Overview on developmental dysplasia of the hip

Developmental dysplasia of the hip (DDH) is an important cause of childhood disability: the spectrum of pathology ranges from acetabular dysplasia with enlocated, stable hips to complete dislocation. The precise definition of DDH is itself controversial and usually refers to an abnormality in development, such as in size, shape, or organization, of the femoral head, acetabulum, or both. These changes may lead to increased contact pressures on the joint and ultimately to hip arthritis. However, before the development of frank degenerative changes, many patients become symptomatic secondary to abnormal hip biomechanics, hip instability, impingement, or labral and chondral pathologies. Treatment depends upon the age of diagnosis. The primary aim of this treatment is to achieve a stable concentric reduction of the hip to enable normal joint development. When detected early, non-surgical treatment with a harness or cast is possible while, when non-surgical treatment fails, open reduction and cast should be considered. A complication of those treatment is avascular necrosis of the hip (AVN). When DDH is detected late, tenotomies, acetabular reorientation, or combined femoral and acetabular osteotomies should be considered. If DDH is not treated, it may lead to juvenile arthritis and lifelong gait problems, in those stages a total hip replacement should be considered.