Materiały źródłowe

• #1 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/

  Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. […] Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. […] The optimal growth of the hip joint depends upon two main factors: first, the concentric reduction of femoral head, and second, adequate balance of growth between acetabular and triradiate cartilages. Any imbalance in these, whether during fetal development or postnatal growth, will result in abnormal hip development. The dynamic femoral and acetabular interactions are crucial in the development of hip joint. The complex nature of this condition is due to a mix of genetic, environmental, and mechanical factors. Various etiological theories of DDH have been proposed in the literature, highlighting hormonal, mechanical, and genetic factors.

• #2 Developmental dysplasia of the hip: Epidemiology and pathogenesis – UpToDate

  https://www.uptodate.com/contents/developmental-dysplasia-of-the-hip-epidemiology-and-pathogenesis

  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. […] The epidemiology and pathogenesis of DDH in otherwise healthy children will be reviewed here.

• #3

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] initial instability thought to be caused by maternal and fetal laxity, genetic laxity, and intrauterine and postnatal malpositioning. […] initial instability leads to dysplasia typical deficiency is anterior or anterolateral acetabulum. […] dysplasia leads to subluxation and gradual dislocation repetitive subluxation of the femoral head leads to the formation of a ridge of thickened articular cartilage called the limbus. […] chronic dislocation leads to development of secondary barriers to reduction pulvinar thickens, ligamentum teres thickens and elongates, transverse acetabular ligament hypertrophies, hip capsule and iliopsoas form hourglass configuration. […] anatomic changes increased femoral anteversion, flattening of the femoral head, increased acetabular anteversion, increased obliquity and decreased concavity of the acetabular roof, thickening of the medial acetabular wall.

• #4 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Developmental dysplasia of the hip occurs due to an abnormal hip development, presenting in infancy or early childhood with a spectrum ranging from dysplasia to dislocation of the hip joint. […] The exact etiology is still elusive. Multifactorial in nature, a combination of genetic, environmental, and mechanical factors play a role. Many genetic loci have also been identified in familial cases. […] Any interference with proper contact between these 2 in utero or infancy (eg, improper swaddling) leads to developmental dysplasia of the hip. […] However, in utero, femoral head growth is faster than acetabulum growth, resulting in under-coverage of the femoral head; therefore, any disturbance in the contact will lead to abnormal development. […] Consequently, misaligned contact between the acetabulum and femur may result in instability, dysplasia (eg, underdevelopment of the acetabulum), subluxation with some contact between the acetabulum and femur, or dislocation. Furthermore, chronic changes like hypertrophy of the capsule, ligament teres, and the formation of thickened acetabular edge (ie, neolimbus) further impede contact and prevent the relocation of the femoral head.

• #5 Developmental Dysplasia of the Hip: A Review of Etiopathogenesis, Risk Factors, and Genetic Aspects

  https://www.mdpi.com/1648-9144/56/4/153

  Developmental dysplasia of the hip (DDH) is characterized by a considerable range of pathology, from minor laxity of ligaments in the hip joint to complete luxation. […] Multifactorial etiology, of which the candidate genes have been studied the most, poses a challenge in understanding this disorder. […] Recent studies show that epigenetic factors, such as DNA methylation affect gene expression and therefore could play an important role in DDH pathogenesis. […] Despite the long history of this disorder and the many specialists involved in this topic, there is still little knowledge about the exact etiopathogenesis of DDH. […] The hip joint begins to develop physiologically from mesenchymal cells as early as the fifth or sixth gestational week. […] Persistent joint instability can be caused by a disorder of reflex contraction in soft tissues, which, under physiological circumstances, fixates the hip joint until six months of age.

• #6 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. […] The term developmental dysplasia of the hip (DDH) has replaced congenital dislocation of the hip because it more accurately reflects the full spectrum of abnormalities that affect the immature hip. DDH can predispose a child to premature degenerative changes and painful arthritis. […] Factors contributing to DDH include breech presentation, female sex, positive family history, firstborn status, and oligohydramnios. […] DDH occurs more often in children who present in the breech position. It is believed that in utero knee extension of the infant in the breech position results in sustained hamstring forces around the hip and contributes to subsequent hip instability.

• #7 Hip dysplasia – Wikipedia

  https://en.wikipedia.org/wiki/Hip_dysplasia

  Hip dysplasia is considered to be a multifactorial condition. That means that several factors are involved in causing the condition to manifest. […] The cause of the condition is unknown; however, some factors of congenital hip dislocation are through heredity and racial background. It is also thought that the higher rates in some ethnic groups (such as some Native American groups) is due to the practice of swaddling of infants, which is known to be a potential risk factor for developing dysplasia. […] Some studies suggest a hormonal link. Specifically, the hormone relaxin has been indicated. […] A genetic factor is indicated since the trait runs in families and there is an increased occurrence in some ethnic populations (e.g., Native Americans, Sami people). A locus has been described on chromosome 13.

• #8 Developmental Dysplasia of the Hip: Navigating the Spectrum in Primary Care

  https://www.clinicaladvisor.com/features/developmental-dysplasia-hip-navigating-spectrum-in-primary-care/

  Early diagnosis of developmental dysplasia of the hip (DDH) in childhood presents challenges for the primary care provider. […] A delayed diagnosis of DDH results in a patient requiring complex reconstructive surgical procedures, which rarely produce normal hips. […] Although the exact etiology of developmental dysplasia of the hip has not been identified through quality studies, specialists are aware of certain risk factors that increase the incidence of this diagnosis. […] The incidence of hip instability is increased in patients who were in the breech position during pregnancy. […] A positive family history of hip dysplasia in the mother or older sibling is also a significant risk factor for hip instability. […] Additional factors that have been shown to increase the incidence of DDH include female gender with girls being 7 to 9 times more frequently diagnosed with DDH at birth than boys, post-terminal gravidity, vaginal compared to cesarean delivery, tight swaddling of the lower extremities, and limited fetal mobility related to oligohydramnios, high birth weight, or primiparity. […] Developmental dysplasia of the hip is not one condition but rather a broad continuum of instability. […] Each of these stages is somewhat artificial and arbitrary, but dividing the condition along these lines can assist with treatment decisions.

