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Introduction: Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH. Materials and methods: In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed. Results: The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0–11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0–1.27). Conclusions: In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered. [ABSTRACT FROM AUTHOR]

Aim: Developmental dysplasia of hip (DDH) is a common disease that can be treated successfully if early diagnosis and treatment are possible. In our study, we aimed to determine the incidence of DDH by examining the pelvic radiographs of 12-24 months old children who were admitted to the pediatric emergency department for reasons other than suspicion of DDH. Material and Method: Between May 1, 2016 and March 9, 2017, 12-24 months old children who were admitted to our pediatric emergency department for various reasons were included in the study. The abdominal radiographs of these patients were obtained from the digital recording system and the radiographs were examined. For measurement; hip quadrants, Shenton-Menard line and acetabular index angle were examined and used for diagnosis. The incidence of DDH was calculated with the data obtained. Results: A total of 2044 patients were included in this study and 152 of them were diagnosed with DDH. Of the 152 patients with DDH, 98 were female and 54 were male. 73 of these patients had pathology in bilateral hips. Of the 152 patients with pathology, 23 had no information about this pathology. It was found that 15.1% of the patients diagnosed with DDH were not diagnosed with DDH. When hip dislocation was compared according to gender, Pearson chi-square test was found to be p<0.001 and it was found to be significantly higher in girls. Conclusion: The early diagnosis of patients with DDH will prevent the irreversible hip problems and surgeries in older ages. Emergency physicians should keep in mind the diagnosis of DDH, especially when examining the abdominal radiographs of children under 2 years of age, regardless of their complaints. [ABSTRACT FROM AUTHOR]

Aim: In Turkey, there is a growing consciousness of developmental dysplasia of the hip (DDH), especially after 2012, when the ministry of health has started the obligatory national DDH screening program. Despite many previous studies, exact national DDH incidence is not known yet. In this study, we aimed to report the incidence of DDH in İstanbul, for adding new data to the literature. Methods: We reviewed the ultrasonography (USG) records of 1491 babies who had undergone hip USG examination during a one-year period (Jan 2, 2016-Dec 30, 2016). We assessed the hips using Graf's classification of DDH. The incidence of DDH was calculated from these data. Result: We identified six type 2a (0.40%) and 1 type 2b (0.06%) cases, and we could not identified any case of type 2c, 2d, 3 and 4. Overall DDH incidence was found to be 0.46%. Of the seven DDH cases, five were female and two were male. None of the hips worsened during the two weeks of follow-up period, but most immature hips healed. Conclusion: This study suggests that the incidence of DDH in northwest İstanbul is lower than in other regions of Istanbul and Turkey. To have a more precise national incidence analysis, prospective multi-centered trials should be organized. [ABSTRACT FROM AUTHOR]

Abstract: Developmental dysplasia of hip (DDH) is one entity one occasionally comes across while in a busy orthopaedic or paediatric outpatient department. The knowledge of risk factors and awareness of the condition is must for every orthopaedic surgeon and paediatrician as well lest the diagnosis will be missed. An early diagnosis can alter the prognosis of the disease and prevent late disabilities. [Copyright &y& Elsevier]

Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH. [ABSTRACT FROM AUTHOR]

Background: Crowe type IV developmental dysplasia of hip (DDH), subtrochanteric shortening osteotomy is required to restore the hip joint. Several approaches have been described for subtrochanteric shortening osteotomy. Several osteotomy fixation techniques have been defined for Crowe type IV DDH. This study evaluates the outcomes of subtrochanteric shortening osteotomy fixed with a combination of split onlay autograft and distal fluted femoral stem. Materials and Methods: A retrospective study was carried out on 41 hips of 37 patients treated with total hip replacement for Crowe type IV developmental dysplasia of the hip by subtrochanteric transverse osteotomy and fixed with split intercalary autograft by two cables. A femoral stem with proximal coated and distally fluted was used. The patients were evaluated at a mean of 34 months (range 12-68 months) for union time, leg equalization, and clinical outcomes. Results: Mean time of union was 13.5 ± 4.6 weeks (range 6-24 weeks). Intraoperative instability of the osteotomy site (n = 16) that was encountered at the trial stage was restored properly by this surgical protocol. Leg length discrepancies were improved to 1.4 ± 0.8 cm (range 0-3 cm). Harris scores were improved from 47.7 ± 10.8 (range 30-68) to 88 ± 5.6 (range 72-98) (P < 0.05) points. There was no nonunion. Conclusions: Distally well-fitted stem and strengthening of fixation with split intercalary autograft promote additional rotational stability and improve bone union. [ABSTRACT FROM AUTHOR]

Background: Persistence of hip dysplasia into adolescence and adulthood can lead to an abnormal gait, which would do harm to patients' physiological and psychological health. The aim of this study was to summarize our results of tibial lengthening for reconstruction of limb length discrepancy in Crowe Type IV developmental dysplasia of hip in adulthood. Methods: Between January 2000 and December 2002, 11 patients' limb length discrepancy in Crowe Type IV developmental dysplasia of hip was treated by tibial lengthening. There were 8 women and 3 men, aged from 18 to 25 years, averaged 21.2 years. The limb length discrepancy was 4.0-7.1 cm. Results: Eleven patients were followed up for a mean of 110 months. The limping was much improved from a moderate or severe degree to a mild degree in all patients. In the group of callus distraction with external fixation, the average external fixation index was 37.0 days/cm. In the group of callus distraction over an intramedullary nail, the average external fixation index was 16.6 days/cm, and the mean radiographic consolidation index was 34.4 days/cm. The extent of lengthening ranged from 4.0 to 7.0 cm. Conclusions: Tibial lengthening may be a reliable treatment for untreated unilateral developmental dysplasia of hip in adolescents without pain but eager for improving limping. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of hip (DDH) is a common condition presenting to a pediatric orthopedic surgeon. There is a consensus on the surgical treatment of children with ages ranged from 18 to 24 months where majority agree on open reduction and hip spica. Open reduction was done with an additional pelvic procedure wherever required to get better results and prevent residual acetabular dysplasia (RAD) and early osteoarthritis. Materials and Methods: 35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2‑7 years). Results: No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI) of 35° and above. These were all from the group where open reduction alone was done. Conclusion: We feel that a preoperative AI of >40° and a per‑operative safe‑zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum. [ABSTRACT FROM AUTHOR]

Background Rotational acetabular osteotomy (RAO), Chiari osteotomy and shelf procedure are important treatments to delay the progression of osteoarthritis in developmental dysplasia of hip (DDH) patients, but their biomechanical differences are still unknown. This study was to evaluate the different biomechanical changes of hip joint after these three surgeries. Methods Sixteen DDH models of 8 human cadaver specimens were reconstructed, and treated by different surgeries, and then strain around femoral head was evaluated by strain gauges. Results Hip strain value of DDH model was decreased after treated by shelf procedure (Pleft = 0.016 and Pright = 0.021) and rotational acetabular osteotomy (P = 0.004), but not in Chiari osteotomy (P = 0.856). Moreover, the improved ratio of RAO treatment was better than shelf procedure (P = 0.015) and Chiari osteotomy (P = 0.0007), and the descendent range of shelf procedure was greater than Chiari osteotomy (P = 0.018). Conclusions From biomechanics points, RAO was more effective in relieving hip joint stress compared with shelf procedure and Chiari osteotomy. [ABSTRACT FROM AUTHOR]

The article provides information about developmental dysplasia of the hip (DDH) in children. Topics discussed are the variations in DDH related to age at the diagnoses, criteria for diagnoses and race, risk factors for DDH, clinical manifestations for DDH, tests performed to detect DDH depending on the age of the child, radiologic evaluation to confirm DDH findings, DDH screening of newborns, and treatment of DDH.

