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Introductory Chapter: Five-Dimensional Approach to the Developmental Dysplasia of the Hip

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Duško Spasovski

Published: April 12th, 2017

DOI: 10.5772/67658

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Developmental dysplasia of the hip (DDH) is not a specific disorder; it is rather a scale of overlapping and transforming conditions. It ranges from occult dysplasia seen on ultrasound screening of newborns, neonatal hip instability and dislocated hip whether reducible by orthopaedic manipulation or not. The hallmark of DDH is acetabular dysplasia—abnormality in size, shape or orientation of acetabulum. A thoughtful elucidation regarding DDH is that it is ‘a common and preventable cause of childhood disability’ [1]. Complications and consequences of DDH make this time interval much longer, though.

The incidence of many faces of DDH is fortunately distributed: it is reported to be as much as 8% for dysplasia, 1–3% for neonatal hip instability and <0.2% for frank dislocation [24]. These epidemiological data are greatly influenced by both diagnostic criteria and diagnostic methods used [5, 6]. They evolve not only due to demographic changes of population, predominantly through migrations and genetic mixing, but also due to changes in nutrition [79].

DDH is not a disease of modern age. It was recognised and described by Hippocrates as a congenital dislocation of the hip. Dysplastic hips and presence of false acetabulum were found in skeletons from medieval times [1014].

Present etiological concept of DDH is multifactorial, consisting of endogenous (genetic disorders of collagen or collagen-related enzymes, transmembrane G-protein) [15, 16] and exogenous factors (related to intrauterine biomechanics, such as breech position and history of prior pregnancies, or environmental like birth in a certain season, swaddling technique) [1719]. Breech presentation, positive family history of DDH, female sex, vaginal delivery, primiparity and oligohydramnion are usually regarded to as DDH risk factors. Some authors include other mechanical intrauterine restrictions (large baby, multiple pregnancy), advanced maternal age and delivery-related conditions (post-maturity) [1, 20]. It is worth noting that premature birth is not a risk factor for DDH [21]. Risk factors have limited clinical importance, however, due to both low sensitivity (10–27% of all infants who have DDH also have any risk factor) and low specificity (under 10% of children with risk factors have DDH) [22, 23].

Historically, there were several crucial events that improved both the diagnosing and treating this disease.

  1. First, understanding the hip biomechanics, Lorenz in 1895 introduced first successful method of closed reduction, using plaster cast in extreme abduction for retention [24]. Results were immediately supported with new method discovered same year: X-rays, and so the Lorenz method became widespread.

  2. Then, in 1935, Italian paediatrician Ortolani established a diagnostic manoeuvre used to verify present dislocation with audible and sensible ‘click’ [25]. He was the first to recognize the importance of diagnosis of dislocated hip in infants. A systematic screening of newborn hips has started.

  3. In 1944, Pavlik begun applying the harness as means for keeping dysplastic hips mobile but limited to advantageous abduction angles, thus promoting biomechanical stimulation of normal hip development [26].

  4. Modern operative treatment of acetabular dysplasia begun with Chiari [27] and Salter [28] pelvic osteotomy.

  5. In 1961, Charnley introduced modern concept of total hip replacement in the treatment of osteoarthritis, a common sequela of hip dysplasia in adult age [29].

  6. Following the technological improvements, Graf introduced ultrasound as a method for visualisation of the hip and described diagnostic criteria for assessment of hip dysplasia [30].

  7. Finally, with screening data available, Klisic introduced a new name ‘developmental dysplasia’ [31].

Basically, there are five very important dilemmas that demarcate the struggle with this rather recalcitrant medical condition. Their analysis reflects both the complexity of problem and diversity of solutions currently available across the medical practice in the whole world.


1. Screening for hip dysplasia: overlooking versus overtreating

Neonatal hip joint demonstrates significant potential for growth and remodelling. Still, the outcome of nonoperative reduction of dislocated femoral head and its safe containment within the acetabulum strongly depends on timing. If a treatment begins within first 7 weeks, it will be highly successful [3235] regardless if one or both hips are treated [36]. That is why meticulous clinical examination of hips in newborns is mandatory for decades. Establishing a diagnosis of DDH after 3 months of age is considered as a late presentation, with estimated incidence from 0.02 to 0.2% [37, 38]. It is associated with higher rate of operative treatment, worse prognosis and increased healthcare cost [3943].