• #9 Developmental dysplasia of the hip – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/developmental-dysplasia-of-the-hip/

  The exact etiology of DDH remains unknown. […] Several risk factors have been identified: Family history, Breech presentation, History of tight swaddling of the lower extremities, A history of prior hip instability that has resolved. […] Children with DDH have varying degrees of abnormal hip growth such as hip instability, hip subluxation, and/or hip dislocation, which result in: Hypertrophy of pulvinar fat in the acetabulum, transverse acetabular ligament, and/or ligamentum teres, Acetabular dysplasia.

• #10 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/

  Developmental dysplasia of the hip (DDH) is a complex disorder that refers to different hip problems, ranging from neonatal instability to acetabular or femoral dysplasia, hip subluxation, and hip dislocation. […] Despite identifying the risk factors, the exact aetiology and pathophysiology are still unclear. […] The optimal growth of the hip joint depends upon two main factors: first, the concentric reduction of femoral head, and second, adequate balance of growth between acetabular and triradiate cartilages. Any imbalance in these, whether during fetal development or postnatal growth, will result in abnormal hip development. The dynamic femoral and acetabular interactions are crucial in the development of hip joint. The complex nature of this condition is due to a mix of genetic, environmental, and mechanical factors. Various etiological theories of DDH have been proposed in the literature, highlighting hormonal, mechanical, and genetic factors.

• #11 Developmental dysplasia of the hip: update of management in: EFORT Open Reviews Volume 4 Issue 9 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/9/2058-5241.4.180019.xml

  The term developmental dysplasia of the hip (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. […] DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). […] Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. […] Adequate growth and development of the hip depends on two main (and necessary) factors: concentric positioning of femoral head into the acetabular cavity and adequate balance in growth between triradiate and acetabular cartilage.

• #12 Developmental Dysplasia of the Hip – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563157/

  Developmental dysplasia of the hip occurs due to an abnormal hip development, presenting in infancy or early childhood with a spectrum ranging from dysplasia to dislocation of the hip joint. […] The exact etiology is still elusive. Multifactorial in nature, a combination of genetic, environmental, and mechanical factors play a role. Many genetic loci have also been identified in familial cases. […] Any interference with proper contact between these 2 in utero or infancy (eg, improper swaddling) leads to developmental dysplasia of the hip. […] However, in utero, femoral head growth is faster than acetabulum growth, resulting in under-coverage of the femoral head; therefore, any disturbance in the contact will lead to abnormal development. […] Consequently, misaligned contact between the acetabulum and femur may result in instability, dysplasia (eg, underdevelopment of the acetabulum), subluxation with some contact between the acetabulum and femur, or dislocation. Furthermore, chronic changes like hypertrophy of the capsule, ligament teres, and the formation of thickened acetabular edge (ie, neolimbus) further impede contact and prevent the relocation of the femoral head.

• #13 Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence in: EFORT Open Reviews Volume 4 Issue 10 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/10/2058-5241.4.190006.xml

  Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and is characterized by mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur and irreducible hip dislocation. It is the leading cause of early hip osteoarthritis in young individuals. […] Both genetic and environmental factors have been proposed to play an important role in the pathogenesis of DDH. […] Several susceptive genes, including WISP3, PAPPA2, HOXB9, HOXD9, GDF5, TGF Beta 1, CX3CR1, UQCC, COL1A1, TbX4 and ASPN have been identified as being associated with the development of DDH. […] Even though genetic components are a crucial part in the aetiology of DDH, several DDH susceptibility genes need further investigation.

• #14 Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence in: EFORT Open Reviews Volume 4 Issue 10 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/10/2058-5241.4.190006.xml

  Genetic and environmental factors are both involved in the pathogenesis of DDH. […] Breech presentation, oligohydramnios, female gender, large birth weight and primiparity may play a role in the occurrence of DDH. […] Several studies have reported multiple genes to be associated with DDH. This underlines the evidence of a genetic cause as the dominant factor in the development of DDH. […] To sum up, alterations in WISP3 and CX3CR1 genes lead to abnormal cartilage formation and chondrocyte development. […] Alterations in UQCC, HOX, and T-box genes are responsible for abnormal chondogenesis and skeleton development. […] PAPPA2 is a protease with a crucial role in the development of bone and cartilage, so possible mutations are associated with DDH. […] A positive correlation between GDF5 polymorphisms and DDH has already been proven.

• #15 Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence in: EFORT Open Reviews Volume 4 Issue 10 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/10/2058-5241.4.190006.xml

  Genetic and environmental factors are both involved in the pathogenesis of DDH. […] Breech presentation, oligohydramnios, female gender, large birth weight and primiparity may play a role in the occurrence of DDH. […] Several studies have reported multiple genes to be associated with DDH. This underlines the evidence of a genetic cause as the dominant factor in the development of DDH. […] To sum up, alterations in WISP3 and CX3CR1 genes lead to abnormal cartilage formation and chondrocyte development. […] Alterations in UQCC, HOX, and T-box genes are responsible for abnormal chondogenesis and skeleton development. […] PAPPA2 is a protease with a crucial role in the development of bone and cartilage, so possible mutations are associated with DDH. […] A positive correlation between GDF5 polymorphisms and DDH has already been proven.

• #16 Developmental Dysplasia of Hip: Perspectives in Genetic Screening

  https://www.mdpi.com/2076-3271/7/4/59

  Development dysplasia of the hip (DDH) is a complex developmental disorder despite being a relatively common condition mainly caused by incompatibility of the femoral head and the abnormal joint socket. […] Association studies managed to identify many candidate (susceptible) genes, such as PAPPA2, COL2A1, HOXD9, GDF-5, and TGFB1, which play a considerable role in the pathogenesis of DDH. […] Genetic components play crucial roles in the pathogenesis of DDH. Genetic risk exhibited a large familial segregation. […] The etiology of DDH is multifactorial. It consists of genetic, environmental, and mechanical risk factors. […] Studies conducted in Asia reported the existence of genes which could be associated with this disorder. […] Recently, exome sequencing and genome linkage studies in large families segregating DDH have been useful to identify some variants in the genes involved in chondrogenesis and bone formation that have been reported to be associated with DDH such as collagen alpha-1(I) chain gene (COL1A1) and vitamin D receptor (VDR).

