Skip to main content
Top
Published in: International Orthopaedics 9/2011

01-09-2011 | Review Article

Screening and treatment in developmental dysplasia of the hip—where do we go from here?

Authors: Mathew D. Sewell, Deborah M. Eastwood

Published in: International Orthopaedics | Issue 9/2011

Login to get access

Abstract

Purpose

Developmental dysplasia of the hip (DDH) is a leading cause of disability in childhood and early adult life. Clinical and sonographic screening programmes have been used to facilitate early detection but the effectiveness of both screening strategies is unproven. This article discusses the role for screening in DDH and provides an evidence-based review for early management of cases detected by such screening programmes.

Methods

We performed a literature review using the key words ‘hip dysplasia,’ ‘screening,’ ‘ultrasound,’ and ‘treatment.’

Results

The screening method of choice and its effectiveness in DDH still needs to be established although it seems essential that screening tests are performed by trained and competent examiners. There is no level 1 evidence to advise on the role of abduction splinting in DDH although clinicians feel strongly that hip instability does improve with such a treatment regime. The definition of what constitutes a pathological dysplasia and when this requires treatment is also poorly understood.

Conclusion

Further research needs to establish whether early splintage of clinically stable but sonographically dysplastic hips affects future risk of late-presenting dysplasia/dislocation and osteoarthritis. There is a need for high quality studies in the future if these questions are to be answered.
Literature
1.
go back to reference Mackenzie IG, Wilson JG (1981) Problems encountered in the early diagnosis and management of congenital dislocation of the hip. J Bone Joint Surg Br 63:38–42PubMed Mackenzie IG, Wilson JG (1981) Problems encountered in the early diagnosis and management of congenital dislocation of the hip. J Bone Joint Surg Br 63:38–42PubMed
2.
go back to reference Dunn PM, Evans RE, Thearle MJ, Griffiths HE, Witherow PJ (1985) Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child 60:407–414PubMedCrossRef Dunn PM, Evans RE, Thearle MJ, Griffiths HE, Witherow PJ (1985) Congenital dislocation of the hip: early and late diagnosis and management compared. Arch Dis Child 60:407–414PubMedCrossRef
3.
go back to reference Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20–33PubMed Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20–33PubMed
4.
go back to reference Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI (2001) Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–99. J Bone Joint Surg Br 83:579–86PubMedCrossRef Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI (2001) Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–99. J Bone Joint Surg Br 83:579–86PubMedCrossRef
5.
go back to reference Klisic PJ (1989) Congenital dislocation of the hip—a misleading term. J Bone Joint Surg Br 71:136PubMed Klisic PJ (1989) Congenital dislocation of the hip—a misleading term. J Bone Joint Surg Br 71:136PubMed
6.
go back to reference Angliss R, Fujii G, Pickvance E, Wainwright AM, Benson MKD (2005) Surgical treatment of late developmental displacement of the hip. J Bone Joint Surg Br 87:384–94PubMedCrossRef Angliss R, Fujii G, Pickvance E, Wainwright AM, Benson MKD (2005) Surgical treatment of late developmental displacement of the hip. J Bone Joint Surg Br 87:384–94PubMedCrossRef
7.
go back to reference Standing Medical Advisory Committee (1969) Screening for the detection of congenital dislocation of the hip in infants. Dept of Health and Social Security, London Standing Medical Advisory Committee (1969) Screening for the detection of congenital dislocation of the hip in infants. Dept of Health and Social Security, London
8.