Background: While various predictors of treatment outcome of Pavlik harness have been reported, appropriate indications for treatment and relationships between patient characteristics and outcome are unclear. The present study aimed to identify radiological predictors for successful Pavlik harness treatment of DDH at the initiation of treatment and investigate the progression of radiological characteristics after successful treatment.Methods: One-hundred-forty-two of 527 infants who visited our hospital for secondary screening of DDH were treated with the Pavlik harness. One-hundred-eight hips of 108 infants experienced successful treatment and could be followed up until 3 years of age (group S); treatment was unsuccessful within the first 2 weeks for 22 hips of 21 infants (group F). We investigated the Graf classification and radiological parameters.Results: We observed the ipsilateral-side measurements of distance A and B as defined by Yamamuro and Chene's method to be significantly smaller and greater, respectively, in group F compared with those of group S. Group F tended to exhibit the smaller distance A and larger distance B compared to the group S among the same Graf type. The cut-off values for successful treatment at were >7.4 mm at initiation of treatment for distance A and <11.2 mm for distance B. The acetabular index (AI) of the ipsilateral side at the initiation of treatment was significantly correlated with that at 1 and 3 years of age. Patients with an AI of >32° at the initiation of harness treatment were more likely to exhibit hip dysplasia at 3 years of age.Conclusions: Radiographic parameters prior to the Pavlik harness could be predictors of treatment failure and DDH in the future. This study showed that AI at the initiation of treatment is associated with residual acetabular dysplasia, suggesting that radiographic assessment may be useful even considering the risks associated with radiation exposure. [ABSTRACT FROM AUTHOR]

Purpose: To address the question, compared to having hip replacement with latent revision, does Bernese periacetabular osteotomy (PAO) before primary hip replacement occupy a preferable treatment strategy for middle aged (aged 35-54 years) hip dysplasia patients? We assessed the mid-term functional outcome and survivorship of PAO in those patients. Methods: Forty-one hips in 36 patients at middle age at the time of surgery (mean age, 39.5 years; range, 35-47 years) were retrospectively identified out of a total PAO cohort of 315 patients. Eleven of the 41 PAO hips also underwent osteochondroplasty at the femoral head-neck junction. Radiographic parameters of lateral centre edge angle, anterior centre edge angle and hip joint medialisation were investigated using the Harris Hip Score (HHS). Results: The average follow-up was 5.1 years (range, two to ten years). Radiographic parameters postoperatively improved into the normal range, whereas no progression was found from preoperative Tonnis osteoarthritis score. Forty hips survived at the last follow-up, with HHS Score improved from 63.7 to 88.4. Compared to the sole PAO group, both postoperative alpha angle and range of joint motion improved in the PAO combined with osteochondroplasty group. However, no difference in HHS score was found. Conclusions: Good survivorship and improved joint function were identified in middle-aged Chinese patients following PAO with or without osteochondroplasty. We prudently suggest PAO as an alternative strategy for treating DDH in those patients. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare the clinical and radiological results of the Salter innominate osteotomy (SIO) and Pemberton pericapsular osteotomy (PPO) in children with bilateral developmental hip dysplasia who had undergone PPO for 1 side and SIO for the other side in a 1-stage operation. Materials and methods: Children with bilateral hip dysplasia who had undergone PPO for 1 side and SIO for the other side in a 1-stage operation were included in this study, and 126 hips of 63 patients were evaluated. Clinical and radiological results were evaluated and compared using the Sutherland Pain Scale, Modified McKay Grading System, and Trevor Clinical Scoring System. Results: PPO had statistically significantly better femoral head covering than SIO (P < 0.05). SIO resulted in better outcomes with respect to range of motion, cervico-diaphyseal angle, and Sharp angle, but the difference between the 2 techniques was not statistically significant (P > 0.05). Conclusion: PPO had better outcomes and a lower complication rate than SIO in the treatment of bilateral congenital dysplasia of the hip. [ABSTRACT FROM AUTHOR]

Background: The principles of treatment of congenital dislocation of hip in old children are different than those of infants and neonates. The purpose of this study is to evaluate the radiographic and functional results of one-stage treatment (open reduction, femoral shortening derotation, and Salter's osteotomy) of DDH in older children. Materials and Methods: Between January 2005 and June 2010, 25 patients (30 hips) underwent one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy for the treatment of DDH. Preoperatively, they were classified according to the Tönnis class. Clinical outcomes were assessed using the modified McKay's criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic assessment was made using Severin's scoring method to measure the centre-edge angle and dysplasia. Results: The mean age at the time of operation was 3.9 years (range 1.6--8 years), and the average duration of followup was 4.1 years (range 2--7.6 years). The McKay's score was excellent in 13 hips, good in 14 hips, fair in 2, and poor in 1 hip. The Severin's class I and II was found in 25 (83.3%) hips at the time of final evaluation as compared to none at the time of presentation. Conclusions: Young children having DDH can safely be treated with an extensive one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy, without increasing the risk of AVN. Early diagnosis and intervention is the successful treatment of patients suffering from DDH. [ABSTRACT FROM AUTHOR]

The article presents an overview on developmental dysplasia of the hip. Among the most common congenital malformations, the causes of developmental dysplasia, and the range of manifestations are not well understood by practitioners. Neonatal screening programs have long been in place, but they are moderately effective. Sonographic imaging has been effective in gaining information about the disorder in newborns, but the course of the disease throughout childhood remains relatively unknown. More information on adult and childhood courses of the disease is required, as are randomized trials on the safety of neonatal screening. INSET: Search strategy and selection criteria.