• #17 Genome-wide association study of developmental dysplasia of the hip identifies an association with GDF5 | Communications Biology

  https://www.nature.com/articles/s42003-018-0052-4

  Developmental dysplasia of the hip (DDH) is the most common skeletal developmental disease. However, its genetic architecture is poorly understood. We find the heritable component of DDH attributable to common genetic variants to be 55% and distributed equally across the autosomal and X-chromosomes. We identify replicating evidence for association between GDF5 promoter variation and DDH (rs143384, effect allele A, odds ratio 1.44, 95% confidence interval 1.34-1.56, P=3.55×10^-22). Gene-based analysis implicates GDF5 (P=9.24×10^-12), UQCC1 (P=1.86×10^-10), MMP24 (P=3.18×10^-9), RETSAT (P=3.70×10^-8) and PDRG1 (P=1.06×10^-7) in DDH susceptibility. We find shared genetic architecture between DDH and hip osteoarthritis, but no predictive power of osteoarthritis polygenic risk score on DDH status, underscoring the complex nature of the two traits. We report a scalable, time-efficient recruitment strategy and establish for the first time to our knowledge a robust DDH genetic association locus at GDF5.

• #18 Genome-wide association study of developmental dysplasia of the hip identifies an association with GDF5 | Communications Biology

  https://www.nature.com/articles/s42003-018-0052-4

  While DDH is heritable, its genetic architecture remains poorly characterised. Several linkage scans and candidate gene studies have implicated possible associated genetic variants, including in GDF5, but to date no replicated loci of genome-wide significance have been identified. […] We find that the heritable component of DDH due to common autosomal variants is approximately 55%, consistent with the complex nature of the disease, and find evidence for genetic correlation but a lack of predictive power of osteoarthritis polygenic risk scores on DDH. We establish variation within GDF5 on chromosome 20 as robustly associated with DDH susceptibility with rs143384 as the causal signal by fine-mapping, although GDF5 variation makes only a small contribution to overall DDH heritability. Through gene-based analyses we identify GDF5, UQCC1, MMP24, RETSAT and PDRG1 to be associated with DDH susceptibility.

• #19 Genome-wide association study of developmental dysplasia of the hip identifies an association with GDF5 | Communications Biology

  https://www.nature.com/articles/s42003-018-0052-4

  Developmental dysplasia of the hip (DDH) is the most common skeletal developmental disease. However, its genetic architecture is poorly understood. We find the heritable component of DDH attributable to common genetic variants to be 55% and distributed equally across the autosomal and X-chromosomes. We identify replicating evidence for association between GDF5 promoter variation and DDH (rs143384, effect allele A, odds ratio 1.44, 95% confidence interval 1.34-1.56, P=3.55×10^-22). Gene-based analysis implicates GDF5 (P=9.24×10^-12), UQCC1 (P=1.86×10^-10), MMP24 (P=3.18×10^-9), RETSAT (P=3.70×10^-8) and PDRG1 (P=1.06×10^-7) in DDH susceptibility. We find shared genetic architecture between DDH and hip osteoarthritis, but no predictive power of osteoarthritis polygenic risk score on DDH status, underscoring the complex nature of the two traits. We report a scalable, time-efficient recruitment strategy and establish for the first time to our knowledge a robust DDH genetic association locus at GDF5.

• #20 Developmental Dysplasia of the Hip: A Review of Etiopathogenesis, Risk Factors, and Genetic Aspects

  https://www.mdpi.com/1648-9144/56/4/153

  Persistent dysplasia over time causes alterations in body position and gait. […] Although we do not know the exact etiology of DDH, we know of risk factors, that contribute to the incidence of primary or secondary hip dysplasia. […] The multifactorial nature of inheritance in DDH is a problematic aspect, as the presence of a potentially pathological genetic finding may not have a phenotypic manifestation. […] Studies in Europe indicate that the main genes involved in DDH pathology are genes for IL-6, TGFB1, and GDF5. […] A recent study found that the condition of methylation of the GDF5 gene is dysregulated in DDH patients. […] The second epigenetic modification is histone modification, which usually is a post-translational modification of histones.

• #21 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/

  The hormonal theory has a significant role in hip dysplasia development. It is based on an imbalanced ratio of estrogen to progesterone. A progesterone-rich environment can promote dislocation, whereas an estrogen-rich environment can inhibit it. […] The mechanical factors are usually related to restricted space in utero resulting in fetal packaging deformities. […] One of the most important mechanical factors that may be a risk for DDH is breech presentation at birth. […] Swaddling may promote deformity in infants. […] An inherited predisposition has been well-established in the literature. […] Persistent DDH left untreated results in a sequence of anatomical alterations that alter the joint biomechanics by raising tension on a reduced-contact articular surface. The maintenance of increased articular pressures for lengthy periods promotes articular cartilage degradation and early coxarthrosis. However, there is a well-established link between AD and coxarthrosis.

• #22 Developmental dysplasia of the hip: update of management in: EFORT Open Reviews Volume 4 Issue 9 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/9/2058-5241.4.180019.xml

  Any alteration in these two conditions leads to a hip dysplasia. […] Hormonal theory is based on a misbalance between oestrogens and progesterone. It has been demonstrated experimentally that oestrogens are protective against dislocation while an environment with higher concentrations of progesterone can facilitate dislocation. […] Mechanical theory sustains that persistent mechanical stimulation can provoke a deformity, especially in periods of high growth. […] The maintained posture with forced hyperflexion of the hip and knee extension associated with breech presentation could lead to hip dysplasia and dislocation. […] Familial predisposition has been well documented in the literature. […] A higher incidence of hip osteoarthritis (OA) and implantation of total hip arthroplasty in the parents and grandparents of patients diagnosed with DDH in comparison with the general population has also been reported.

• #23 Hip dysplasia – Wikipedia

  https://en.wikipedia.org/wiki/Hip_dysplasia

  Hip dysplasia is considered to be a multifactorial condition. That means that several factors are involved in causing the condition to manifest. […] The cause of the condition is unknown; however, some factors of congenital hip dislocation are through heredity and racial background. It is also thought that the higher rates in some ethnic groups (such as some Native American groups) is due to the practice of swaddling of infants, which is known to be a potential risk factor for developing dysplasia. […] Some studies suggest a hormonal link. Specifically, the hormone relaxin has been indicated. […] A genetic factor is indicated since the trait runs in families and there is an increased occurrence in some ethnic populations (e.g., Native Americans, Sami people). A locus has been described on chromosome 13.

