Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologic conditions, ranging from subtle acetabular dysplasia to irreducible hip dislocation. When DDH is recognized in the first 6 months of life, treatment with a Pavlik harness frequently results in an excellent outcome. In children older than 6 months, achieving a concentrically reduced hip while minimizing complications is more challenging. Bracing, traction, closed reduction, open reduction, and femoral or pelvic osteotomies are frequently used treatment modalities for children aged 6 months to 4 years. In the past, treatment recommendations have often been based on the patient’s age. However, recent practice has placed more emphasis on addressing the specific disorder and avoiding iatrogenic osteonecrosis. The incidence of osteonecrosis of the femoral head has been reduced by avoiding immobilization of the hip in extreme abduction and by using femur-shortening osteotomies when appropriate. Pelvic osteotomy continues to gain favor for the treatment of selected patients over 18 months of age.
Dr. Vitale is Assistant Professor of Orthopaedic Surgery, Children’s Hospital of New York, New York-Presbyterian Medical Center, New York, NY. Dr. Skaggs is Assistant Professor of Orthopedic Surgery, University of Southern California Keck School of Medicine, Los Angeles.
Reprint requests: Dr. Skaggs, Division of Orthopaedic Surgery, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop 69, Los Angeles, CA 90027.