Aim: To study the cost-effectiveness of clinical screen with ultrasonography (USG) of hip for diagnosing developmental dysplasia of the hip (DDH) in newborns.Methods: Retrospective study (2006-14). Term newborns had (i) target scan at 6 weeks-family history of DDH or breech presentation-and (ii) early scan-abnormal clinical screen.Results: In all, 736 babies had USG scan. Five early scans (Graf's classification; three Type IIA, one Type IIC and one Type IIIB] and 15 target scans (Type IIA) were reported abnormal. All Type IIA DDH had subsequent 12 weeks' scans normal. Babies with Type IIIB and IIC had hip reduction surgery at 6 and 16 months of age, respectively. At cost 200 INR/scan, total 147 200 INR was incurred against two possible hip replacements prevented.Conclusion: Universal clinical screen with USG of hip can aid in early diagnosis of DDH in newborns. Large population-based studies from developing countries need to look in its cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: To determine gender and ethnic distribution of developmental dysplasia of hip in newborns using Graf method for ultrasound. To determine the significance of association between developmental dysplasia of hip with ethnicity in newborns using Graf’s method ultrasound. Method: This analytical cross-sectional observational study was conducted in Karachi from January through June 2022. A total of 115 healthy newborns (both male and female) aged under 28 days were included in the study after parental informed consent. Hip dislocation was assessed clinically using Barlow and Ortolani maneuvers. The gender, ethnicity and hip angles were recorded in the proforma. Graf’s method ultrasound was used to measure the hip angles. Acetabular roof, head of femur, triradiate cartilage and acetabular labrum were used as landmarks for angle measurements. The hip joint was classified based on Graf method criteria. Results: The incidence of hip dysplasia was higher in male (16.08%) as compared to female infants (14.78%). The difference between gender distributions was not significant. The predominant ethnicities with pathological hip were Sindhi (9.13%), Punjabi (7.39%) and Pathan (6.08%). The association between ethnicity and pathological hips was statistically significant (p=0.021). Conclusion: There is no significant difference in incidence of DDH with gender. However, there is a significant association between ethnicity and incidence of developmental dysplasia of hip in neonates of 28 days age. Incidence of DDH is high in the Sindhi, Punjabi and Pathan populations. [ABSTRACT FROM AUTHOR]

Background and Objectives: Congenital dislocation of the hip (DDH) is a common cause of morbidity in different communities. The rapeutic implications include reduction and surgical stabilization of the hip joint. The purpose of this study was to compare the results of femoral osteotomy with Salter osteotomy. Materials and Methods: In a descriptive analytical study on 40 children 23 were treated with salter osteotomy and 17 cases underwent femoral osteotomy therapeutic outcome and c omplications were compared between two groups . Results were analyzed using Mc.Kay classification. Results: S tud ied group were 40 children ( age 4.3±1.5 years M/F 17/23). All patients in both groups had stable hip joint after treatment , and all patients achieved full range of joint motion . Trendelenburg gait was improved in all patients in both groups. Excellent results was achieved in 65% after Salter osteotomy and in 47% of cases femoral osteotomy , the difference was not statistically significant . The most important complication in Salter osteotomy was avascular necrosis of femoral head in 13% of the treated patients. It was not detected in femoral osteotomy method . On the contrary in femoral osteotomy, limb length discrepancy was the most important complication observed in 5 patients (29.1%). Conclusion: Femoral osteotomy and Salter both methods are successful in stabilizing the hip joint. Both femoral and salter osteotomy methods could successfully stabilize the hip joint . [ABSTRACT FROM AUTHOR]

Focuses on the surgery of tumor in the left inguinal region. Effect of left of dislocated developmental hip dysplasia on the heal of the boy; Effectiveness of abductor tenotomy; Study on the motion of the hips.

Background: Age of onset in symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement syndrome (FAIS) varies. The purpose of this study was to investigate whether psychological factors, radiographic, and clinical variables were related to age of onset of hip pain in DDH and FAIS.Methods: We collected demographic, clinical, and radiographic data on 56 DDH and 84 FAIS patients. Each was diagnosed based on radiographic findings and clinical history. Age of onset was operationalized by subtracting patient reported duration of symptoms from patient age at presentation. Pain catastrophizing (PCS) and depression were assessed with the pain catastrophizing scale and hospital anxiety and depression scale (HADS), respectively. Multiple linear regression modeling, with Lasso variable selection, was implemented.Results: Pain catastrophizing, anxiety, and depression were not significantly related to age of DDH onset (p-values > 0.27) or age of FAIS onset (p-values > 0.29). LASSO-penalized linear regression revealed alpha Dunn angle, Tonnis grade, prior hip surgery, WOMAC pain score, and iHOT total score were associated with age of onset in FAIS (Adjusted R2 = 0.3099). Lateral center edge angle (LCEA), alpha frog angle, Tonnis grade, SF12 physical functioning, and body mass index (BMI) were associated with age of DDH onset (Adjusted R2 = 0.3578).Conclusions: Psychological factors, as measured by PCS and HADS, were not associated with age of onset in DDH or FAIS. Functional impairment as measured by WOMAC pain and impaired active lifestyle as measured by iHOT were found to affect age of FAIS onset. For DDH, impaired physical functioning and increasing BMI were found to be associated with age of onset. Severity of the disease, as measured radiographically by LCEA and alpha Dunn angle, was also found to be associated with earlier age of onset in DDH and FAIS, respectively. A patient's radiographic severity may have more of a relationship to the onset of pain than physiologic factors. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty (THA) in young patients is a controversial subject, due to the high failure rates reported in the literature, and even more so in patients with a history of developmental dysplasia of the hip (DDH). A group of 11 patients, all under the age of 30 years at the time of surgery, underwent THA due to congenital dislocation of the hip. Mean age at the time of operation was 23.3 years (range 16–30 years). The mean follow-up period was 9 years (range 3–14 years). The mean preoperative Harris' hip score (HHS) was 56.9 compared with the postoperative HHS of 90.6. Due to aseptic loosening of the cup, 4 patients underwent successful revision arthroplasty. These encouraging medium-term results in our patients suggest that THA may be a good solution for young patients suffering from coxarthrosis due to DDH, at least temporarily, especially when other alternatives, such as arthrodesis or resection arthroplasty, are considered. [ABSTRACT FROM AUTHOR]

Introduction: The anatomic abnormalities in developmental dysplasia of hip (DDH) often make total hip replacement (THR) inevitable at a younger age. However, there is no universal gold standard technique of THR for high dislocated dysplastic hips.Materials and methods: Here we present the outcomes of midterm follow-up after THR in patients diagnosed with DDH Crowe type III and IV hospitalized in a tertiary center in Iran for whom placement of a cup in true acetabulum and selective transverse subtrochanteric osteotomy was performed. Pre- and postoperative Harris Hip Score, leg length discrepancy and postoperative complications were evaluated.Results: A total of 48 patients with DDH Crowe type III and IV (uni- or bilateral which made 52 hips) were studied. Mean age of patients was 41 years with minimum follow-up ranging from 12 months to 3 years. Mean Harris Hip Score significantly improved from 41.70 preoperatively to 88.1 at last follow-up postoperatively. Leg length discrepancy of less than 2 cm was observed which was well tolerated using shoe lifts. Regarding postoperative complications, two patients had transient peroneal nerve palsy in early postoperative period which recovered within 2 months. No other major complication was encountered.Conclusion: THR in patients with DDH (Crowe III and IV) with a cup positioned in true acetabulum and transverse subtrochanteric osteotomy is a safe successful procedure. [ABSTRACT FROM AUTHOR]