• #24 Developmental Dysplasia of the Hip (DDH) – Orthopedic & Sports Medicine

  https://orthosportsmed.com/developmental-dysplasia-of-the-hip-ddh/

  Developmental Dysplasia of the Hip (DDH) used to be called congenital dislocation of the hip. However, we now know that this condition is a developmental and ongoing process that is not always detectable at birth. […] Dysplasia is the abnormal formation of the hip joint that occurs between fetal life and maturity as a result of instability. The ball at the top of the thighbone (femoral head) is not stable in the socket (acetabulum) and the ligaments of the hip may be loose or stretched. […] Maternal hormones that are associated with pelvic relaxation around the time of birth can aggravate the instability of a newborn hip joint by softening and stretching the babys hip ligaments. […] DDH is a multifactorial disease in which both environmental and genetic factors play roles. Causes may be physiologic, involving the childs basic makeup, or mechanical, involving positional influences in the uterus. DDH does not result from injury or trauma.

• #25 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/

  The hormonal theory has a significant role in hip dysplasia development. It is based on an imbalanced ratio of estrogen to progesterone. A progesterone-rich environment can promote dislocation, whereas an estrogen-rich environment can inhibit it. […] The mechanical factors are usually related to restricted space in utero resulting in fetal packaging deformities. […] One of the most important mechanical factors that may be a risk for DDH is breech presentation at birth. […] Swaddling may promote deformity in infants. […] An inherited predisposition has been well-established in the literature. […] Persistent DDH left untreated results in a sequence of anatomical alterations that alter the joint biomechanics by raising tension on a reduced-contact articular surface. The maintenance of increased articular pressures for lengthy periods promotes articular cartilage degradation and early coxarthrosis. However, there is a well-established link between AD and coxarthrosis.

• #26 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. […] The term developmental dysplasia of the hip (DDH) has replaced congenital dislocation of the hip because it more accurately reflects the full spectrum of abnormalities that affect the immature hip. DDH can predispose a child to premature degenerative changes and painful arthritis. […] Factors contributing to DDH include breech presentation, female sex, positive family history, firstborn status, and oligohydramnios. […] DDH occurs more often in children who present in the breech position. It is believed that in utero knee extension of the infant in the breech position results in sustained hamstring forces around the hip and contributes to subsequent hip instability.

• #27 Developmental Dysplasia of the Hip in Childhood – Etiology, Diagnostics and Conservative Treatment | IntechOpen

  https://www.intechopen.com/chapters/54362

  Thus, DDH represents a dynamic process that results in the action of a number of exogenous and endogenous factors, physiological and mechanical, exerted to the mother and to the child during pregnancy and after delivery. Therefore, we are talking about a multifactorial etiology of DDH. […] The mechanism of hip dislocation in children is consisted in the fact that in fetal pelvic presentation, hips are in maximal flexion and knees in maximal extension. […] The muscles of the posterior aspect of the upper leg cause an increased pressure of the proximal part of the femur on the articular capsule and the head gradually slipping from the acetabulum. […] Further progression of the deformity flow is accelerated in the postnatal period with traditional practices of diapering a child (with a cloth), present in our country, with maximum outstretched legs.

• #28 Developmental Dysplasia of the Hip in Childhood – Etiology, Diagnostics and Conservative Treatment | IntechOpen

  https://www.intechopen.com/chapters/54362

  Thus, DDH represents a dynamic process that results in the action of a number of exogenous and endogenous factors, physiological and mechanical, exerted to the mother and to the child during pregnancy and after delivery. Therefore, we are talking about a multifactorial etiology of DDH. […] The mechanism of hip dislocation in children is consisted in the fact that in fetal pelvic presentation, hips are in maximal flexion and knees in maximal extension. […] The muscles of the posterior aspect of the upper leg cause an increased pressure of the proximal part of the femur on the articular capsule and the head gradually slipping from the acetabulum. […] Further progression of the deformity flow is accelerated in the postnatal period with traditional practices of diapering a child (with a cloth), present in our country, with maximum outstretched legs.

• #29 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  The postnatal extrauterine environment also plays a role in DDH. The incidence of DDH is high in Native American cultures that use swaddling, which forces the hips into adduction and extension. […] The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. Intervention in early childhood, when remodeling potential is greater, provides the best opportunity for the development of a normal joint. […] Children with untreated hip dysplasia have been shown to develop premature degenerative changes by the time they reach skeletal maturity, and develop painful arthritis in their thirties.

• #30 Hip dysplasia – Wikipedia

  https://en.wikipedia.org/wiki/Hip_dysplasia

  In the breech position the femoral head tends to get pushed out of the socket and the breech position is probably the most important single risk factor, whether an infant is delivered vaginally or by cesarean section. […] As an acquired condition it has been linked to traditions of swaddling infants, use of overly restrictive baby seats, carriers and other methods of transporting babies, or use of a cradle board which locks the hip joint in an „adducted” position (pulling the knees together tends to pull the heads of the femur bone out of the sockets or acetabulae) for extended periods.

• #31 Detecting Developmental Dysplasia of the Hip – Page 3

  https://www.medscape.com/viewarticle/452673_3

  An understanding of the embryology and postnatal growth and development of the hip is essential to a more complete understanding of this unique disorder. Four critical developmental periods for hip dislocation have been identified and include the following: 12 weeks gestation, 18 weeks gestation, 36 to 40 weeks gestation, and the postnatal period. […] Hip formation begins in the seventh week of gestation, when a cleft separates the tissue that will become the femoral head from the tissue that will become the pelvis. In turn, the femoral head, when properly positioned, forms the large, cup-shaped cavity on the lateral surface of the pelvis known as the acetabulum. If the head of the femur is not positioned properly in the acetabulum, or if movement of the femoral head is reduced, normal bone modeling and a shallow hip socket may develop.