Unstable or dislocated hip is usually diagnosed by combined Ortolani-Barlow manoeuvre, with satisfactory specificity (>84%) but controversial sensitivity (from 7 to 98% in various studies) [44]. These clinical signs, however, cannot pinpoint acetabular dysplasia. For that reason, in some medical systems, an ultrasound screening is also mandatory and universal [8], while in others, it is used only in selected, targeted cases [45]. These variations in screening protocol are due to economic, organisational reasons, as well as the concern of over diagnosing and possible unnecessary treatment [4648]. Most common ultrasound screening methods are according to Graf, Harcke, Terjesen and Suzuki. Data from Austria, UK and Ireland suggest that universal ultrasonic screening for DDH reduced both overall average healthcare expenses and the need for operative treatment [2, 45, 4952], although there are different opinions in the USA [53].

While very valuable for early detection of hip dislocation, and without any absolute contraindications [54] ultrasound in first 2 weeks of life has limited sensitivity to detect clinically relevant dysplasia, since a fraction of newborns have underdeveloped but healthy hips—a temporarily false positive result [4, 55, 56]. Some authors even suggest that ultrasound in first 6 weeks should confirm the diagnosis of DDH only if hip is decentred (Graf III type) or dislocated (Graf IV type). For true incidence of hip dysplasia, a correlation of ultrasound data, clinical examination and the number of late presented cases requiring operative treatment should all be analysed.

Nevertheless, the problem how to discriminate between dysplastic hips and healthy hips still remains—ultrasound is too dependent on examiner’s skills, while radiographic criteria are usually biased by pelvic rotation [57]. Effective screening for DDH should be characterised by low percentage of cases that require surgical intervention, and all of those due to failures of nonoperative treatment, rather than due to late detection [49, 58]. In some studies, the majority of patients with symptomatic dysplasia in adult age did not meet criteria for selective ultrasound screening in infant age—they were false negative on clinical examination [59].


2. Neonatal hip instability: nature versus therapy

Like hip dysplasia, neonatal hip instability follows similar diagnostic concerns. This condition is diagnosed either by provocative tests (Barlow) or by dynamic ultrasound testing (Harcke technique) [60] with substantial reproducibility and accuracy only achieved in combination of these methods [40]. On the other hand, failure of recognition and treatment of neonatal hip instability can lead to significant hip dysfunction [61].

Neonates are usually born with slight flexion contracture (25–30°), which should spontaneously decrease to <20° at 6 weeks, and 7° at 12 weeks. In addition, one should bear in mind that majority of hips clinically unstable at birth will resolve spontaneously within first 8 weeks [62], in some cases until 3 years of age [63]. In other words, specificity of clinical and ultrasonic examination improves with growth. This is particularly true for testing if there is limited abduction, which meets its peak of reliability as DDH marker at the age between 3 and 6 months [64].

The relation between abduction position and movements and proper stimulation of dysplastic/unstable acetabulum to become better is clearly demonstrated, and positioning of legs influences the outcome of hip development [65]. While wide (double) diapering stimulates beneficial dynamic abduction of both hips, there is also an opposite praxis of swaddling (hips in extension and in zero abduction) either due to traditional routine in some parts of the world (Middle East, Japan, Native Americans, etc.) [6668] or for the prevention of excessive crying and promoting sleep [69]. It is clear, however, that risk for hip deterioration if legs are kept laced grossly surpasses all potential benefits, which are easily achievable by other, less hazardous means.


3. Natural history of DDH: prevention versus operation

We already stated that dysplastic and unstable hips may undergo spontaneous recovery [70]. As for the cohort of non-recovering hips, it has been observed that DDH leads to significant loss of normal joint function [71]. Dysplastic hips have tendency to evolve over years into painful and debilitating osteoarthritis [7274], while dislocated hips are accompanied with short posture and waddling gait throughout life, and if not reduced operatively within the first 8 years, painful syndrome may eventually develop [59, 75]. In patients with untreated unilateral dislocation, pelvic obliquity deteriorates the distribution of hip force on contralateral hip joint, contributing to degeneration on that side as well, along with further compensatory dysfunctions of trunk and knees [11].