Background: Osteopoikilosis (OPK) is a rare benign sclerosing bone dysplasia and is often incidentally found on plain radiography. OPK generally does not require treatment. Nevertheless, osteonecrosis or degenerative joint disease can occur in the setting of OPK, and little is known with regard to the longevity of arthroplasty prostheses implanted into OPK-bearing bones.Case Presentation: A 55-year-old male presented with progressive right hip pain in 2012. He was diagnosed with coexisting osteopoikilosis and developmental dysplasia of the right hip with advanced osteoarthritis after a series of imaging studies including radiographs, magnetic resonance imaging (MRI), and bone scan. A cementless total hip arthroplasty was performed to treat his right hip pain. Radiographs at eight-year follow-up showed the prosthetic components were well-fixed. Harris hip score of the patient's right hip was 93. The patient can walk without assistance and work as a construction worker.Conclusion: Cementless arthroplasty can be considered in patients with hip arthropathies and co-existing osteopoikilosis. Continued follow-up is required to establish the long-term results. [ABSTRACT FROM AUTHOR]

Development dysplasia of the hip (DDH) is a complex developmental disorder despite being a relatively common condition mainly caused by incompatibility of the femoral head and the abnormal joint socket. Development dysplasia of the hip describes a wide spectrum of disorders ranging from minor acetabular dysplasia to irreducible dislocation of the hip. Modern medicine still suffers from lack of information about screening and precise genetic examination. Genome wide linkage and association studies have brought significant progress to DDH diagnosis. Association studies managed to identify many candidate (susceptible) genes, such as PAPPA2, COL2A1, HOXD9, GDF-5, and TGFB1, which play a considerable role in the pathogenesis of DDH. Early detection of DDH has a big chance to help in preventing further disability and improve the psychological health and quality of life in those children. This emphasizes the importance to establish a universal screening program along with the genetic counseling. [ABSTRACT FROM AUTHOR]

A correction is presented to the article ''Results of crowe Type IV developmental dysplasia of hip treated by subtrochantric osteotomy and total hip arthroplasty'' which appeared in the September 2018 issue 4, Volume 52.

Background: The international hip dysplasia institute (IHDI) classification is a new method for quantifying the severity of the developmental dysplasia of the hip (DDH). Objectives: This study aimed to compare the reliability of this classification between different medical personnel such as pediatricians, general practitioners, and family doctors in addition to orthopedic surgeons and radiologists. Methods: Hundred pelvic radiographic films (with 200 hips) were randomly selected from the files of children already diagnosed and treated as DDH cases. These films were analyzed by 12 independent observers of four different specialties: three orthopedic surgeons (Ortho Group), three radiologists (Radio Group), three pediatricians (Pediat Group), and three general practitioners (GP Group). Results: The average measures (Cronbach's alpha) for the intraclass correlation coefficient (ICC) for absolute agreement between all observers was 0.874 (with 95% confidence intervals between 0.780 and 0.925). This was considered as having a good level of reliability and agreement between all observers. The ICC for agreement between the observers of radio group showed the highest score (0.904) while that between those of GP Group had the lowest one (0.826). However, during the comparison between the mean score of each group with that of the other groups by the one-way ANOVA method, there was no statistically significant difference between all groups (P values were 0.563, 0.415, 0.399, and 0.291 respectively). Conclusion: The IHDI classification method for cases of DDH has a good level of reliability among different medical personnel regardless of their specialties. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of hip (DDH) is a relatively common disorder of the paediatric age group and can have a significant impact on the quality of life, if left untreated. Some research has been done in this field from India over the past many decades, thereby helping to attain the present state of knowledge about DDH. Through this review, an attempt was made to identify and acknowledge important contributions in this field from India. Purpose: To provide some historical aspects and summarise the evidence developed in India concerning different facets of DDH since 1920. Methods: Information about the evolution of DDH management in India was collated from recollections of the senior author (ANJ), from existing records, and contributions from senior Paediatric Orthopaedic surgeons of the country. The Medline database was searched for Indian literature concerning different aspects of DDH. All studies published in English language were included. Included studies were categorised into original studies, reviews, book chapters, case series and case reports, and their contribution to the understanding of DDH was highlighted. Results: The analysis showed 63 published studies on DDH from India. The majority of publications occurred between 2011 and 2020. Retrospective cohort studies and reviews comprised 46% of the published literature. Conclusion: There is a scarcity of research on DDH from India, with many knowledge gaps still prevalent. The overall quality of published literature is poor, with very few good quality original research. However, an increasing trend for research on different aspects of DDH was observed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to know about the outcome of bipolar release of congenital muscular torticollis in children above 5-years. Introduction: Congenital muscular torticollis is the 3rd most common musculo-skeletal anomaly after club foot and developmental dysplasia of hip. It is characterized by shortening of the sternocleidomastoid muscle leading to tilting of head towards and chin to the opposite side. Physical therapy yields excellent results when diagnosed early. Surgery is indicated for late presentation or those with residual deformity after physical therapy. Material and Methods: It was a descriptive observational study utilizing consecutive nonprobability sampling technique. Patients with congenital muscular torticollis and age above 05 years were included in the study. Bipolar release was performed in all and outcome was measured with scoring system of Lee et al. Setting: The study was carried out at the Department of Orthopaedic and Spine Surgery, Haytabad Medical Complex, Peshawar from September 2008 to January 2020. Results: During the study period a total of 29-patients with Congenital Muscular Torticollis (CMT) underwent bipolar release of the SCM muscle. The mean age at surgery was 08.92±2.20 years (range = 05-18 years). Out of 29-patients excellent or good results were noted in 23 (79.3%). A score of 17-18 points was achieved in 17-patients (58.6%) accounting to excellent results whereas 08-patients (27.6%) were graded as good (15-16 points). Fair outcome was noted in 3 patient (10.3%). One patient had poor result in the study. Conclusion: Bipolar release of the sternocleadomastoid is a safe and effective method for treating Congenital Muscular Torticollis even in children older than 5 years. It has got few complications and it provides good cosmetic and functional results. It resolves the deformity and restores the neck range of motion. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic reduction has become increasingly popular as an alternative to open reduction for the treatment of developmental dysplasia of the hip (DDH). However, patient outcomes beyond one and a half years after surgery remain unclear. The purpose of this study is to report the medium-term outcomes of walking-age patients who received arthroscopic reduction after an unsuccessful closed reduction. This research was conducted as part of a retrospectively registered study. Methods: We performed arthroscopic reduction in eight children with DDH after failed closed reduction between January 2010 and January 2012 and followed all cases for a minimum of 5 years. Arthroscopic reduction was performed using a two-portal approach without traction. Capsular release and resection of the transverse acetabular ligament were also performed if needed. Patient demographics, clinical variables, anatomical assessment measures, and post-operative complications were extracted from medical records. Results: Wetreatedfivemaleandthreefemalepatientswithanaverageageatoperationof15.6months(range, 12 to 22 months). All obstacles to reduction were corrected arthroscopically. Concentric reduction of the hip joint was observed in post-operative X-rays in all cases. The average safe zone was increased from 17.5° (8° to 30°) to 42.1° (36° to 50°) after the operation. The average acetabular (AC) index was reduced from 40.3° (33° to 65°) to 21. 9° (19° to 26°) at the end of follow-up. No complications occurred and no patients developed necrosis of the femoral head, recurrent dislocation, or residual hip dysplasia. Conclusions: Arthroscopic reduction is a suitable surgical procedure for the treatment of DDH among walking-age children with failed closed reduction and severe dislocation. This method is quick and safe, and it can be performed without post-operative complications over the medium term. [ABSTRACT FROM AUTHOR]

