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Developmental dysplasia of the hip from six months to four years of age

M G Vitale1, D L Skaggs

  • 1Orthopaedic Surgery, Children's Hospital of New York, New York-Presbyterian Medical Center, New York, NY, USA.

The Journal of the American Academy of Orthopaedic Surgeons
|December 4, 2001
PubMed

Insights

Developmental dysplasia of the hip (DDH) treatment varies by age. Newer approaches focus on specific hip conditions and avoiding femoral head osteonecrosis for better outcomes.

Area of Science:

  • Orthopedics
  • Pediatric Surgery
  • Developmental Biology

Background:

  • Developmental dysplasia of the hip (DDH) encompasses a range of hip abnormalities.
  • Early diagnosis and Pavlik harness use yield excellent results in infants under 6 months.
  • Treatment for DDH in older children (over 6 months) is more complex, aiming for concentric reduction and complication avoidance.

Purpose of the Study:

  • To review current treatment modalities for developmental dysplasia of the hip in children.
  • To highlight the shift in treatment focus from age-based to condition-specific management.
  • To emphasize strategies for minimizing iatrogenic osteonecrosis of the femoral head.

Main Methods:

  • Review of established and evolving treatment strategies for DDH.
  • Analysis of outcomes associated with various interventions like bracing, traction, and surgical osteotomies.
  • Discussion of factors influencing the risk of osteonecrosis.

Main Results:

  • Pavlik harness is highly effective for early-stage DDH (infants < 6 months).
  • For older children, achieving hip reduction requires diverse methods including bracing, traction, and osteotomies.
  • Avoiding extreme hip abduction and utilizing femur-shortening osteotomies reduce osteonecrosis incidence.
  • Pelvic osteotomy is increasingly favored for DDH in children over 18 months.

Conclusions:

  • Modern DDH management prioritizes addressing the specific pathology over solely relying on patient age.
  • Minimizing iatrogenic osteonecrosis is a key consideration, achieved through careful technique and surgical choices.
  • Pelvic osteotomy represents a valuable surgical option for select older DDH patients.

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