Developmental dysplasia of the hip: Epidemiology and pathogenesis
- Scott B Rosenfeld, MD
Scott B Rosenfeld, MD
- Assistant Professor of Pediatric Orthopaedic Surgery and Scoliosis
- Baylor College of Medicine
Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. It encompasses abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint.
Newborns often have physiologic laxity of the hip and immaturity of the acetabulum during the first few weeks of life. In most cases, the laxity resolves, and the acetabulum proceeds to develop normally. With assessment of risk factors, serial physical examination of the hips, and appropriate use of imaging, most children with pathologic hips can be correctly diagnosed and treated without long-term sequelae. (See "Developmental dysplasia of the hip: Treatment and outcome".)
Typical DDH, which generally occurs in otherwise healthy infants, will be the focus of this topic review. Hip dysplasia and instability also occur in association with other conditions. Teratologic hip dysplasia occurs in association with various syndromes (eg, Ehlers Danlos, Down syndrome, arthrogryposis), and neuromuscular hip dysplasia occurs when there is weakness and/or spasticity in some or all of the hip muscle groups (eg, in spina bifida or cerebral palsy). The diagnosis and management of teratologic and neuromuscular hip dysplasia differ from the diagnosis and management of hip dysplasia in otherwise healthy infants.
The epidemiology and pathogenesis of DDH in otherwise healthy children will be reviewed here. The clinical features, diagnosis, treatment, and outcome are discussed separately. (See "Developmental dysplasia of the hip: Clinical features and diagnosis" and "Developmental dysplasia of the hip: Treatment and outcome".)
The terminology for developmental problems of the hip has changed over time. "Congenital hip dislocation" was used at a time when most children were diagnosed after they began walking and the dislocation was assumed to be congenital. "Developmental dysplasia of the hip" (DDH) is now the preferred term . "Developmental" is preferred to "congenital" since the condition is not always present or identifiable at birth and develops during early childhood [2,3]. "Dysplasia" is preferred to "dislocation" because it includes a broader spectrum of changes in the shape and position of the femoral head and acetabulum.
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