• #32 Detecting Developmental Dysplasia of the Hip – Page 3

  https://www.medscape.com/viewarticle/452673_3

  The first critical period for hip dislocation occurs at 12 weeks gestation when the fetal lower limbs rotate nearly 90 medially, so that the knees point anteriorly and the hips assume their normal position in the pelvis. Dislocations that occur at this stage are labeled teratologic because they will have further impact on all of the ongoing elements of hip development. […] Eighteen weeks gestation is the second critical period in hip development because this is the time that the surrounding muscles develop. Normal fetal movements stretch the developing ligaments and ensure proper position of the femur in the acetabulum. […] The last 4 weeks of pregnancy is the third critical period for DDH. During this stage, mechanical forces related to the infant’s position (ie, breech) or uterine forces (ie, oligohydramnios) limit movement and can disrupt normal development.

• #33

  https://www.orthobullets.com/pediatrics/4118/developmental-dysplasia-of-the-hip-ddh

  Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability. […] initial instability thought to be caused by maternal and fetal laxity, genetic laxity, and intrauterine and postnatal malpositioning. […] initial instability leads to dysplasia typical deficiency is anterior or anterolateral acetabulum. […] dysplasia leads to subluxation and gradual dislocation repetitive subluxation of the femoral head leads to the formation of a ridge of thickened articular cartilage called the limbus. […] chronic dislocation leads to development of secondary barriers to reduction pulvinar thickens, ligamentum teres thickens and elongates, transverse acetabular ligament hypertrophies, hip capsule and iliopsoas form hourglass configuration. […] anatomic changes increased femoral anteversion, flattening of the femoral head, increased acetabular anteversion, increased obliquity and decreased concavity of the acetabular roof, thickening of the medial acetabular wall.

• #34 Pathogenesis of DDH : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/pathogenesis-of-ddh/

  – Discussion: – dislocated femoral head: – femoral head and neck remain anteverted and in the valgus position; – is pulled proximally laterally by hip abductors; – becomes misshapen flattened; – has delayed ossification of capital epiphysis; – muscles crossing the hip joint (hamstring, hip adductors, psoas) become shortened and contracted; – psoas cross acetabulum, blocking reduction; – arthrogram may show hour glass configuration of joint space; – if hip remains dislocated (for weeks), limitation of abduction becomes a more consistent clinical finding; – hip joint fills w/ fibrofatty debris known as pulvinar; – acetabular labrum – becomes enlarged along the superior, posterior, and inferior rim; – may infold into joint (inverted limbus); – limbus blocks reduction of femoral head; – acetabulum – becomes flattened (dysplastic) because it is not stimulated to develop around the absent femoral head; – ligamentum teres becomes lengthened, hypertrophic redundant; – transverse acetabular ligament: – is pulled superiorly w/ capsule which blocks lower portion of acetabulum; – capsule of hip joint becomes expanded

• #35 Congenital Hip Dysplasia | PM&R KnowledgeNow

  https://now.aapmr.org/congenital-hip-dysplasia/

  When the femoral head and acetabulum are not approximated appropriately, the acetabulum will flatten over time, leading to dysplasia and instability at the hip joint. This instability can lead to subluxation or dislocation at the hip which can further worsen the dysplastic changes. […] Key factors that influence pathoanatomy include: Disruption of femoral head and acetabulum relationship, Fatty tissues in the depths of the hip, preventing reduction and stability, Hypertrophy of the ligamentum teres, preventing reduction, Thickened transverse acetabular ligament, narrowing the opening of the acetabulum, Shortened iliopsoas tendon across the anterior hip creates an hourglass shape to the hip capsule, limits access of the femoral head to the acetabulum. […] The success of a functional hip joint relies on the close approximation of the femoral head and acetabulum; therefore, treatment goals are to achieve stable reduction between the femoral head and acetabulum and thus promote normal development.

• #36 Pathogenesis of DDH : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/pathogenesis-of-ddh/

  – Discussion: – dislocated femoral head: – femoral head and neck remain anteverted and in the valgus position; – is pulled proximally laterally by hip abductors; – becomes misshapen flattened; – has delayed ossification of capital epiphysis; – muscles crossing the hip joint (hamstring, hip adductors, psoas) become shortened and contracted; – psoas cross acetabulum, blocking reduction; – arthrogram may show hour glass configuration of joint space; – if hip remains dislocated (for weeks), limitation of abduction becomes a more consistent clinical finding; – hip joint fills w/ fibrofatty debris known as pulvinar; – acetabular labrum – becomes enlarged along the superior, posterior, and inferior rim; – may infold into joint (inverted limbus); – limbus blocks reduction of femoral head; – acetabulum – becomes flattened (dysplastic) because it is not stimulated to develop around the absent femoral head; – ligamentum teres becomes lengthened, hypertrophic redundant; – transverse acetabular ligament: – is pulled superiorly w/ capsule which blocks lower portion of acetabulum; – capsule of hip joint becomes expanded

• #37 Pathogenesis of DDH : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/pathogenesis-of-ddh/

  – Discussion: – dislocated femoral head: – femoral head and neck remain anteverted and in the valgus position; – is pulled proximally laterally by hip abductors; – becomes misshapen flattened; – has delayed ossification of capital epiphysis; – muscles crossing the hip joint (hamstring, hip adductors, psoas) become shortened and contracted; – psoas cross acetabulum, blocking reduction; – arthrogram may show hour glass configuration of joint space; – if hip remains dislocated (for weeks), limitation of abduction becomes a more consistent clinical finding; – hip joint fills w/ fibrofatty debris known as pulvinar; – acetabular labrum – becomes enlarged along the superior, posterior, and inferior rim; – may infold into joint (inverted limbus); – limbus blocks reduction of femoral head; – acetabulum – becomes flattened (dysplastic) because it is not stimulated to develop around the absent femoral head; – ligamentum teres becomes lengthened, hypertrophic redundant; – transverse acetabular ligament: – is pulled superiorly w/ capsule which blocks lower portion of acetabulum; – capsule of hip joint becomes expanded

• #38 Developmental Dysplasia of the Hip in Childhood – Etiology, Diagnostics and Conservative Treatment | IntechOpen

  https://www.intechopen.com/chapters/54362

  Thus, DDH represents a dynamic process that results in the action of a number of exogenous and endogenous factors, physiological and mechanical, exerted to the mother and to the child during pregnancy and after delivery. Therefore, we are talking about a multifactorial etiology of DDH. […] The mechanism of hip dislocation in children is consisted in the fact that in fetal pelvic presentation, hips are in maximal flexion and knees in maximal extension. […] The muscles of the posterior aspect of the upper leg cause an increased pressure of the proximal part of the femur on the articular capsule and the head gradually slipping from the acetabulum. […] Further progression of the deformity flow is accelerated in the postnatal period with traditional practices of diapering a child (with a cloth), present in our country, with maximum outstretched legs.

