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Developmental dysplasia of the hip in the newborn: A systematic review

Vivek Gulati1, Kelechi Eseonu, Junaid Sayani

  • 1Vivek Gulati, Kelechi Eseonu, Junaid Sayani, Nizar Ismail, Adeel Aqil, Saket Tibrewal, Department of Orthopaedic Surgery, Imperial College NHS Trust, London W6 8RF, United Kingdom.

World Journal of Orthopedics
|April 24, 2013
PubMed

Insights

Developmental dysplasia of the hip (DDH) is diagnosed and monitored using clinical tests and ultrasound. While the Pavlik harness is the gold standard treatment, success rates vary, and complications like avascular necrosis can occur.

Area of Science:

  • Orthopedics
  • Pediatric Imaging
  • Developmental Biology

Background:

  • Developmental dysplasia of the hip (DDH) encompasses a range of hip abnormalities, from mild acetabular dysplasia to complete dislocations.
  • Diagnosis and monitoring rely on clinical examination and ultrasound imaging, with classification systems utilizing alpha and beta angles and dynamic coverage index (DCI).
  • Screening programs for DDH exhibit geographic variability, and specific risk factors prompt ultrasound assessment in newborns.

Purpose of the Study:

  • To review the diagnostic methods, classification systems, and evolving treatment strategies for developmental dysplasia of the hip.
  • To evaluate the efficacy and potential complications associated with current treatments, particularly the Pavlik harness.
  • To discuss alternative non-surgical and surgical interventions for DDH.

Main Methods:

  • Review of clinical diagnostic tests and ultrasound imaging parameters (alpha angle, beta angle, DCI).
  • Analysis of treatment modalities including the Pavlik harness, alternative non-surgical devices, and surgical procedures (osteotomies).
  • Examination of reported success rates and complications associated with different treatment approaches.

Main Results:

  • Ultrasound parameters like beta angle and DCI can predict Pavlik harness treatment success.
  • Pavlik harness treatment success rates range widely (7%-99%), with avascular necrosis occurring in 0%-28% of cases.
  • Surgical options include femoral and pelvic osteotomies, with potential complications such as epiphyseal or sciatic nerve damage.

Conclusions:

  • Ultrasound plays a crucial role in diagnosing, classifying, and monitoring DDH, aiding in treatment selection.
  • The Pavlik harness remains a primary treatment, but careful monitoring is essential due to variable success and complication rates.
  • Both non-surgical and surgical interventions offer alternatives, each with specific indications and potential risks that must be managed.

Keywords:
CongenitalDevelopmental dysplasia of the hipPavlik harnessPelvic osteotomyUltrasound screening

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