DDH and osteoarthritis share genetic biomechanical etiological aspects [76]. Longitudinal studies have revealed that degenerative changes induced by hip dysplasia develop more rapidly than in other predisposing conditions [77]. Total hip replacement (THR) is a surgical procedure that is most often performed in treating symptomatic advanced osteoarthritis, especially in younger age [7882]. The diagnosis of DDH in first-order relative increases a chance for THR by the age of 65 [83]. Recent studies show that average hospital cost for primary THR secondary to DDH is higher than in other cases. Also, the severity of DDH additionally increases those expenses [79, 84]. If DDH is diagnosed early and the treatment was nonoperative, the rate of osteoarthritis at long-term follow-up is twice lower than after open reduction [81]. On the other hand, survival rate of dislocated hips that undergone operative treatment in infancy including innominate osteotomy was 54% at the age of 45 [85].


4. The follow-up challenge: hip morphology versus function

Since DDH is a kind of ‘moving target’ throughout patient’s life, several assessment protocols are in use for follow-up once the diagnosis is established, depending on the kind of intervention (observation, nonoperative or operative procedure), age and complaints. They all have the same two prominent characteristics:

  1. Low reliability and inter-observer concordance [86].

  2. Inadequate correlation of functional and radiographic results [87], implying that not all radiographically dysplastic/arthritic hip joints are the same, and that more than morphologic factors influence the onset and severity of symptoms.

Health-related part of elusive term we refer to as ‘quality of life’ (QoL) includes, but is not limited to, satisfaction in physical, emotional and social aspects of life. Quality of life with DDH is mostly affected by pain, gait disturbance, limited range of motion and leg length discrepancy. These factors are not independent, they aggravate each other. Patients become regular consumers of various healthcare services and products, spending days and money on rehabilitation, usually getting weight because of inadequate activity. Several studies demonstrated long-term improvement in QoL after THA in patients diagnosed with DDH [88, 89]. Although very important for patient, QoL assessment should be primarily used to identify their expectation regarding the type of treatment and should not replace clinical examination and standard diagnostic methods [90, 91].


5. The impact of DDH on healthcare: cause versus effect

Many diseases have been imposing a strong burden to healthcare service on global scale, in aspects of organisation, cost and consequences of diagnostic and therapeutic modalities indicated. In a rather long list, one could count in tuberculosis, diabetes, cardiac failure, cancer, AiDS and DDH. Most of them share the same characteristic of significant mortality, direct or indirect through complications. On the other hand, DDH is among the few exceptions that are not directly life threatening but deteriorate the quality of life and/or working ability up to great extent and for a long time [92].

Osteoarthritis is one of the major causes of non-cancer pain, impairing daily and social activities, and carrying a significant economic burden measurable in billions of dollars annually [93, 94]. Estimations are that there are more than 4.7 million THA operations done annually in the whole world, with significant portion due to DDH [95]. Average total expenses of THA treatment are about 20,000 euros per patient [17], with great variance. For illustration, in Serbian healthcare system, it is less than 10,000 euros using the same modern implants.

In accordance to non-maleficent approach, detailed patient examination and utilisation of all diagnostic and therapeutic procedures that are indicated for suspected condition in every patient, always leads to better clinical outcome. But in everyday practice, there is usually more than one option for every step in patient management. These options sometimes differ not only in side effects, reliability, safety or indication requirements but also in technical and financial availability. That’s where statistics and economics come to interfere with strictly medical issues. In some cases, such as DDH, many factors need to be considered in order to see the whole picture [9698].

For instance, introduction of ultrasound examination to clinical screening for hip dysplasia revealed that some clinically positive cases are false positive, but also vice versa; it brought a fraction of clinically normal, but sonographically dysplastic or lax hips. Since it incurred extra cost and organisational effort, subsequent justification had to come from economic studies [45, 68].

Factors that contribute to late diagnosing of DDH include inconsistent implementation of screening protocol, lack of appropriate awareness of the disease and its complications and insufficient training in proper and timely detection of DDH and therapeutic actions [42, 99]. Important but often neglected issue in this situation, where operative treatment makes the method of choice, is the involvement of parents (usually mother) in the process of treatment. Mothers stay with their child for the whole duration of the treatment—usually for 3–6 months following open reduction, with the child immobilised in bed by plaster cast or skin traction, in hospital and/or at home for weeks. This is tangled with many new problems involving the patient itself (such as feeding, hygiene in the cast, dressing, sleeping, transport), mother (employment status, social isolation, existing physical and mental health condition) and the rest of the family (altered daily activities) for a long period of time [100]. There is a general lack of information and outpatient support about recovering child’s complex needs during that period [101, 102].



