DEVELOPMENTAL DYSPLASIA OF THE HIP

Objective. The definition and early treatment of congenital dysplasia of the hip are controversial. The purpose of this study was to discuss the reasons for changing the acronym to developmental dysplasia of th e hip (DDH) and to address its early detection and treatment. Design. This multicenter study was designed to provide an updated assessment o f the definition, pathologic anatomy, prevalence, etiology, natural hi story, early detection, and treatment of DDH. Results. DDH more accura tely describes the condition previously termed congenital dysplasia of the hip. The disorder is not always present at birth (congenital) and an infant may have a normal neonatal hip screening examination and su bsequently develop a dysplastic or dislocated hip. Developmental dyspl asia encompasses the wide spectrum of hip problems seen in infants and children. Physicians should understand that a normal neonatal screeni ng examination does not assure normal hip development, The diagnosis o f developmental dysplasia is made by physical examination. The Ortolan i and Barlow maneuvers were designed to detect a subluxatable, disloca table, or dislocated hip in the neonatal period. In the older child, l imited abduction becomes a more reliable sign. The examination is vari able depending on the type of dysplasia and changes with growth. The u ltrasound is proving to be a sensitive tool in confirming the diagnosi s in newborns and infants from birth to 4 months of age. The ultrasoun d is also valuable in older infants in terms of documenting that the d ysplasia is responding to treatment. However, the ultrasound depends o n an experienced sonographer and, in some cases, may be too sensitive, resulting in overtreatment. After 3 to 4 months of age, an anteropost erior pelvis radiograph can confirm the diagnosis. Conclusions. All ne wborns should have a neonatal hip screening physical examination. Afte r screening, the hips should be re-examined during health examination visits at 2 weeks, 2 months, 4 months, 6 months, 9 months, and 1 year of age. If any question arises during these visits or if there are ass ociated risk factors, we recommend an ultrasound if the infant is <4 m onths of age or an anteroposterior pelvis radiograph if >4 months of a ge.