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Developmental Dysplasia of the Hip

  • Frederic Shapiro
Chapter

Abstract

Developmental dysplasia of the hip is a general term referring to a spectrum of deformities, usually diagnosed in the neonatal period, in which the structural relationship of the proximal femur to the acetabulum is intermittently or continuously abnormal. The spectrum includes (i) a subluxatable or dislocatable hip associated with capsular laxity in which the head of the femur moves partially or totally out of the acetabulum with extension and adduction and back into it with flexion and abduction, (ii) a subluxated hip in which there is a partial but persisting loss of the normal relationship of the head of the femur to the acetabulum in extension with the head more lateral than normal in the acetabulum and the acetabulum more shallow than normal with its lateral roof angled outwardly and upwardly, and (iii) a dislocated hip in which there is a complete and persisting loss of any femoral head-acetabular relationship, regardless of the position of the hip. Developmental dysplasia of the hip (DDH), as currently defined, is not associated with clinically evident connective tissue, neuromuscular, or other diseases. The single most important initial pathoanatomic change appears to be a capsular laxity which renders the hip unstable at birth with all subsequent abnormalities being secondary phenomena which develop an increasing variation from the norm the longer a hip is allowed to grow with any persisting malposition. The terminology used to describe this condition has always been variable and imprecise primarily due to the imperfect understanding of the pathoanatomy and timing of its initial occurrence.

Keywords

Terminology Normal hip development Historical understanding Pathoanatomy Structural changes worsen with growth in displaced position Etiology Experimental models Clinical profile Idiopathic versus teratologic variants Evolution of management profile Residual deformity causing osteoarthritis Complications with initial operative approaches Extensive avascular necrosis (AVN) with forceful closed reduction/extreme hip spica positioning Universal acceptance of neonatal examination Value of earlier diagnosis and treatment Imaging modalities and normal/abnormal values: radiographic, ultrasound, three-dimensional CT and MR Radiographic (Tönnis) and ultrasound (Graf) classifications Pavlik harness management (neonatal) Closed reduction and hip spica in “human position” (to protect vascularity) Surgical approaches with age range recommendations: open reduction, proximal femoral varus osteotomy, acetabular repositioning (innominate, Pemberton, Dega) Results based on clinical/radiographic findings and treatment programs Minimizing effects of AVN: classification of AVN, blood supply of hip, precautions with closed and open reduction and cast positioning, early diagnosis with MR imaging 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Frederic Shapiro
    • 1
    • 2
  1. 1.Visiting Scholar, Stanford University School of Medicine, Department of Medicine/Endocrinology (Bone Biology)Palo AltoUSA
  2. 2.Formerly, Associate Professor of Orthopaedic Surgery, Harvard Medical SchoolBoston Children’s HospitalBostonUSA

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