There is considerable diversity in opinions worldwide regarding both diagnostic and therapeutic approach to DDH. Besides orthopaedic, many other factors could contribute to it: demographic, socioeconomic and differences regarding healthcare organisation [5]. Reflecting this diversity, in this book authors will present their experience and opinion on several important issues regarding DDH: screening for DDH, biomechanical considerations, diagnostic procedures in all age groups, treatment modalities of hip dysplasia and dislocation in childhood, and dealing with the consequences in adulthood.


  1. 1. Woodacre T, Ball T, Cox P. Epidemiology of developmental dysplasia of the hip within the UK: refining the risk factors. Journal of Children’s Orthopaedics. 2016;10(6):633–42.
  2. 2. Woodacre T, Dhadwal A, Ball T, Edwards C, Cox PJ. The costs of late detection of developmental dysplasia of the hip. Journal of Children’s Orthopaedics. 2014;8(4):325–32.
  3. 3. Jacobsen S, Sonne-Holm S, Søballe K, Gebuhr P, Lund B. Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study. Acta Orthopaedica. 2005;76(2):149–58.
  4. 4. Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. 2007;369(9572):1541–52.
  5. 5. Mulpuri K, Schaeffer EK, Kelley SP, Castañeda P, Clarke NM, Herrera-Soto JA, Upasani V, Narayanan UG, Price CT, IHDI Study Group. What is the impact of center variability in a multicenter international prospective observational study on developmental dysplasia of the hip? Clinical Orthopaedics and Related Research. 2016;474(5):1138–45.
  6. 6. Dogruel H, Atalar H, Yavuz OY, Sayli U. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. International Orthopaedics. 2008;32:415–9.
  7. 7. Loder RT, Shafer C. The demographics of developmental hip dysplasia in the Midwestern United States (Indiana). Journal of Children’s Orthopaedics. 2015;9(1):93–8.
  8. 8. Thaler M, Biedermann R, Lair J, et al. Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. The Journal of Bone and Joint Surgery. British Volume. 2011;93:1126–30.
  9. 9. Grundt JH, Nakling J, Eide GE, Markestad T. Possible relation between maternal consumption of added sugar and sugar-sweetened beverages and birth weight—time trends in a population. BMC Public Health. 2012;12:901.
  10. 10. Rogers J, Watt I, Dieppe P. Medical history: arthritis in Saxon and mediaeval skeletons. BMJ. 1981;283(6307):1668–70.
  11. 11. Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthopedics. 2011:1-46.
  12. 12. Thould AK, Thould BT. Arthritis in Roman Britain. BMJ. 1983;287(6409):1909–11.
  13. 13. Blatt SH. To swaddle, or not to swaddle? Paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America. American Journal of Human Biology. 2015;27(1):116–28.
  14. 14. Mitchell PD, Redfern RC. Diagnostic criteria for developmental dislocation of the hip in human skeletal remains. International Journal of Osteoarchaeology. 2008;18(1):61–71.
  15. 15. Soran N, Altindag O, Aksoy N, Cakır H, Taşkın A, Soran M, Işıkan E. The association of serum prolidase activity with developmental dysplasia of the hip. Rheumatology International. 2013;33(8):1939–42.
  16. 16. Feldman GJ, Parvizi J, Levenstien M et al. Developmental dysplasia of the hip: linkage mapping and whole exome sequencing identify a shared variant in CX3CR1 in all affected members of a large multigeneration family. Journal of Bone and Mineral Research. 2013;28:2540–9.
  17. 17. Palmén K. Prevention of congenital dislocation of the hip. Acta Orthopaedica Scandinavica. 1984;55(208):5–107.
  18. 18. Loder RT, Shafer C. Seasonal variation in children with developmental dysplasia of the hip. Journal of Children’s Orthopaedics. 2014;8(1):11–22.
  19. 19. Colta RC, Stoicanescu C, Nicolae M, Oros S, Burnei G. Hip dysplasia screening-epidemiological data from Valcea County. Journal of Medicine and Life. 2016;9(1):106.
