony and soft tissues of knee as a whole organ, thereby helping in better management and outcome of the disease. Also MRI plays an important role in depicting early changes of osteoarthtis.

State of Synovial Medium in Patients with Degenerative Dystrophic Changes of Knee Joint Accompanied by Articular Surface Defects

The purpose of the work was to determine the concentrations of mineral elements in subchondral bone and synovial fluid of patients with degenerative dystrophic knee joint diseases accompanied by articular surface defects. Subchondral bone and synovial fluid were used as a study material. Analysis of mineral content indices included the determination of calcium, phosphate, magnesium and chlorides concentrations by spectrophotometry. It was shown that the indices of basic electrolytes, i.e. of calcium and phosphate ions, in bone and synovial fluid did not correlate with each other and changed in different directions. Calcium content decreased in the bone while phosphate ions - in synovial fluid.

State of Synovial Medium in Patients with Degenerative Dystrophic Changes of Knee Joint Accompanied by Articular Surface Defects

The purpose of the work was to determine the concentrations of mineral elements in subchondral bone and synovial fluid of patients with degenerative dystrophic knee joint diseases accompanied by articular surface defects. Subchondral bone and synovial fluid were used as a study material. Analysis of mineral content indices included the determination of calcium, phosphate, magnesium and chlorides concentrations by spectrophotometry. It was shown that the indices of basic electrolytes, i.e. of calcium and phosphate ions, in bone and synovial fluid did not correlate with each other and changed in different directions. Calcium content decreased in the bone while phosphate ions - in synovial fluid.

Fibrosis is a common outcome following total knee arthroplasty.

Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3–10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n = 30) or revision (n = 27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees.

Supporting Safety for Prebariatric Surgery Candidates: Effects of Obesity and Degenerative Joint Disease on Movement

Abstract Date Presented 4/16/2015 Obesity and knee degenerative joint disease affect clients’ mobility and participation. The influence of body structures on mobility for clients undergoing bariatric surgery was examined in this study. Occupational therapists have the expertise to create client-centered, occupation-based interventions to reduce clients’ fall risks.

Developmental dysplasia of the hip: What has changed in the last 20 years?

Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Different screening programs for DDH were implicated. The suspicion is raised based on a physical examination soon after birth. Radiography and ultrasonography are used to confirm the diagnosis. The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined; however, extensive research is underway on this subject. Treatment depends on the age of the patient and the reducibility of the hip joint. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. If this fails, closed reduction and spica casting is usually done. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades.