Unilateral limitation of abduction of the hip

Abstract

Between 1992 and 1997, we undertook a prospective, targeted clinical and ultrasonographic hip screening programme to assess the relationship between ultrasonographic abnormalities of the hip and clinical limitation of hip abduction. A total of 5.9% (2 of 34) of neonatal dislocatable hips and 87.5% (7 of 8) of ‘late’ dislocated hips seen after the age of six months, presented with unilateral limitation of hip abduction. All major (Graf type III) and 44.5% of minor (Graf type II) dysplastic hips presented with this sign. Statistically, bilateral limitation of hip abduction was not a useful clinical indicator of underlying hip abnormality because of its poor sensitivity, but unilateral limitation of abduction of the hip was a highly specific (90%) and reasonably sensitive sign (70%). It was more sensitive than the neonatal Ortolani manoeuvre, which has been considered to be the method of choice. It was, however, not sensitive enough to be of value as a routine screening test in developmental dysplasia of the hip. We consider unilateral limitation of hip abduction to be an important clinical sign and its presence in an infant over the age of three to four months makes further investigation essential.

Is limitation of hip abduction a useful clinical sign in the diagnosis of developmental dysplasia of the hip?

“…The clinical examination was undertaken independently of the ultrasound hip scan. LHA was noted at this initial assessment, and any block to full abduction was noted from the horizontal and was considered clinically present if it was estimated to be equal to or more than 20° compared to the other hip, as less than this has been shown to be within the normal range 1 6. Clinically, it is difficult to detect a difference between both hips in unilateral LHA of less than 20°; however, no assessment was made regarding the absolute degree of limited abduction and dysplasia as this sign was considered as positive if >20° or negative if <20°.…”

“…The Graf α angle is the angle subtended by two lines, a baseline running tangentially to the wall of the ilium and an acetabular roof line. A modification of these sonographic measurements1 was used (figure 1). …”

“…‘Pathological’ sonographic DDH was considered to be Graf Type III, IV or hip joint irreducibility 1 5. As 90% of Graf Type II dysplasia spontaneously resolve, the majority of Graf Type II hips were considered to be ‘physiological’ 9 –11.…”

“…In a previous 5-year prospective longitudinal observational study, we suggested that if unilateral LHA is detected clinically, at 3–4 months of age, further investigation is warranted 1. By contrast, it was noted that the presence of bilateral LHA was a poor clinical sign due to its lack of sensitivity.…”

“…The relationship between the presence and severity of sonographically diagnosed developmental dysplasia of the hip (DDH) and the clinical abnormality of limitation of hip abduction (LHA) of the affected hip is currently controversial 1. It is generally accepted that LHA is associated with irreducible or late diagnosed dislocation 2.…”