  20. 20. Chan A, McCaul K, Cundy P, Haan E, Byron-Scott R. Perinatal risk factors for developmental dysplasia of the hip. Archives of Disease in Childhood. Fetal and Neonatal Edition. 1997;76(2):F94–100.
  21. 21. Orak MM, Onay T, Gümüştaş SA, Gürsoy T, Muratlí HH. Is prematurity a risk factor for developmental dysplasia of the hip? A prospective study. The Bone & Joint Journal. 2015;97(B):716–20.
  22. 22. Boere-Boonekamp MM, Kerkhoff TH, Schuil PB, et al. Early detection of developmental dysplasia of the hip in The Netherlands: the validity of a standardized assessment protocol in infants. American Journal of Public Health. 1998;88(2):285–8.
  23. 23. Sahin F, Akturk A, Beyazova U, et al. Screening for developmental dysplasia of the hip: results of a 7-year follow-up study. Pediatrics International. 2004;46(2):162-6.
  24. 24. Lorenz A. The So-Called Congenital Dislocation of the Hip. Its Pathology and Treatment. Stuttgart: Enke; 1920, pp. 95–6.
  25. 25. Ortolani M. A very little known sign and its importance in the early diagnosis of congenital hip predislocation. Pediatria. 1937;45:129.
  26. 26. Pavlik A. Method of functional therapy with strap braces as a principle of conservative therapy of congenital dislocation of the hip in infants. Zeitschrift fur Orthopadie and Ihre Grenzgebiete. 1957;89:341–52.
  27. 27. Chiari K. Results of pelvic osteotomy as of the shelf method acetabular roof plastic. Zeitschrift fur Orthopadie and Ihre Grenzgebiete. 1955;87(1):14–26.
  28. 28. Salter RB. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. The Bone & Joint Journal. 1961;43(3):518–39.
  29. 29. Charnley J. Arthroplasty of the hip: a new operation. Lancet. 1961;1(7187):1129–32.
  30. 30. Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasound combound treatment. Archives of Orthopaedic and Trauma Surgery. 1980;97:117–33.
  31. 31. Klisic PJ. Congenital dislocation of the hip: a misleading term. The Journal of Bone and Joint Surgery. British Volume. 1989;71:136.
  32. 32. Van der Sluijs JA, De Gier L, Verbeke JI et al. Prolonged treatment with the Pavlik harness in infants with developmental dysplasia of the hip. The Journal of Bone and Joint Surgery. British Volume. 2009;91:1090–3.
  33. 33. Atalar H, Sayli U, Yavuz OY, Uras I, Dogruel H. Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip. International Orthopaedics. 2007;31:145–50.
  34. 34. Walton MJ, Isaacson Z, McMillan D, Hawkes R, Atherton WG. The success of management with the Pavlik harness for developmental dysplasia of the hip using a United Kingdom screening programme and ultrasound-guided supervision. The Journal of Bone and Joint Surgery. British Volume. 2010;92:1013–16.
  35. 35. Cashman JP, Round J, Taylor G, Clarke NM. The natural history of developmental dysplasia of the hip after early supervised treatment in the Pavlik harness. A prospective, longitudinal follow-up. The Journal of Bone and Joint Surgery. British Volume. 2002;84:418–25.
  36. 36. Borowski A, Thawrani D, Grissom L, Littleton AG, Thacker MM. Bilaterally dislocated hips treated with the Pavlik harness are not at a higher risk for failure. Journal of Pediatric Orthopaedics. 2009;29:661–5.
  37. 37. Azzopardi T, van Essen P, Cundy P, Tucker G, Chan A. Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors. Journal of Pediatric Orthopaedics B. 2011;20:1–7.
  38. 38. Pollet V, Percy V, Prior HJ. Relative risk and incidence for developmental dysplasia of the hip. The Journal of Pediatrics. 2016;181:202-7.
  39. 39. Sharpe P, Mulpuri K, Chan A, Cundy PJ. Differences in risk factors between early and late diagnosed developmental dysplasia of the hip. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2006;91(3):158–62.
  40. 40. American Academy of Paediatrics. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. Clinical practice guideline: early detection of developmental dysplasia of the hip. Pediatrics. 2000;105:896.
