Late Developmental Dislocation of the Hip After Initial Normal Evaluation

Abstract

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologies ranging from hip instability to frank dislocation. The current understanding is that cases of late diagnosis were missed during the newborn period. However, there is some evidence that a number of hip subluxations or dislocations may have been clinically stable in the neonatal period, but dislocate late. We present 5 cases of otherwise healthy children with normal physical examinations and hip radiographs in the first 3 months of life who later developed hip dislocations. Four of the 5 cases required surgical open reduction. In light of these cases and others in the literature, normal neonatal screening for DDH does not assure that continued normal development of the hip joint will happen. Our study confirms the existence of another entity in the wide spectrum of DDH: the late hip dislocation. Therefore, hip evaluations should be continued beyond the neonatal period until the child begins to walk. Parents should be informed that hip dislocation can occur in a late form, and they should be encouraged to take their children for repeated evaluations even if the neonatal screening is normal.

Treatment of Developmental Dysplasia of the Hip: Short and Mid-term Outcome

“…Of the 17 children seeking treatment, 14 (82.4%) presented after age of 4 months. This late presentation is a problem also faced by orthopaedic surgeons in other developing countries 9,10 . There are no other reports of delayed presentation in Malaysia for comparison, but it is reasonable to believe that this is a common problem.…”

Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions

“…Most cases of DDH in SA are diagnosed clinically, and a high quality clinical hip examination of newborns by a competent examiner remains a powerful tool. However, an early neonatal hip examination that finds nothing abnormal does not always preclude DDH at a later follow‐up 17 . Early discharge from hospital is a risk factor for late DDH in SA; previous research found a higher incidence when mother and child were discharged less than 4 days after the birth 4 .…”

“…However, an early neonatal hip examination that finds nothing abnormal does not always preclude DDH at a later follow-up. 17…”

Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip

“…NIH can normalize spontaneously (Gardiner and Dunn 1990, Rosendahl et al 1994, Bialik et al 1999). Also, cases of late-presenting DDH can be clinically and morphologically normal at birth (Lennox et al 1993, Raimann et al 2007) and even up to early school age (Modaressi et al 2011). Despite such possible crossover, early diagnosis and treatment of NIH clearly reduces the incidence of late DDH (Fredensborg 1976, Hansson et al 1983, Dunn et al 1985, Myers et al 2009).…”