What is the diagnosis and treatment for developmental dysplasia of the hip (DDH)?

From the Guidelines

Hip dysplasia should be screened for in infants with risk factors, such as family history of DDH, breech presentation, and inconclusive findings on physical examination, using a combination of physical examination and selective ultrasound screening, as recommended by the American Academy of Pediatrics 1. The most important risk factors for DDH are female gender, breech positioning in utero, and a positive family history, carrying relative risks of 2.5,3.8, and 1.4, respectively, in a large meta-analysis 1. Some key points to consider in the management of hip dysplasia include:

• The natural history of DDH depends on the type and degree of abnormality, with most borderline “abnormal” hips during the neonatal period likely representing physiologic immaturity, as 60% to 80% identified by physical examination and more than 90% identified by ultrasound (US) spontaneously normalize at follow-up 1.
• Late presentation is a major negative prognostic factor, with these patients more likely to require complex treatment and surgical intervention, and to experience long-term complications 1.
• The goals of an ideal screening program are early detection of patients who have DDH when therapy is typically noninvasive and often most effective, and exclusion of patients without DDH for whom unnecessary treatment could be costly and potentially harmful 1.
• The most important screening method is a hip examination at every well-baby visit according to the recommended periodicity schedule for well-baby examinations 1.
• Universal US screening for DDH in newborns is not recommended, as it may lead to overtreatment and iatrogenic avascular necrosis, and instead, selective screening should be performed in infants with risk factors or based on physical examination findings 1. Some of the key treatment options for hip dysplasia include:
• For infants, a Pavlik harness is typically used for 6-12 weeks to guide proper hip development, with an overall success rate ranging from 67% to 83% 1.
• In older children, more intensive treatments may be necessary, including closed reduction with a spica cast or surgery.
• For adults with hip dysplasia, treatment focuses on managing symptoms with physical therapy, anti-inflammatory medications, and activity modification, with surgical options including periacetabular osteotomy to reposition the hip socket or total hip replacement.

From the Research

Definition and Diagnosis of Hip Dysplasia

• Hip dysplasia is a condition where the hip joint doesn't form properly, leading to an increased risk of osteoarthritis 2, 3.
• The diagnosis of hip dysplasia can be challenging, as the clinical presentation of mild and borderline acetabular dysplasia is similar to that of other young adult hip disorders, such as femoroacetabular impingement 2.
• A thorough history, physical examination, and radiographic evaluation are essential for proper diagnosis 2.

Treatment Options for Hip Dysplasia

• Periacetabular osteotomy (PAO) is a common treatment for acetabular dysplasia, with good outcomes reported at over 20 years postoperatively 2, 3, 4.
• PAO can be performed using a mini-invasive technique, which has been shown to be effective in improving functional and radiological outcomes 4.
• Other treatment options include surgical hip dislocation and PAO, which can provide comprehensive deformity correction in patients with Perthes-like hip deformities and acetabular dysplasia 5.
• Total hip arthroplasty (THA) may be necessary in some cases, particularly in patients with advanced osteoarthritis, and various surgical techniques are available for acetabular and femoral reconstruction in dysplastic hips 6.

Outcomes and Complications of Treatment

• The outcomes of PAO have been shown to be encouraging, with improved hip joint survival and clinical outcomes reported at medium-term follow-up 3.
• The most common complication of PAO is transient lateral femoral cutaneous nerve hypoaesthesia 4.
• Cartilage thickness has been shown to be preserved up to 2.5 years after PAO, and the presence of labral tears does not accelerate cartilage degeneration after PAO 3.
• The treatment of intra-articular labrochondral pathology and femoral head-neck offset abnormalities at the time of PAO has become more common, with the goal of improving long-term outcomes 2.