go back to reference Sanghrajka AP, Murnaghan C, Shekkiris A, Hill RA, Roposch A, Eastwood DM. A consecutive case series review of open reductions for DDH over 5 years: what are the implications for current screening programmes using this proxy measure for failure. J Bone Joint Surg [Br] (suppl) 2009 in press Sanghrajka AP, Murnaghan C, Shekkiris A, Hill RA, Roposch A, Eastwood DM. A consecutive case series review of open reductions for DDH over 5 years: what are the implications for current screening programmes using this proxy measure for failure. J Bone Joint Surg [Br] (suppl) 2009 in press
9.
go back to reference Godward S, Dezateux C (1998) Surgery for congenital dislocation of the hip in the UK as a measure of outcome of screening. Lancet 351:1149–1152PubMedCrossRef Godward S, Dezateux C (1998) Surgery for congenital dislocation of the hip in the UK as a measure of outcome of screening. Lancet 351:1149–1152PubMedCrossRef
10.
go back to reference Jones D (1998) Neonatal detection of development dysplasia of the hip. J Bone Joint Surg Br 80:943–945PubMed Jones D (1998) Neonatal detection of development dysplasia of the hip. J Bone Joint Surg Br 80:943–945PubMed
11.
go back to reference Kim HT, Wenger DR (1997) Location of acetabular deficiency and associated hip dislocation in neuromuscular hip dysplasia: three dimensional computed topographic analysis. J Paediatr Orthop 17:143–151 Kim HT, Wenger DR (1997) Location of acetabular deficiency and associated hip dislocation in neuromuscular hip dysplasia: three dimensional computed topographic analysis. J Paediatr Orthop 17:143–151
13.
go back to reference Walton MJ, Isaacson Z, McMillan D, Hawkes R, Atherton WG (2010) The success of management with the Pavlik harness for developmental dysplasia of the hip using a United Kingdom screening programme and ultrasound-guided supervision. J Bone Joint Surg Br 92:1013–16PubMedCrossRef Walton MJ, Isaacson Z, McMillan D, Hawkes R, Atherton WG (2010) The success of management with the Pavlik harness for developmental dysplasia of the hip using a United Kingdom screening programme and ultrasound-guided supervision. J Bone Joint Surg Br 92:1013–16PubMedCrossRef
14.
go back to reference Van der Sluijs JA, De Gier L, Verbeke JI et al (2009) Prolonged treatment with the Pavlik harness in infants with developmental dysplasia of the hip. J Bone Joint Surg Br 91:1090–1093PubMedCrossRef Van der Sluijs JA, De Gier L, Verbeke JI et al (2009) Prolonged treatment with the Pavlik harness in infants with developmental dysplasia of the hip. J Bone Joint Surg Br 91:1090–1093PubMedCrossRef
15.
go back to reference Atalar H, Sayli U, Yavuz OY, Uras I, Dogruel H (2007) Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. Int Orthop 31:145–150PubMedCrossRef Atalar H, Sayli U, Yavuz OY, Uras I, Dogruel H (2007) Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. Int Orthop 31:145–150PubMedCrossRef
16.
go back to reference Viere RG, Birch JG, Herring JA, Roach JW, Johnston CE (1990) Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 72:238–244PubMed Viere RG, Birch JG, Herring JA, Roach JW, Johnston CE (1990) Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 72:238–244PubMed
17.
go back to reference Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory committee (1986) Screening for the detection of congenital dislocation of the hip. Dept of Health and Social Security, London Standing Medical Advisory Committee and Standing Nursing and Midwifery Advisory committee (1986) Screening for the detection of congenital dislocation of the hip. Dept of Health and Social Security, London
18.
go back to reference Ortolani M (1976) The classic. Congenital hip dysplasia in the light of early and very early diagnosis. Clin Orthop Relat Res 119:6–10PubMed Ortolani M (1976) The classic. Congenital hip dysplasia in the light of early and very early diagnosis. Clin Orthop Relat Res 119:6–10PubMed
19.