  41. 41. Sewell MD, Eastwood DM. Screening and treatment in developmental dysplasia of the hip-where do we go from here? International Orthopaedics. 2011;35(9):1359–67.
  42. 42. Yagmurlu MF, Bayhan IA, Tuhanioglu U, Kilinc AS, Karakas ES. Clinical and radiological outcomes are correlated with the age of the child in single-stage surgical treatment of developmental dysplasia of the hip. Acta Orthopaedica Belgica. 2013;79(2):159–65.
  43. 43. Studer K, Williams N, Antoniou G, Gibson C, Scott H, Scheil WK, Foster BK, Cundy PJ. Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions. Medical Journal of Australia. 2016;204(6):240.
  44. 44. Omeroglu H, Koparal S. The role of clinical examination and risk factors in the diagnosis of developmental dysplasia of the hip: a prospective study in 188 referred infants. Archives of Orthopaedic and Trauma Surgery. 2001;121:7–11.
  45. 45. Elbourne D, Dezateux C, Arthur R, Clarke NM, Gray A, King A, Quinn A, Gardner F, Russell G. Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet. 2002;360(9350):2009–17.
  46. 46. Phelan N, Thoren J, Fox C, O’Daly BJ, O’Beirne J. Developmental dysplasia of the hip: incidence and treatment outcomes in the Southeast of Ireland. Irish Journal of Medical Science. 2015;184(2):411–5.
  47. 47. von Kries Reudiger, et al. General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case-control study. The Journal of Pediatrics. 2012;160(2):271–5.
  48. 48. Lennox IAC, McLauchlan J, Murali R. Failures of screening and management of congenital dislocation of the hip. The Journal of Bone and Joint Surgery. 1993;75-B:72–5.
  49. 49. Clegg J, Bache CE, Raut VV. Financial justification for routine ultrasound screening of the neonatal hip. The Journal of Bone and Joint Surgery. British Volume. 1999;81-B:852–7.
  50. 50. Gray A, Elbourne D, Dezateux C, King A, Quinn A, Gardner F, United Kingdom Collaborative Hip Trial Group. Economic evaluation of ultrasonography in the diagnosis and management of developmental hip dysplasia in the United Kingdom and Ireland. The Journal of Bone and Joint Surgery. American Volume. 2005;87(11):2472–9.
  51. 51. Thallinger C, Pospischill R, Ganger R, Radler C, Krall C, Grill F. Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. Journal of Children’s Orthopaedics. 2014;8(1):3–10.
  52. 52. Kolb A, Schweiger N, Mailath-Pokorny M, Kaider A, Hobusch G, Chiari C, Windhager R. Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. International Orthopaedics. 2016;40(1):123–7.
  53. 53. US Preventive Services Task Force. Screening for developmental dysplasia of the hip: recommendation statement. Pediatrics. 2006;117(3):898–902.
  54. 54. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. Journal of Ultrasound in Medicine. 2009;28:114–9.
  55. 55. Delaney LR, Karmazyn B. Developmental dysplasia of the hip: background and the utility of ultrasound. Seminars in Ultrasound, CT and MRI. 2011;32(2):151–6.
  56. 56. Gardner R, Alshryda S, Kelley SP, Wedge J. Evidence-based management of developmental dysplasia of the hip. In: Alshryda S, Huntley J, Banaszkiewicz PA, editors. Paediatric orthopaedics: an evidenced-based approach to clinical questions. Springer; Basel, Switzerland;2016, pp. 27–42.
  57. 57. Wenger D, Düppe H, Tiderius CJ. Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip: a cohort study of 243 infants. Acta Orthopaedica. 2013;84(5):483–8.
  58. 58. Sanghrajka AP, Murnaghan CF, Shekkeris A, Eastwood DM. Open reduction for developmental dysplasia of the hip: failures of screening or failures of treatment? The Annals of the Royal College of Surgeons of England. 2013;95(2):113–7.
  59. 59. Sink EL, Ricciardi BF, Torre KD, Price CT. Selective ultrasound screening is inadequate to identify patients who present with symptomatic adult acetabular dysplasia. Journal of Children’s Orthopaedics. 2014;8:451–5.
  60. 60. Harcke HT, Clarke NM, Lee MS et al. Examination of the infant hip with real-time ultrasonography. Journal of Ultrasound in Medicine. 1984;3:131–7.