• #39 The Radiology Assistant : Developmental Dysplasia of the Hip

  https://radiologyassistant.nl/pediatrics/hip/developmental-dysplasia-of-the-hip-ultrasound

  Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns. […] Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal problems in newborns. It is also known as congenital hip dysplasia, but actually this is a misnomer. It is a developmental disease. […] So we have to realize that DDH is a dynamic disease and it is not always present at birth as suggested by the name congenital hip dysplasia. Treatment is easier and complications are less likely to occur when DDH is diagnosed early. […] Developmental dysplasia of the hip is more common in girls especially if there has been a breech presentation or when they have a positive family history. These risk factors play a lesser role in boys. […] The alpha-angle, which is a measurement of the bony roof of the acetabulum, mainly determines the hip type.

• #40 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/

  The hormonal theory has a significant role in hip dysplasia development. It is based on an imbalanced ratio of estrogen to progesterone. A progesterone-rich environment can promote dislocation, whereas an estrogen-rich environment can inhibit it. […] The mechanical factors are usually related to restricted space in utero resulting in fetal packaging deformities. […] One of the most important mechanical factors that may be a risk for DDH is breech presentation at birth. […] Swaddling may promote deformity in infants. […] An inherited predisposition has been well-established in the literature. […] Persistent DDH left untreated results in a sequence of anatomical alterations that alter the joint biomechanics by raising tension on a reduced-contact articular surface. The maintenance of increased articular pressures for lengthy periods promotes articular cartilage degradation and early coxarthrosis. However, there is a well-established link between AD and coxarthrosis.

• #41 Developmental dysplasia of the hip (DDH) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/developmental-dysplasia-of-the-hip-ddh

  In a baby with DDH, the socket is abnormally shallow, which prevents a stable fit. Slack ligaments may also allow the femur to slip out of joint. […] A baby born with a dislocated hip can be successfully treated with a Pavlik harness. […] In some babies, the ligaments around the hip joint are loose, which in most circumstances, corrects during the first few months of life. […] Complications of untreated DDH in an older child may include stability problems with the knee joints and injury to nerves supplying the femur (the thigh bone between the hip and the knee).

• #42 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  The postnatal extrauterine environment also plays a role in DDH. The incidence of DDH is high in Native American cultures that use swaddling, which forces the hips into adduction and extension. […] The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. Intervention in early childhood, when remodeling potential is greater, provides the best opportunity for the development of a normal joint. […] Children with untreated hip dysplasia have been shown to develop premature degenerative changes by the time they reach skeletal maturity, and develop painful arthritis in their thirties.

• #43 Developmental dysplasia of the hip (DDH) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/developmental-dysplasia-of-the-hip-ddh

  In a baby with DDH, the socket is abnormally shallow, which prevents a stable fit. Slack ligaments may also allow the femur to slip out of joint. […] A baby born with a dislocated hip can be successfully treated with a Pavlik harness. […] In some babies, the ligaments around the hip joint are loose, which in most circumstances, corrects during the first few months of life. […] Complications of untreated DDH in an older child may include stability problems with the knee joints and injury to nerves supplying the femur (the thigh bone between the hip and the knee).

• #44 Congenital Hip Dysplasia | PM&R KnowledgeNow

  https://now.aapmr.org/congenital-hip-dysplasia/

  When the femoral head and acetabulum are not approximated appropriately, the acetabulum will flatten over time, leading to dysplasia and instability at the hip joint. This instability can lead to subluxation or dislocation at the hip which can further worsen the dysplastic changes. […] Key factors that influence pathoanatomy include: Disruption of femoral head and acetabulum relationship, Fatty tissues in the depths of the hip, preventing reduction and stability, Hypertrophy of the ligamentum teres, preventing reduction, Thickened transverse acetabular ligament, narrowing the opening of the acetabulum, Shortened iliopsoas tendon across the anterior hip creates an hourglass shape to the hip capsule, limits access of the femoral head to the acetabulum. […] The success of a functional hip joint relies on the close approximation of the femoral head and acetabulum; therefore, treatment goals are to achieve stable reduction between the femoral head and acetabulum and thus promote normal development.

• #45 Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10488138/

  The hormonal theory has a significant role in hip dysplasia development. It is based on an imbalanced ratio of estrogen to progesterone. A progesterone-rich environment can promote dislocation, whereas an estrogen-rich environment can inhibit it. […] The mechanical factors are usually related to restricted space in utero resulting in fetal packaging deformities. […] One of the most important mechanical factors that may be a risk for DDH is breech presentation at birth. […] Swaddling may promote deformity in infants. […] An inherited predisposition has been well-established in the literature. […] Persistent DDH left untreated results in a sequence of anatomical alterations that alter the joint biomechanics by raising tension on a reduced-contact articular surface. The maintenance of increased articular pressures for lengthy periods promotes articular cartilage degradation and early coxarthrosis. However, there is a well-established link between AD and coxarthrosis.

• #46 Developmental dysplasia of the hip: update of management in: EFORT Open Reviews Volume 4 Issue 9 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/9/2058-5241.4.180019.xml

  Persistent dysplasia alters hip biomechanics, overloading the articular cartilage. This overload can wear articular cartilage, leading to early OA. Avoiding OA development is the main goal of the treatment for DDH. […] The natural history of acetabular dysplasia without dislocation or subluxation is not well-known because it is commonly underdiagnosed. […] On the other hand, subluxation of the hip invariably leads to hip OA because of the increased contact forces between the femoral head and acetabulum. […] In true dislocation, the presence of a secondary acetabulum is the main risk factor for OA development. OA develops because of the wear of the femoral head against the pelvic bone.