go back to reference Barlow TG (1962) Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 44:292–301 Barlow TG (1962) Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 44:292–301
20.
go back to reference Jones D (1977) An assessment of the value of examination of the hip in the newborn. J Bone Joint Surg Br 59:318–22PubMed Jones D (1977) An assessment of the value of examination of the hip in the newborn. J Bone Joint Surg Br 59:318–22PubMed
21.
go back to reference Macnicol MF (1990) Results of a 25-year screening programme for neonatal hip instability. J Bone Joint Surg Br 72:1057–1060PubMed Macnicol MF (1990) Results of a 25-year screening programme for neonatal hip instability. J Bone Joint Surg Br 72:1057–1060PubMed
22.
go back to reference Jari S, Paton RW, Srinivasan MS (2002) Unilateral limitation of abduction of the hip a valuable clinical sign for DDH? J Bone Joint Surg Br 84:104–107PubMedCrossRef Jari S, Paton RW, Srinivasan MS (2002) Unilateral limitation of abduction of the hip a valuable clinical sign for DDH? J Bone Joint Surg Br 84:104–107PubMedCrossRef
23.
go back to reference Ryder CT, Mellin WG, Caffey J (1962) The infant’s hip—normal or dysplastic? Clin Orthop Relat Res 22:7–19 Ryder CT, Mellin WG, Caffey J (1962) The infant’s hip—normal or dysplastic? Clin Orthop Relat Res 22:7–19
24.
go back to reference Visser F, Sprij AJ, Bos CF (2009) Comment on: clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 33:883–884PubMedCrossRef Visser F, Sprij AJ, Bos CF (2009) Comment on: clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 33:883–884PubMedCrossRef
25.
go back to reference Sanfridson J, Redlund-Johnell I, Busfield PI (1967) Dislocatable hip and dislocated hip in the newborn infant. BMJ 4:377–381CrossRef Sanfridson J, Redlund-Johnell I, Busfield PI (1967) Dislocatable hip and dislocated hip in the newborn infant. BMJ 4:377–381CrossRef
26.
28.
go back to reference Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97:117–133PubMedCrossRef Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97:117–133PubMedCrossRef
29.
go back to reference Rosendahl K, Markestad T, Lie RT (1994) Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics 94:47–52PubMed Rosendahl K, Markestad T, Lie RT (1994) Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics 94:47–52PubMed
30.
go back to reference Harcke HT, Clarke NM, Lee MS et al (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137PubMed Harcke HT, Clarke NM, Lee MS et al (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137PubMed
31.
go back to reference Dias JJ, Thomas IH, Lamont AC et al (1993) The reliability of ultrasonographic assessment of neonatal hips. J Bone Joint Surg Br 75:479–482PubMed Dias JJ, Thomas IH, Lamont AC et al (1993) The reliability of ultrasonographic assessment of neonatal hips. J Bone Joint Surg Br 75:479–482PubMed
32.
go back to reference Morin C, Harcke HT, MacEwen GD (1985) The infant hip: real-time US assessment of acetabular development. Radiology 157:673–677PubMed Morin C, Harcke HT, MacEwen GD (1985) The infant hip: real-time US assessment of acetabular development. Radiology 157:673–677PubMed
33.
go back to reference Holen KJ, Tegnander A, Eik-Nes SH, Terjesen T (1999) The use of ultrasound in determining the initiation of treatment in instability of the hip in neonates. J Bone Joint Surg Br 81:846–851PubMedCrossRef Holen KJ, Tegnander A, Eik-Nes SH, Terjesen T (1999) The use of ultrasound in determining the initiation of treatment in instability of the hip in neonates. J Bone Joint Surg Br 81:846–851PubMedCrossRef
34.
go back to reference Holen KH, Tegnander A, Bredland T et al (2002) Universal or selective screening of the neonatal hip using ultrasound? J Bone Joint Surg Br 84-B:886–890CrossRef Holen KH, Tegnander A, Bredland T et al (2002) Universal or selective screening of the neonatal hip using ultrasound? J Bone Joint Surg Br 84-B:886–890CrossRef
35.