Objective: To determine whether more precise cup positioning can be achieved with robot‐assisted total hip arthroplasty (THA) as compared to conventional THA. Methods: In this study, between July 2019 and May 2021, 93 patients aged 23–75 years with osteonecrosis of the femoral head (ONFH) and adult developmental dysplasia of hip who underwent first hip surgery were included in the study. They were randomly assigned to either the robotic‐assisted THA group (n = 45) or the conventional THA group (n = 48). After the operation, all patients were given routine rapid rehabilitation guidance. The duration of operation was recorded to estimate the learning curve through cumulative summation analysis. We compared the demographics, duration of operation, cup positioning, leg length discrepancy, hip offset, and Harris Hip Score between robot‐assisted THA and manual THA. Precision in the positioning of the acetabular prosthesis using the MAKO system was also compared between the two groups. Results: The mean duration of operation for the robot‐assisted THA group was 91.37 ± 17.34 min (range: 63 to 135 min), which was significantly higher than that for the conventional THA group. When the number of procedures was increased to 13, the duration of operation in the robot‐assisted group decreased significantly and gradually became stable. In terms of duration of operation, robot‐assisted THA was associated with a learning curve of 13 cases. The mean amount of bleeding in the robot‐assisted THA group was not significantly different from that in conventional THA group (328 ± 210 ml vs 315 ± 205 ml) (p = 0.741). There was no significant difference in the proportion of prostheses located within Lewinnek's safe zone between robot‐assisted THA group and conventional THA group (69.81% vs 64.41%). The leg length discrepancy (LLD) was significantly smaller in the robot‐assisted THA group than in the conventional THA group (p < 0.001), but both were within acceptable limits (10 mm). The inclination and anteversion angles of the acetabular prosthesis planned before operations were correlated with the actual measurement (r = 0.857 p < 0.001, r = 0.830, p < 0.001). After surgery, none of the patients experienced hip dislocation, aseptic loosening, or periprosthetic infection during the 3 months of follow‐up. Conclusion: The proportion of acetabular prostheses in the Lewinnek's safety zone was higher and the extent of LLD was significantly lower in the robot‐assisted THA group, as compared to the same metrics in the conventional THA group. The MAKO robot improved the accuracy of implant placement in THA. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of the hip (DDH) is the most common skeletal dysplasia. Two principal methods used in early diagnosis of DDH are clinical examination and ultrasonographic investigation. Dogruel et al. found a low specificity of clinical examination in patients with DDH. Additionally, Kamath et al. stated that ultrasonography performed by a radiologist in routine clinical practice is more reliable than physical examination performed by the average clinician. In clinical practice, the application and assessment of hip ultrasonography are completed by a single person. This assessment determines the followup of the patient. Thus, hip ultrasonography performed on the same person by different individuals underthe same conditions will yield a more accurate assessment of the reliability of ultrasonographic assessment of DDH. Although inter-observer reliability was high in many previous studies of ultrasound image evaluation, reliability rates vary among studies of the application of ultrasonography. Materials and Methods: Inter-examiner reliability of hip ultrasonography was analyzed among four investigators who separately evaluated 100 hips (50 infants). The obtained bone structure angles (α), cartilage structure angles (β), and distribution of hip types were compared among the investigators. All infants were brought to the hospital for a healthy child followup examination, according to the country's health policy. Babies between 0 and 6 months were included in the study. Babies with any neuromuscular disorders, neural tube defects or any type of genetic anomalies were excluded from the study. The study was explained to the families of all infants and written informed consent was obtained. Results: There was a significant difference in the hip type determined by the investigators with respect to α and β angles (P< 0.01, P< 0.01, P= 0.002). The average alpha measurements of the first orthopedist, second orthopedist, first radiologist, and second radiologist were 67.38 ± 6.24, 65.60 ± 5.84, 65.44 ± 4.59, and 62.59 ± 4.50, respectively. The average beta measurements of the first orthopedist, second orthopedist, first radiologist, and second radiologist were 53.85 ± 8.86, 50.74 ± 7.80, 44.77 ± 6.30, and 44.39 ± 5.81, respectively. Agreement among the results obtained by the clinicians was investigated in dual comparisons. The relative agreement according to the alpha angle ranged from 3.6% to 44.5%, and the relative concordance according to the beta angle ranged from 0.9% to 45.3%. Agreement regarding hip typing was determined to range from 19.1% to 42.6%. Conclusion: Sonographic evaluation of the hip appears to vary depending on the investigator. [ABSTRACT FROM AUTHOR]