• #47 Reduced dynamic loads due to hip dislocation induce acetabular cartilage degeneration by IL-6 and MMP3 via the STAT3/periostin/NF-κB axis | Scientific Reports

  https://www.nature.com/articles/s41598-022-16585-6

  Developmental dysplasia of the hip (DDH) is characterized by anatomical abnormalities of the hip joint, ranging from mild acetabular dysplasia to hip subluxation and eventually dislocation. The mechanism underlying the cartilage degeneration of the hip joints exposed to reduced dynamic loads due to hip dislocation remains unknown. […] In summary, reduced dynamic loads due to hip dislocation induced acetabular cartilage degeneration via IL-6 and MMP3 through STAT3/periostin/NF-B signaling in the rodent DA-DDH models. […] The abnormal contact stress to the acetabulum due to acetabular dysplasia is associated with cartilage degeneration in DDH. […] Although most of the acetabulum is barely loaded due to hip dislocation since infancy in DDH patients with complete dislocation, cartilage degeneration develops even in unloaded cartilage.

• #48 Reduced dynamic loads due to hip dislocation induce acetabular cartilage degeneration by IL-6 and MMP3 via the STAT3/periostin/NF-κB axis | Scientific Reports

  https://www.nature.com/articles/s41598-022-16585-6

  We hypothesized that the phenotype and mechanism of degeneration in cartilage subjected to reduced dynamic load are different from those of cartilage subjected to excessive stress and traumatic damage. […] We also revealed that the expression of Postn, IL-6, and Mmp3 was upregulated and that of Col2a1 and Acan was downregulated in the articular cartilage of the unloaded acetabulum in DA-DDH models, compared with that in controls. […] Our findings provide supporting evidence that reduced dynamic load can promote acetabular cartilage degeneration by activating the STAT3/Postn/NF-B/IL-6 and Mmp3 feedback loop in an autocrine or paracrine manner and may suppress chondrogenesis during the hip dislocation of DDH.

• #49 Reduced dynamic loads due to hip dislocation induce acetabular cartilage degeneration by IL-6 and MMP3 via the STAT3/periostin/NF-κB axis | Scientific Reports

  https://www.nature.com/articles/s41598-022-16585-6

  We hypothesized that the phenotype and mechanism of degeneration in cartilage subjected to reduced dynamic load are different from those of cartilage subjected to excessive stress and traumatic damage. […] We also revealed that the expression of Postn, IL-6, and Mmp3 was upregulated and that of Col2a1 and Acan was downregulated in the articular cartilage of the unloaded acetabulum in DA-DDH models, compared with that in controls. […] Our findings provide supporting evidence that reduced dynamic load can promote acetabular cartilage degeneration by activating the STAT3/Postn/NF-B/IL-6 and Mmp3 feedback loop in an autocrine or paracrine manner and may suppress chondrogenesis during the hip dislocation of DDH.

• #50 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  The postnatal extrauterine environment also plays a role in DDH. The incidence of DDH is high in Native American cultures that use swaddling, which forces the hips into adduction and extension. […] The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. Intervention in early childhood, when remodeling potential is greater, provides the best opportunity for the development of a normal joint. […] Children with untreated hip dysplasia have been shown to develop premature degenerative changes by the time they reach skeletal maturity, and develop painful arthritis in their thirties.

• #51 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or decreased agility. Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2.

• #52 Developmental dysplasia of the hip: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000971.htm

  Developmental dysplasia of the hip (DDH) is a dislocation of the hip joint that is present at birth. The cause is unknown. Low levels of amniotic fluid in the womb during pregnancy can increase a baby’s risk for DDH. DDH occurs in about 1 to 1.5 of 1,000 births. […] A hip that is truly dislocated in an infant should be detected at birth, but some cases are mild and symptoms may not develop until after birth, which is why multiple exams are recommended. Some mild cases are silent and cannot be found during a physical exam. […] If hip dysplasia is found in the first few months of life, it can almost always be treated successfully with a positioning device (bracing). Hip dysplasia that is found after early infancy may lead to a worse outcome and may need more complex surgery to fix the problem. […] Untreated, hip dysplasia will lead to arthritis and deterioration of the hip, which can be severely debilitating.

• #53 Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj220101/sicotj220101.html

  Approximately 25-50% of patients with hip dysplasia develop radiographic osteoarthritis by 50 years of age. […] In comparison with a normal hip, if hip instability is present at birth, the relative risk of total hip arthroplasty (THA) is 2.6. […] Late diagnosis of DDH or late presenting DDH in adolescence or adulthood requires complex surgical intervention demanding greater resources from the healthcare system for management. […] Early diagnosis of DDH (3 months of age) can be successfully managed non-operatively with a Pavlik harness or abduction braces, while the late diagnosis of DDH (3 months of age) increases the need for surgical intervention such as a closed or open reduction or a hip preservation surgery including pelvic, acetabular or femoral osteotomy. […] Overall, despite the universal clinical screening programme with selective ultrasound screening, the prevalence of DDH is over 40% in the adult population examined in this study, as determined by radiographic analysis of patients below 50 years of age undergoing THA. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge of the prevalence of DDH in the adult population. Ultimately, early detection and treatment of DDH will reduce the onset of secondary osteoarthritis, thereby decreasing the need for expensive THA techniques and financially benefiting the healthcare system.

• #54 Developmental dysplasia of the hip: update of management in: EFORT Open Reviews Volume 4 Issue 9 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/9/2058-5241.4.180019.xml

  The term developmental dysplasia of the hip (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. […] DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). […] Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. […] Adequate growth and development of the hip depends on two main (and necessary) factors: concentric positioning of femoral head into the acetabular cavity and adequate balance in growth between triradiate and acetabular cartilage.

• #55 Current concepts in developmental dysplasia of the hip and Total hip arthroplasty | Arthroplasty | Full Text

  https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-019-0004-6

  Developmental dysplasia of the hip (DDH) is a spectrum of pathology that involves dysplasia of both the acetabulum and the femur. If left untreated, it can develop to hip pain and osteoarthritis, which eventually require total hip arthroplasty (THA). […] DDH represents a condition where the ball and socket joint of the hip does not properly form in infants and young children. DDH occurs one in every 1000 live births and is more common in girls. It is the most common cause of secondary osteoarthritis in adults under 40 years of age. If left untreated, it can lead to hip pain and osteoarthritis, which eventually require total hip arthroplasty. […] Because of morphological diversity of deformities, technical difficulties, inadequately designed prostheses, and so on, THA in dysplastic hips, especially in high dislocation, remains a challenging task.