go back to reference Marks DS, Clegg J, Al-Chalabi AN (1994) Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip. J Bone Joint Surg Br 76-B:534–538 Marks DS, Clegg J, Al-Chalabi AN (1994) Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip. J Bone Joint Surg Br 76-B:534–538
36.
go back to reference Rosendahl K, Markestad T, Lie RT (1992) Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology. Pediatr Radiol 22:430–433PubMedCrossRef Rosendahl K, Markestad T, Lie RT (1992) Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology. Pediatr Radiol 22:430–433PubMedCrossRef
37.
go back to reference Rosenberg N, Bialik V, Norman D, Blazer S (1998) The importance of combined clinical and sonographic examination of instability of the neonatal hip. Int Orthop 22(3):185–188PubMedCrossRef Rosenberg N, Bialik V, Norman D, Blazer S (1998) The importance of combined clinical and sonographic examination of instability of the neonatal hip. Int Orthop 22(3):185–188PubMedCrossRef
38.
go back to reference Dogruel H, Atalar H, Yavuz OY, Sayli U (2008) Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 32:415–419PubMedCrossRef Dogruel H, Atalar H, Yavuz OY, Sayli U (2008) Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 32:415–419PubMedCrossRef
39.
go back to reference Paton RW, Sriivasan MS, Shah B et al (1999) Ultrasound screening for hips at risk in developmental dysplasia of the hip: is it worth it? J Bone Joint Surg Br 81:255–258PubMedCrossRef Paton RW, Sriivasan MS, Shah B et al (1999) Ultrasound screening for hips at risk in developmental dysplasia of the hip: is it worth it? J Bone Joint Surg Br 81:255–258PubMedCrossRef
40.
go back to reference Paton RW (2009) Development dysplasia of the hip: ultrasound screening and treatment. How are they related? Hip Int 19:S3–8PubMed Paton RW (2009) Development dysplasia of the hip: ultrasound screening and treatment. How are they related? Hip Int 19:S3–8PubMed
41.
go back to reference Ihme N, Altenhofen L, von Kries R, Niethard FU (2008) Hip ultrasound screening in Germany. Results and comparison with other screening procedures. Orthopade 37(541–6):548–549 Ihme N, Altenhofen L, von Kries R, Niethard FU (2008) Hip ultrasound screening in Germany. Results and comparison with other screening procedures. Orthopade 37(541–6):548–549
42.
go back to reference Von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, Niethard FU (2003) Effect of ultrasound screening on the rate of first operative procedure for developmental hip dysplasia in Germany. Lancet 362:1883–1887CrossRef Von Kries R, Ihme N, Oberle D, Lorani A, Stark R, Altenhofen L, Niethard FU (2003) Effect of ultrasound screening on the rate of first operative procedure for developmental hip dysplasia in Germany. Lancet 362:1883–1887CrossRef
43.
go back to reference Clegg J, Bache CE, Raut VV (1999) Financial justification for routine ultrasound screening of the neonatal hip. J Bone Joint Surg Br 81:852–857PubMedCrossRef Clegg J, Bache CE, Raut VV (1999) Financial justification for routine ultrasound screening of the neonatal hip. J Bone Joint Surg Br 81:852–857PubMedCrossRef
44.
go back to reference Gray A, Elbourne D, Dezateux C et al (2005) Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the UK and Ireland. J Bone Joint Surg Am 87:2472–2479PubMedCrossRef Gray A, Elbourne D, Dezateux C et al (2005) Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the UK and Ireland. J Bone Joint Surg Am 87:2472–2479PubMedCrossRef
45.
go back to reference US Preventative Services Task Force (2006) Screening for developmental dysplasia of the hip: recommendation statement. Pediatrics 117:898–902CrossRef US Preventative Services Task Force (2006) Screening for developmental dysplasia of the hip: recommendation statement. Pediatrics 117:898–902CrossRef
46.
go back to reference Tegnander A, Terjesen T, Bredland T, Holen KJ (1994) Incidence of late-diagnosed hip dysplasia after different screening methods in newborns. J Paediatr Orthop B 3:86–88CrossRef Tegnander A, Terjesen T, Bredland T, Holen KJ (1994) Incidence of late-diagnosed hip dysplasia after different screening methods in newborns. J Paediatr Orthop B 3:86–88CrossRef