Background: Treatment for developmental dysplasia of the hip (DDH) varies according to the age of the patient. For children under 3 months, the preferred treatment is Pavlik bandaging and/or dynamic hip orthosis;for children of 3-18 months (with/without arthrography), closed and open reductions (ORs) are most common; and for children 18 months and older, pelvic osteotomies are used. Radiological and functional outcomes of patients between 16 months and 7 years of age who underwent Pemberton pericapsular osteotomy (PPO) were evaluated. Materials and Methods: Twelve patients with developmental dysplasia of the hip (DDH) received treatment on 14 hips between 2001 and 2006. All patients with DDH had PPO as pelvic osteotomy. PPO was done solely in 3 hips, PPO and open reduction (OR) in and OR + PPO + femoral shortening in 6. The average age was 39.85 months (range 16-83 months). All had 1-stage surgery. Acetabular index (AI) and the grade of displacement were determined according to Tönnis'. Center-edge (CE) angle was evaluated. Clinical evaluations were made as described by McKay, radiological assessments by Severin's criteria and femoral head avascular necrosis measurements by Kalamchi-MacEwen's criteria. Average followup periods were 83.35 months (range 48-115 months). Results: Preoperative and postoperative average AI levels were 41.92° (range 30-50°) and 19,5° (range 5-34°), respectively ( P < 0.001). According to Severin's classification, 11 (78.57%) patients were Ia, 1 (7.14%) was Ib, 1 (7.14%) was II and 1 (7.14%) was III. According to Kalamchi-McEven criteria, 12 (85.71%) patients were type I, 2 (14.28%) patients were type II. CE postoperatively was measured as 24.24° (range 12-41°). Clinically (McKay), the functional results in 13 (92.85%) patients were very good (I) and in 1 (7.14%) was good (II). Conclusions: Functional and radiological mid term outcomes were found to be comparable in most of the patients with DDH undergoing PPO between the ages of 16 months and 7 years. [ABSTRACT FROM AUTHOR]

Purpose: Patients undergoing surgical reduction of the dislocated hip secondary to developmental dysplasia may have a contralateral undisplaced dysplastic hip. This study aimed to compare the observation of the contralateral undisplaced dysplastic hip with the treatment by acetabuloplasty in terms of persistent dysplasia to determine the need for bilateral surgery. Methods: Acetabular dysplasia was defined by an acetabular index (AI) of more than 30 degrees plus a center edge angle (CEA) of less than 20 degrees. A surgical database was queried retrospectively for a cohort between 2008 and 2016. Inclusion criteria were aged between 1 and 6 years, unilateral developmental dysplasia (international hip dysplasia institute grade 1) with contralateral dislocation, no previous treatment and a minimum follow-up of 1 year. Results: Fifty-seven patients were included, 40 in the observation group and 17 in the acetabuloplasty group. The mean age (interquartile range) was 20 (17–23) months, and the mean follow-up was 42 (22–62) months. The baseline values were similar for both groups. At the final follow-up, no hip had dysplasia, as specified a priori in either group, but the final AI and CEA were corrected more in the acetabuloplasty group (p < 0.001). Based on the adjusted analysis, both acetabuloplasty and follow-up without treatment were associated with improved acetabular coverage. Conclusion: Watchful expectancy of undisplaced hip dysplasia presenting in patients undergoing contralateral hip reconstruction during years of acetabular growth is safe as the risk of persistent dysplasia and additional surgery is low. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Eur J Clin Invest 2012; 42 (10): 1121-1125 Abstract Background Developmental dysplasia of the hip (DDH) is a developmental disorder of the hip joint that results in an abnormal socket of the femoral head, ranging from instability, subluxation and complete dislocation of the hip joint. DDH has a considerable genetic component. Design We reviewed the recent progress on genetic study of DDH. Results By linkage and case-control association studies, DDH loci have been identified with several susceptibility genes that involve in bone and joint biology; however, no unequivocal genes with global significance have been detected. The current problem of the association study in DDH is discussed. Conclusions By advanced technologies and international collaboration, we need to find more susceptibility genes and bridge the gap between genetic evidence and molecular mechanisms. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns and young children, attracting considerable controversy. The purpose of the present study was to analyze the research trends and hotspots over the past three decades in this field. Methods: All related publications were collected from the Web of Science Core Collection from 1994 to 2023. Of these, characteristics of the top 50 cited articles for each decade (1994–2003, 2004–2013 and 2014–2023) were evaluated in detail. Visualized studies were operated via VOSviewer. GraphPad Prism and Microsoft Excel were used to perform statistical analysis. The characteristic of the present study is a cross-sectional study. Results: In total, 1,300 publications with 19,815 citations from 1994 to 2023 were selected. The number of publications increased significantly during the past three decades, from 23 in 1994 to 132 in 2023 (P < 0.0001). Studies with collaboration among institutions have raised significantly over time (P < 0.0001). The United States was the leading country to the top 50 publications in each decade. Publications with evidence level IV led the way every ten years. Visualized co-occurrence analysis clustered the keywords into four clusters: hip arthroplasty, congenital dislocation, ultrasound diagnosis and developmental dysplasia of the hip. Conclusions: This study analyzed the global tendency and collaborations on developmental dysplasia of the hip over the past three decades. Even though the research trend has evolved to be collaborative with more multi-institutional publications and authors, studies with high evidence levels are still missing. [ABSTRACT FROM AUTHOR]

Purpose: Diagnostics and treatment pathways for developmental dysplasia of the hip are highly variable in clinical practice. Recently, two national guidelines were developed in the Netherlands, providing a uniform protocol for the diagnosis and treatment of developmental dysplasia of the hip in children under the age of 1 year. The aim of this survey study was to assess whether diagnostic and treatment strategies have changed amongst paediatric orthopaedic surgeons in the Netherlands compared to a similar survey study in 2011, after the introduction of the guidelines. Methods: A web-based online questionnaire was developed and shared amongst the members of the Dutch Paediatric Orthopaedic Society. The questions concerned the diagnosis and treatment of developmental dysplasia of the hip, ranging from mildly dysplastic to dislocated hips, in children under the age of 1 year. We used a questionnaire similar to the previous study and evaluated the results. Results: Thirty-four participants completed the survey. Regarding diagnosis and follow-up, ultrasonography was generally applied for children younger than 6 months, while radiography was more frequently used for children aged 6–12 months. In 2011, radiography was more widely applied in all age groups. Initial treatment for dysplastic, stable hips was mostly active monitoring, while this was generally a rigid splint in 2011. For dislocated unstable hips, the first step in treatment was generally the Pavlik harness, as in 2011. Conclusion: The diagnostic and treatment pathways of developmental dysplasia of the hip in children under the age of 1 year seem to have partially changed amongst Dutch paediatric orthopaedic surgeons compared to 2011, after the publication of new guidelines. [ABSTRACT FROM AUTHOR]

Giant congenital melanocytic nevi are rare congenital disfiguring benign neoplasms with a risk of transformation to malignant melanoma. They often present with various extra-cutaneous features. Here, we describe a case of giant melanocytic nevus with developmental dysplasia of bilateral hip, a novel association. [ABSTRACT FROM AUTHOR]

