Developmental dysplasia of the hip: update of management

Overview

This 2019 review in EFORT Open Reviews by Vaquero-Picado, González-Morán, Gil Garay and Moraleda (Hospital Universitario La Paz, Madrid) updates the diagnosis and management of developmental dysplasia of the hip (DDH). DDH is a spectrum that runs from neonatal instability and acetabular dysplasia to subluxation and complete dislocation. The authors present DDH as a leading cause of early osteoarthritis and of hip replacement in young adults.

Who it is for

Paediatric orthopaedic surgeons, paediatricians, neonatologists, paediatric radiologists and primary care doctors involved in newborn and infant hip assessment.

Key areas covered

The review describes normal hip development and the adaptive changes of the dysplastic hip, and weighs mechanical, hormonal and familial theories of origin. Breech presentation and family history are singled out as the most consistently supported risk factors. It explains that many mild neonatal findings resolve on their own, while persistent dysplasia overloads the articular cartilage. On diagnosis, it covers the Barlow and Ortolani manoeuvres in the newborn, limited abduction as the key sign in older infants, and the limited value of isolated clicks and skin-fold asymmetry. On imaging, it discusses ultrasound in early infancy and radiographic assessment once the femoral head ossifies.

Notable emphasis

The authors support universal clinical examination of newborns combined with selective ultrasound for infants with abnormal findings or key risk factors. They note that universal ultrasound screening has not reduced late dysplasia and increases overtreatment. Treatment is framed around three principles: a concentric, stable reduction (by harness in young infants, or closed or open reduction guided by arthrography when that fails); monitoring of acetabular development; and pelvic or femoral osteotomy for residual dysplasia. Avascular necrosis is described as an iatrogenic complication linked to excessive abduction and forced reduction.

How to use this guideline

The article summarises imaging parameters, harness principles and osteotomy options. Readers should consult the full text for specific diagnostic criteria, age windows and angle measurements.