47.
go back to reference Cashman JP, Round J, Taylor G, Clarke NM (2002) The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. J Bone Joint Surg Br 84:418–425PubMedCrossRef Cashman JP, Round J, Taylor G, Clarke NM (2002) The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. J Bone Joint Surg Br 84:418–425PubMedCrossRef
48.
go back to reference Bradley J, Wetherill M, Benson MK (1987) Splintage for congenital dislocation of the hip. Is it safe and reliable? J Bone Joint Surg Br 69:257–263PubMed Bradley J, Wetherill M, Benson MK (1987) Splintage for congenital dislocation of the hip. Is it safe and reliable? J Bone Joint Surg Br 69:257–263PubMed
49.
go back to reference Johnson AH, Aadalen RJ, Eilers VE, Winter RB (1981) Treatment of congenital hip dislocation and dysplasia with the Pavlik harness. Clin Orthop Relat Res 155:25–29PubMed Johnson AH, Aadalen RJ, Eilers VE, Winter RB (1981) Treatment of congenital hip dislocation and dysplasia with the Pavlik harness. Clin Orthop Relat Res 155:25–29PubMed
50.
go back to reference Fujioka F, Terayama K, Sugimoto N, Tanikawa H (1995) Long-term results of congenital dislocation of the hip treated with the Pavlik harness. J Paediatr Orthop 15:747–752CrossRef Fujioka F, Terayama K, Sugimoto N, Tanikawa H (1995) Long-term results of congenital dislocation of the hip treated with the Pavlik harness. J Paediatr Orthop 15:747–752CrossRef
51.
go back to reference Mubarak S, Garfin S, Vance R et al (1981) Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip. J Bone Joint Surg Am 63:1239–1248PubMed Mubarak S, Garfin S, Vance R et al (1981) Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip. J Bone Joint Surg Am 63:1239–1248PubMed
52.
go back to reference Rampal V, Sabourin M, Erdeneshoo E et al (2008) Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg Br 90:858–863PubMedCrossRef Rampal V, Sabourin M, Erdeneshoo E et al (2008) Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years. J Bone Joint Surg Br 90:858–863PubMedCrossRef
53.
go back to reference Morcuende JA, Meyer MD, Dolan LA, Weinstein SL (1997) Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am 79:810–817PubMed Morcuende JA, Meyer MD, Dolan LA, Weinstein SL (1997) Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am 79:810–817PubMed
54.
go back to reference Roposch A, Stohr KK, Dobson M (2009) The effect of the femoral head ossific nucleus in the treatment of developmental dysplasia of the hip. A meta-analysis. J Bone Joint Surg Am 91:911–918PubMedCrossRef Roposch A, Stohr KK, Dobson M (2009) The effect of the femoral head ossific nucleus in the treatment of developmental dysplasia of the hip. A meta-analysis. J Bone Joint Surg Am 91:911–918PubMedCrossRef
55.
go back to reference Spence G, Hocking R, Wedge JH, Roposch A (2009) Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am 91:2622–2636PubMedCrossRef Spence G, Hocking R, Wedge JH, Roposch A (2009) Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am 91:2622–2636PubMedCrossRef
56.
go back to reference Clarke NM, Jowett AJ, Parker L (2005) The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following appearance of the capital femoral ossific nucleus. J Pediatr Orthop 25:434–439PubMedCrossRef Clarke NM, Jowett AJ, Parker L (2005) The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following appearance of the capital femoral ossific nucleus. J Pediatr Orthop 25:434–439PubMedCrossRef
Metadata
Title
Screening and treatment in developmental dysplasia of the hip—where do we go from here?
Authors
Mathew D. Sewell
Deborah M. Eastwood
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 9/2011
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-011-1257-z

Other articles of this Issue 9/2011

International Orthopaedics 9/2011 Go to the issue