A 3-year-old girl presenting with blue sclera, hyperlaxity and developmental dysplasia of hip was found to have bilateral corneal thinning with astigmatism and keratoconus. By clinical exome sequencing, a frameshift mutation c.713_716 del TTTG p.(Val238Alafs*35) in PRDM5 gene causing brittle cornea syndrome 2 and a novel frameshift mutation c.401dup p.(Ser135Glufs*53) in SLC6A5 gene causing Hyperekplexia 3 were identified. No features of hyperekplexia were identified in proband. The novel homozygous mutation of SLC6A5 gene in the proband was presently asymptomatic but they were apprised of the possibility of developing neurological symptoms in the later years. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Developmental dysplasia of the hip (DDH) is a spectrum of disorders that develop in utero, involving the femoral head and acetabular cup development, ranging from dysplasia to dislocation. The prevalence of DDH in Saudi Arabia is 10.46 per 1000 live births. However, the late presentation of DDH in Saudi Arabia is around 30%, believed to be significantly due to a lack of awareness of the disease among mothers and pregnant women. Aims: This study aimed to measure maternal perceptions and awareness regarding DDH in children among mothers and pregnant women in Makkah City, Saudi Arabia. Method: In total, 406 women participated in an electronic survey. The survey questions were adapted from previously published research, and the questionnaire was available in Arabic. Results: The age distribution of the participants ranged from below 20 to over 50 years, with the largest group being 31–40 years old. Most of the participants had a university-level education (61.1%). The overall assessment showed a predominance of poor knowledge (41.1%), followed by good knowledge (34.7%), and then medium knowledge (24.1%). Conclusion: The present study revealed significant knowledge gaps and barriers to the early detection and intervention of DDH among Makkah City mothers and pregnant women. The findings underscore the need for targeted educational campaigns, increased access to screening programs, and heightened healthcare provider knowledge to improve DDH's perception and awareness. Future interventions should focus on addressing these gaps and promoting early detection and intervention strategies to minimize the long-term consequences of DDH. [ABSTRACT FROM AUTHOR]

Background: DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH. Aim: To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH. Materials and methods: This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4). Results: 18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (n = 10,629) were females and 44% (n = 8325) were males. According to Graf classification, 34.9% (n = 6621) were 1A, 52.7% (n = 9999) were 1B, 4.0% (n = 753) were 2A+, 2.5% (n = 478) were 2A-, 1.5% (n = 284) were 2B, 1% (n = 196) were 2C, 1.3% (n = 243) were 2D, 1% (n = 193) were 3 and 1.0% (n = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63–6.20) followed by a family history (OR 2.35; 95% CI, 2.08–2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21–3.42), oligohydramnios (OR 1.75; 95% CI, 1.44–2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27–1.60). Conclusions: Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of hip (DDH) is a condition in which there is an abnormal relationship between the head of femur and acetabulum. Currently there is no single definition of the disease in the aspect of morphology, clinical, radiological studies. Objective: To know the level of knowledge, attitude and skills among parents with a DDH-diagnosed child, to compare the socio-demographic status between parents and how it affects the disease, to compare attitude between parents with previously diagnosed child with DDH against those who are not. Materials and methods: A cross-sectional study was conducted on a sample of 340 across parents in city of Riyadh, Saudi Arabia. Using the simple random technique with the help of a questionnaire, the data were processed using SPSS version 23 (SPSS Inc., Chicago, Illinois, USA). Results: From a total of 340, only 234 (68.8%) of the participants had a previous knowledge about DDH, while 106 (32.2%) had no idea about DDH. From a total of 72, only 42 (58.3%) of the fathers do know about DDH, while 30 (41.7%) of them do not. From a total of 268, only 192 (71.6%) of the mothers do know about DDH, while 76 (28.4%) of them do not. There is a significant association between being a mother and knowing about DDH (p<0.05). Conclusion: As the DDH awareness level in Saudi Arabia is suboptimal, additional efforts need to be done to ensure the delivery of simple and reliable information regarding this condition through various media portals and campaigns. [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal disease in infants, and delayed diagnosis can worsen the prognosis. Clinical evidence increasingly supports universal ultrasound (US) screening over selective US screening. The Graf method remains the most widely accepted US technique. Performing an US screening at one month of age seems appropriate as it allows for some hip maturity and early detection, thereby increasing the chances of a favorable outcome. This paper presents an approach to US findings based on the femoral head coverage method. Considering the long-term cost and psychosocial impact of missed DDH cases, universal ultrasound screening appears to be a cost-effective alternative. [ABSTRACT FROM AUTHOR]

National Health Service Quality Improvement Scotland (NHS QIS) published a health technology scoping report in 2006 acknowledging that there are serious concerns within Scotland in relation to Developmental Dysplasia of Hip (DDH) as there is no formal screening program in place and there are significant variations between NHS boards leading to confusion for staff and parents. NHS QIS identified need for audit work to improve hip screening in Scotland. The aim of this study is review of current practice of selective screening for DDH. All newborns who had their first hip scan during one year period (2014) were included in this retrospective study and followed up until June 2015 to include any surgical intervention for dysplastic hip. Out of 428 babies (856 hip scans), abnormality was seen in 119 babies/147 hips (134 Graf 2a/2b, 10 hips were 2c and 3 hips were Graf grade 3). Average age when first scan was performed was 5 weeks (range 3 weeks to 22 weeks). Analysis of risk factors in 119 babies with abnormal scan was consistent with literature (83 breech, 12 family history, 12 HBW, 10 instability and 2 twins of breech). Twelve babies (16 hips) required treatment and were successfully treated in Pavlik harness. There was one case of missed/late dislocation, which lived in outside catchment area for 3 years since birth. During this study period there was no case of avascular necrosis or femoral nerve palsy as a result of treatment. In our experience, selective hip screening by ultrasound scan is useful in avoiding overtreatment and minimizing late presentations. [ABSTRACT FROM AUTHOR]

The article discusses the recommendations for screening for developmental hip dysplasia (DDH) in newborn infants. The recommendations include selective screening in areas with high prevalence of DDH, screening of infants who are at risk of DDH and infants with foot deformities or breech presentation. Also discussed are the treatment of DDH and the consequences of untreated DDH.

Purpose: Literature regarding total hip arthroplasty for pediatric hip diseases is scarce. This review aims to portray the various orthopedic conditions of childhood that can lead to significant impairment of the hip joint and, ultimately, to total hip arthroplasty in adolescence and adulthood. Methods: In total, 61 out of 3666 articles were selected according to (1) the diagnosis of one of the 12 pediatric hip pathologies (Legg–Perthes–Calvé disease, developmental dysplasia of the hip, slipped capital femoral epiphysis, neuromuscular hip dysplasia, post-traumatic avascular necrosis of the proximal femur, juvenile rheumatoid arthritis, achondroplasia, spondyloepiphyseal dysplasia, mucopolysaccharidosis, mucolipidosis, hip infections, and tumors) that required total hip arthroplasty; (2) minimum follow-up of 16 months; (3) assessed outcome with a clinical or radiologic score; (4) Methodological Items for Non-Randomized Studies quality score of 9 or higher. The following information for each pathology was retrieved: mean age at total hip arthroplasty, reason for total hip arthroplasty, type of total hip arthroplasty, surgical technique, mean follow-up, and outcomes. Results: Overall, the mean age at total hip arthroplasty for pediatric hip disease is in the sixth and seventh decade, except for tumors and skeletal dysplasias. The reason for performing total hip arthroplasty is often osteoarthrosis and abnormal anatomy. Prosthesis types change based on patient's conditions and technological advances; custom-made implants are used for tumors, juvenile rheumatoid arthritis, and skeletal dysplasias; for other diseases, the most frequent are modular cementless implants. Outcomes are generally good, and all studies portray functional and pain improvements. Conclusion: Total hip arthroplasty is performed more frequently than in the past in patients with pediatric hip pathologies; it enhances patients' quality of life by reducing pain and improving function. However, revision rate in these patients is not negligible. [ABSTRACT FROM AUTHOR]

