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World J Orthop. Apr 18, 2013; 4(2): 32-41
Published online Apr 18, 2013. doi: 10.5312/wjo.v4.i2.32
Developmental dysplasia of the hip in the newborn: A systematic review
Vivek Gulati, Kelechi Eseonu, Junaid Sayani, Nizar Ismail, Chika Uzoigwe, Muhammed Zaki Choudhury, Pooja Gulati, Adeel Aqil, Saket Tibrewal
Vivek Gulati, Kelechi Eseonu, Junaid Sayani, Nizar Ismail, Adeel Aqil, Saket Tibrewal, Department of Orthopaedic Surgery, Imperial College NHS Trust, London W6 8RF, United Kingdom
Chika Uzoigwe, Department of Orthopaedic Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, United Kingdom
Muhammed Zaki Choudhury, Department of Orthopaedic Surgery, Birmingham Healthcare Trust, Edgbaston, Birmingham B15 2TH, United Kingdom
Pooja Gulati, London Rheumatology Rotation, London W6 8RF, United Kingdom
Author contributions: Gulati V researched and wrote the paper; Eseonu K researched the area and identified papers and wrote the manuscript; Sayani J reviewed and edited the paper; Ismail N researched the area and helped write, structure the manuscript; Uzoigwe C researched the area and helped correct, edit and structure the manuscript; Gulati P researched the area and helped write, structure the manuscript; Choudhury MZ helped structure the manuscript and provide novel categories; Aqil A helped research the subject area and write the manuscript; Tibrewal S was the senior author and helped provide extensive senior review of the manuscript.
Correspondence to: Vivek Gulati, Specialist Registrar, Orthopaedic Surgeon, Masters Research Fellow, Department of Orthopaedic Surgery, Imperial College NHS Trust, Fulham Palace Road, London W6 8RF, United Kingdom.
Telephone: +44-7803-902595 Fax:+44-1612-255372
Received: September 16, 2012
Revised: December 29, 2012
Accepted: January 17, 2013
Published online: April 18, 2013

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of conditions ranging from subtle acetabular dysplasia to irreducible hip dislocations. Clinical diagnostic tests complement ultrasound imaging in allowing diagnosis, classification and monitoring of this condition. Classification systems relate to the alpha and beta angles in addition to the dynamic coverage index (DCI). Screening programmes for DDH show considerable geographic variation; certain risk factors have been identified which necessitate ultrasound assessment of the newborn. The treatment of DDH has undergone significant evolution, but the current gold standard is still the Pavlik harness. Duration of Pavlik harness treatment has been reported to range from 3 to 9.3 mo. The beta angle, DCI and the superior/lateral femoral head displacement can be assessed via ultrasound to estimate the likelihood of success. Success rates of between 7% and 99% have been reported when using the harness to treat DDH. Avascular necrosis remains the most devastating complication of harness usage with a reported rate of between 0% and 28%. Alternative non-surgical treatment methods used for DDH include devices proposed by LeDamany, Frejka, Lorenz and Ortolani. The Rosen splint and Wagner stocking have also been used for DDH treatment. Surgical treatment for DDH comprises open reduction alongside a combination of femoral or pelvic osteotomies. Femoral osteotomies are carried out in cases of excessive anteversion or valgus deformity of the femoral neck. The two principal pelvic osteotomies most commonly performed are the Salter osteotomy and Pemberton acetabuloplasty. Serious surgical complications include epiphyseal damage, sciatic nerve damage and femoral neck fracture.

Keywords: Developmental dysplasia of the hip, Congenital, Pavlik harness, Ultrasound screening, Pelvic osteotomy