  61. 61. Engesaeter IO, Lie SA, Lehmann TG, Furnes O, Vollset SE, Engesaeter LB. Neonatal hip instability and risk of total hip replacement in young adulthood: follow-up of 2,218,596 newborns from the Medical Birth Registry of Norway in the Norwegian Arthroplasty Register. Acta Orthopaedica. 2008;79:321–6.
  62. 62. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: what has changed in the last 20 years? World Journal of Orthopedics. 2015;6(11):886.
  63. 63. Pruszczynski B, Harcke HT, Holmes L, Bowen JR. Natural history of hip instability in infants (without subluxation or dislocation): a three year follow-up. BMC Musculoskeletal Disorders. 2014;15(1):1.
  64. 64. Shipman SA, Helfand M, Moyer VA, Yawn BP. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics. 2006;117(3):e557–76.
  65. 65. Mahan ST, Kasser JR. Does swaddling influence developmental dysplasia of the hip? Pediatrics. 2008;121:177–8.
  66. 66. Schwend RM, Shaw BA, Segal LS. Evaluation and treatment of developmental hip dysplasia in the newborn and infant. Pediatric Clinics of North America. 2014;61:1095–107.
  67. 67. Yamamuro T, Ishida K. Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan. Clinical Orthopaedics and Related Research. 1984;184:34–40.
  68. 68. Kutlu A, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and its relation to swaddling used in Turkey. Journal of Pediatric Orthopaedics. 1992;12:598–602.
  69. 69. Clarke NM. Swaddling and hip dysplasia: an orthopaedic perspective. Archives of Disease in Childhood. 2014;99(1):5–6.
  70. 70. Munkhuu B, Essig S, Renchinnyam E, Schmid R, Wilhelm C, Bohlius J, Chuluunbaatar B, Shonkhuuz E, Baumann T. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PLoS One. 2013;8(10):e79427.
  71. 71. Angliss R, Fujii G, Pickvance E, Wainwright AM, Benson MKD. Surgical treatment of late developmental displacement of the hip. The Journal of Bone and Joint Surgery. British Volume. 2005;87:384–94.
  72. 72. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. The Journal of Bone and Joint Surgery. American Volume. 1995;77:985–9.
  73. 73. Harris WH. Etiology of osteoarthritis of the hip. Clinical Orthopaedics and Related Research. 1986;213:20–33.
  74. 74. Mahan ST, Katz JN, Kim YJ. To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. The Journal of Bone and Joint Surgery. American Volume. 2009;91:1705–19.
  75. 75. Hartofilakidis G, Lampropoulou-Adamidou K. Lessons learned from study of congenital hip disease in adults. World Journal of Orthopedics. 2016;7(12):785.
  76. 76. Altman RD, Hochberg MC, Moskowitz RW, Schnitzer TH. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis & Rheumatism. 2000;43(9):1905–15.
  77. 77. Wyles CC, Heidenreich MJ, Jeng J, Larson DR, Trousdale RT, Sierra RJ. The John Charnley award: redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clinical Orthopaedics and Related Research. 2017;475(2):336-50.
  78. 78. Engesaeter IO, Lehmann T, Laborie LB, Lie SA, Rosendahl K, Engesaeter LB. Total hip replacement in young adults with hip dysplasia: age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty Register between 1987 and 2007. Acta Orthopaedica. 2011;82(2): 149–54.
  79. 79. Ashraf A, Larson AN, Maradit-Kremers H, Kremers WK, Lewallen DG. Hospital costs of total hip arthroplasty for developmental dysplasia of the hip. Clinical Orthopaedics and Related Research. 2014;472(7):2237–44.
  80. 80. Australian Orthopaedic Association. National joint replacement registry annual report. AOA, Adelaide; 2011.
  81. 81. Swedish Hip Arthroplasty Register. Annual report 2010 Göteborg. 2011. Accessed from
  82. 82. National Joint Replacement Registry for England and Wales. 8th annual report 2011 Hertfordshire. 2011. Accessed from
  83. 83. Lee CB, Mata-Fink A, Millis MB, Kim YJ. Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip. Journal of Pediatric Orthopaedics. 2013;33(2):107–11.