Objectives: To show the vital role of dynamic ultrasound in hip instability screening and review the management plans available for DDH associated with instability with a view to reduce the incidence of complication from delayed diagnosis in our region. Place and Duration of the study: Helena governmental rehabilitation center for children with special needs, Erbil-Iraq, between Nov'21 to Jan'23. Material and Method: This study included 942 infants' hips presenting with high risk indicators or a positive clinical examination ranging in age from 6 weeks to 6 months. We performed the ultrasonography using static Graf technique to determine the DDH Types and then apply the dynamic scan to find stability using Moren-Terjesen's and Harcke methods. The management approaches were conducted considering both techniques. We used SPSS version 28 along with Chi-square test for data analysis and comparison of proportions. Results: In this retrospective cross-sectional study of 942 hips, the mean age of the infants was 11.9± 4.8 weeks with male to female percentage of 46% to 54%. We found a correlation between family history and breech presentation to the dynamic scan stability. In the Graf technique 55% showed absence of dysplasia while the dynamic scan showed 66% of the hips as normal and 34% as unstable. Further the significant statistical association (P= 0.001) between results of dynamic scan stability to the effect on the management plan was also found to advise the change for the unstable hips. Conclusion: It is crucial to apply both static and dynamic scans in screening of DDH, so that we can reduce the possibility of late detection and elevate the level of diagnostic accuracy. We should follow a strict guideline for management of all DDH cases (stable and unstable) and change the plan accordingly. [ABSTRACT FROM AUTHOR]

Background: Conflicting evidence exists regarding outcomes in middle-aged patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip (DDH). Aims: To compare patient reported outcomes (PROMs) of middle-aged PAO patients with younger patient groups. Methods: Retrospective analysis of prospectively collected data of PAO patients between 01/2015 and 06/2017 at a single orthopedic university center with a primary diagnosis of symptomatic DDH. The cohort was divided into four age groups and compared: < 20, 20–30, 30–40 and > 40 years. Joint function was assessed using iHOT-12, mHHS and SHV. Activity level was assessed using UCLA Activity score. Patient satisfaction and pain were assessed on the numerical rating scale 0–10. Conversion rates to THA were assessed. Results: Out of 202 PAOs, 120 cases with complete data were included. Mean follow-up was 63 months (range 47–81 months). Eighteen patients were < 20 years old, 54 were 20–30 years, 37 were 30–40 years, 11 patients were older than 40. No significant differences were observed for preoperative or postoperative iHOT-12 (p = 0.898; p = 0.087), mHHS (p = 0.878; p = 0.103), SHV (p = 0.602; p = 0.352) or UCLA (p = 0.539; p = 0.978) between groups. Improvement deltas were also not significantly different for all PROMs. Postoperative patient satisfaction was similar between groups (p = 0.783). Conclusion: Patients with symptomatic DDH may benefit from PAO even at middle age with similar outcomes and pre- to postoperative improvements as younger age groups. Indication should be based on biological age and preoperative joint condition rather than age. [ABSTRACT FROM AUTHOR]

For Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA‐THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA‐THA and to summarize the relevant literature on this topic. Between June 2016 and June 2023, we retrospectively evaluated patients diagnosed with Crowe IV hip dysplasia at our institution. Criteria identified 11 patients who underwent SO during DAA‐THA. Comprehensive data encompassing demographic information, radiological data, prosthetic implant type, and surgical intricacies were collected. In addition, an exhaustive review of existing case series literature was undertaken utilizing the PubMed databases. There were no revisions, deaths, dislocations, or infections. One hip (9.09%) had an intraoperative proximal split fracture, two hips (18.2%) had lower limb deep vein thrombosis, and one hip (9.09%) had symptoms of femoral nerve injury. Radiological data showed improved bilateral femoral offset, leg length discrepancy, and anatomical acetabular. During the mean follow‐up of 2.18(1.06‐2.46) years, patients demonstrated enhanced functional outcomes, with average changes of 25.2 in the Harris hip score and 47 in the WOMAC score. Reviewing the literature, most studies have favored S‐ROM prostheses and transverse osteotomy techniques. Intraoperative fractures were notably frequent, with rates peaking at 25%. Nonunion and nerve injury were secondary common complications. SO via DAA‐THA may offer satisfactory clinical and radiographic outcomes, but the literature review underscores the need for heightened awareness of intraoperative fracture risk. Proximal detachment of the vastus intermedius plays a pivotal role in SO exposure through the DAA. [ABSTRACT FROM AUTHOR]

Objective: To evaluate pre and post acetabular index in patients with Developmental Dysplasia of Hip whom underwent Salter innominate osteotomy. Methodology: This cross sectional study was carried out on patients with CDH that underwent Salter innominate osteotomy. All cases with CDH admitted in Imam Khomeini and Razi Hospitals from November 2007 to August 2009 were included. Age, sex, number of involved limb, and affected side were recorded. Antero-posterior (AP) roentgenogram were done and acetabular index were calculated before and after surgery. Five months later after surgery, AP Roentgenogram were obtained from cases and acetabular index were calculated again. Before and after surgery acetabular index were compared for each cases. Dislocation of hip and avascular necrosis occurrence and grading were assessed for each case. Dislocation rate were assessed based on proposed criteria by author from 0 to 4. This criteria was based on percentage of head of femur, which was not covered by acetabulum. Our classification is as follows: Grade 0: No dislocation; grade I: 30% subluxation; grade II: 30-60% subluxation grade III: 60-90% subluxation; grade IV: Complete dislocation. Results: During two year period of the study, fourteen CDH patients were operated. From these cases, four hips were excluded because the patients did not come for follow up. Pre operative acetabular index was 34.40±1.22 and post operative acetabular index was 19.20±1.22. There was significant difference among pre- and post- acetabular index. Conclusion: This study showed that there was significant difference among pre and post operative acetabular index. Our limitations in this study were low sample size and short duration of follow-up. Another prospective study with more sample and long duration is recommended. [ABSTRACT FROM AUTHOR]

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