Developmental dysplasia of the hip

doi:10.1136/bmj.b4454

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M D Sewell, specialist registrar trauma and orthopaedics1,
K Rosendahl, consultant paediatric radiologist2,
D M Eastwood, consultant paediatric orthopaedic surgeon12

¹Catterall Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP
²Department of Radiology, Great Ormond Street Hospital for Children, London, UK

Correspondence to: D M Eastwood d.m.eastwood{at}btinternet.com

Accepted 16 October 2009

Developmental dysplasia of the hip affects 1-3% of newborns.1 2 ^w1-w3 A registry based study showed that it was responsible for 29% of primary hip replacements in people up to age 60 years.3 The effectiveness of screening programmes aimed at early detection varies according to their organisation, methods of ascertainment, and diagnostic criteria.1 4 5 ^w4 Delay in diagnosis means that more complex treatments with higher failure rates will be required, so early diagnosis and prompt, appropriate treatment are essential. We describe the diagnosis, management, and screening controversies for hip dysplasia and provide a framework for early assessment, based on the available literature, including studies with level 1 evidence.

Summary points

Developmental dysplasia of the hip affects 1-3% of all newborns; it ranges from mild acetabular dysplasia with a stable hip to a frankly dislocated hip with a dysmorphic femoral head and acetabulum
Delayed diagnosis requires more complex treatment and has a less successful outcome than dysplasia diagnosed early
Limited hip abduction (<60°) in 90° of hip flexion may be the most sensitive sign for detecting a dislocated hip in neonates; the Barlow and Ortolani tests can be difficult to elicit and must be performed properly
Ultrasound, assessing both morphology and stability, helps diagnosis in children under 4.5 months; after this, pelvic radiographs are more useful
Controversy still exists regarding the role of clinical versus ultrasound screening for developmental dysplasia of the hip in the newborn and whether ultrasound screening should be selective (high risk) or universal

What is developmental dysplasia of the hip?

The term refers to a spectrum of pathology, ranging from mild acetabular dysplasia with a stable hip through more severe forms of dysplasia, often associated with neonatal hip instability, to established hip dysplasia with or without later subluxation or dislocation. The condition used to be known as congenital dislocation of the …