  84. 84. Sakellariou VI, Christodoulou M, Sasalos G, Babis GC. Reconstruction of the acetabulum in developmental dysplasia of the hip in total hip replacement. The Archives of Bone and Joint Surgery. 2014;2(3):130–6.
  85. 85. Thomas SR, Wedge JH, Salter RB. Outcome at forty-five years after open reduction and innominate osteotomy for late-presenting developmental dislocation of the hip. The Journal of Bone and Joint Surgery. American Volume. 2007;89:2341–50.
  86. 86. Ali AM, Angliss R, Fujii G, et al. Reliability of the Severin classification in the assessment of developmental dysplasia of the hip. Journal of Pediatric Orthopaedics B. 2001;10(4):293–7.
  87. 87. Schwend RM, Pratt WB, Fultz J. Untreated acetabular dysplasia of the hip in the Navajo. A 34 year case series follow-up. Clinical Orthopaedics and Related Research. 1999;364:108–16.
  88. 88. Knutsson S, Engberg IB. An evaluation of patients’ quality of life before, 6 weeks and 6 months after total hip replacement surgery. Journal of Advanced Nursing. 1999;30(6):1349–59.
  89. 89. Roidis NT, Pollalis AP, Hartofilakidis GC. Total hip arthroplasty in young females with congenital dislocation of the hip, radically improves their long-term quality of life. Journal of Arthroplasty. 2013;28(7):1206–11.
  90. 90. Motamed N, Ayatollahi A, Zare N, Sadeghi Hassanabadi A. Validity and reliability of the Persian translation of the SF-36 version 2 questionnaire. Eastern Mediterranean Health Journal. 2005;11(3):349–57.
  91. 91. Sanei F, Jamebozorgi AA, Irani A, Akbarzade Baghban A, Qoreishi M. Comparing the quality of life before and after total hip arthroplasty operation in patients with developmental dysplasia of the hip. Physical Treatments-Specific Physical Therapy Journal. 2016;5(4):219–24.
  92. 92. World Health Organization. World report on disability. Malta: WHO; 2011. Accessed from index.html
  93. 93. Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education and research. The National Academies Press, Washington, DC; 2011.
  94. 94. Gustavsson A, Bjorkman J, Ljungcrantz C, Rhodin A, Rivano-Fischer M, Sjolund KF, et al. Socio-economic burden of patients with a diagnosis related to chronic pain-register data of 840,000 Swedish patients. European Journal of Pain. 2012;16(2):289–99.
  95. 95. Li H, Wang L, Dai K, Zhu Z. Autogenous impaction grafting in total hip arthroplasty with developmental dysplasia of the hip. Journal of Arthroplasty. 2013;28(4):637–43.
  96. 96. Araujo B, Hernández Simón LM, Domininguez Hernández VM. Systemic parameter estimation for the diagnosis and treatment of developmental dysplasia of the hip in children. In: Proceedings of the 58th Annual Meeting of the ISSS, Washington, DC; Vol. 1(1); 2015.
  97. 97. Laborie LB, Engesæter IØ, Lehmann TG, Eastwood DM, Engesæter LB, Rosendahl K. Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Pediatrics. 2013;132:492–501.
  98. 98. Shorter D, Hong T, Osborn DA. Cochrane review: screening programmes for developmental dysplasia of the hip in newborn infants. Evidence Based Child Health. 2013;8:11–54.
  99. 99. Melo TE, Resende TM, Silva RC, Cruz SA, Oliveira VM. Developmental dysplasia of the hip: do the responsible for screening know what to do? Acta Ortopédica Brasileira. 2016;24(6):312–7.
  100. 100. Demir SG, Erden S, Bulut H, Carboga B, Elbas NO. The problems experienced by parents providing postoperative home care following their child’s surgery for developmental dysplasia of the hip. Orthopaedic Nursing. 2015;34(5):280–6.
  101. 101. Sparks L, Ortman MR, Aubuchon P. Meeting the developmental needs of a child in a body cast. Journal of Orthopaedic Nursing. 2005;9(1):35–8.
  102. 102. Tiroyan M. Investigation of obstacles for early detection of developmental dysplasia of the hip in children. Master thesis. American University of Armenia, Yerevana; 2007.

Written By

Duško Spasovski

Published: April 12th, 2017