• #56 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  The postnatal extrauterine environment also plays a role in DDH. The incidence of DDH is high in Native American cultures that use swaddling, which forces the hips into adduction and extension. […] The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. Intervention in early childhood, when remodeling potential is greater, provides the best opportunity for the development of a normal joint. […] Children with untreated hip dysplasia have been shown to develop premature degenerative changes by the time they reach skeletal maturity, and develop painful arthritis in their thirties.

• #57 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  The postnatal extrauterine environment also plays a role in DDH. The incidence of DDH is high in Native American cultures that use swaddling, which forces the hips into adduction and extension. […] The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] The goal of operative treatment of DDH is to normalize the hip joint to delay or prevent the premature onset of osteoarthritis. Intervention in early childhood, when remodeling potential is greater, provides the best opportunity for the development of a normal joint. […] Children with untreated hip dysplasia have been shown to develop premature degenerative changes by the time they reach skeletal maturity, and develop painful arthritis in their thirties.

• #58 SciELO Brazil – Developmental Dysplasia of the Hip – Part 1 Developmental Dysplasia of the Hip – Part 1

  https://www.scielo.br/j/rbort/a/bMbLB6VHKnGMZD9RzWjnN9B/

  Developmental dysplasia of the hip is probably a disease of multifactorial origin, and we must consider some risk factors for investigation. […] Hip positioning within the first few months of life can influence adequate joint development. […] The universal ultrasound screening of newborns is controversial because of its high cost. In addition, it requires professional training and predisposes to overtreatment and its complications. […] The interpretation of a neonatal hip radiograph can be a challenge. However, from the 6th month of life onwards, it gets easier, and it is essential for DDH follow-up. […] Developmental dysplasia of the hip treatment requires maintaining a concentric reduction between the femoral head and the acetabulum, positioning the hip in 90 to 110 of flexion and 30 to 65 of abduction while respecting the safety zone. […] Acetabular remodeling is directly related to stability and age at institution of treatment. It is slower in children 12 months. From 18 months old onwards, we recommend a pelvic osteotomy with a hip reduction procedure.

• #59 Congenital Hip Dysplasia | PM&R KnowledgeNow

  https://now.aapmr.org/congenital-hip-dysplasia/

  When the femoral head and acetabulum are not approximated appropriately, the acetabulum will flatten over time, leading to dysplasia and instability at the hip joint. This instability can lead to subluxation or dislocation at the hip which can further worsen the dysplastic changes. […] Key factors that influence pathoanatomy include: Disruption of femoral head and acetabulum relationship, Fatty tissues in the depths of the hip, preventing reduction and stability, Hypertrophy of the ligamentum teres, preventing reduction, Thickened transverse acetabular ligament, narrowing the opening of the acetabulum, Shortened iliopsoas tendon across the anterior hip creates an hourglass shape to the hip capsule, limits access of the femoral head to the acetabulum. […] The success of a functional hip joint relies on the close approximation of the femoral head and acetabulum; therefore, treatment goals are to achieve stable reduction between the femoral head and acetabulum and thus promote normal development.

• #60 Developmental Dysplasia of the Hip in Childhood – Etiology, Diagnostics and Conservative Treatment | IntechOpen

  https://www.intechopen.com/chapters/54362

  Although the cause of disease is found to be multifactorial, still there are certain conditions that can be extracted, characteristics of medical history and risks that show a significant correlation with the incidence of DDH. […] Continuous traction aims to gradually progressively stretch the shortened soft tissues and to center the hip head in acetabulum, with the gradual adaptation of vascular and neurological elements. […] Continuous traction is always carried out at the hospital. […] Here we should mention the position in which the reposition always takes place, and that is abduction and internal rotation. […] We emphasize that the cast immobilization is done in the human position, which is the position of the upper leg abduction of 45, 100 degrees of flexion with neutral rotation.

• #61 Developmental Dysplasia of the Hip – Lower Extremity Disorders for Physician Assistant

  https://www.picmonic.com/pathways/physician-assistant/courses/standard/pathology-10894/lower-extremity-disorders-39698/developmental-dysplasia-of-the-hip_2214

  Developmental dysplasia of the hip (DDH) is a disorder characterized by abnormal positioning of the femoral head in the acetabulum of the pelvis. In patients with severe degrees of DDH, the femoral head may be subluxed or completely dislocated. […] The Barlow maneuver is a physical maneuver performed on infants, used to screen for DDH to assess for subluxation or dislocation of the femoral head. The dislocation will be palpable. […] If DDH is diagnosed at 6 months of age or earlier, the condition can typically be corrected using an abduction device. The device must be worn for 24 hours a day until the condition is resolved, and the hip is stable. […] If treatment with an abduction device is unsuccessful or if the child is diagnosed after 6 months of age, a closed reduction will be performed to correct the condition.

• #62 Developmental Dysplasia of the Hip (DDH) – Orthopedic & Sports Medicine

  https://orthosportsmed.com/developmental-dysplasia-of-the-hip-ddh/

  Fetal development in the breach position may also be a cause of DDH. Of those children with DDH, 30-50% developed in a breach position though only 2-3% of babies born are delivered in a breach position, DDH is also associated with other disorders caused by intrauterine position, such as congenital muscular torticollus (wry neck), talipes equinovarus (club foot), metatarsus adductus (toes bent inward). […] If caught early, treatment of DDH simply involves maintaining the hip in a position of flexion (knee up toward head) and abduction (knee away from center line) for 1-2 months using a Pavlik harness. The Pavlik device maintains the proper position of the femoral head (ball of hip joint), allowing the ligaments to tighten and normal hip socket formation to occur. […] In some children with DDH, especially older children, surgery is sometimes necessary to reshape and tighten the hip joint.

• #63 Mechanism of Hip Dysplasia and Identification of the Least Energy Path for its Treatment by using the Principle of Stationary Potential Energy

  https://stars.library.ucf.edu/etd/1418/

  Developmental dysplasia of the hip (DDH) is a common newborn condition where the femoral head is not located in its natural position in the acetabulum (hip socket). […] One of the most effective methods of treatment is the use of Pavlik Harness, which directs the femoral head toward the natural position inside the acetabulum. […] This dissertation presents a developed method for identifying the least energy path that the femoral head would follow during reduction. […] The potential energy stems from strain energy stored in the muscles and gravitational potential energy of four rigid-body components of lower limb bones. […] Clinical observations indicate that reduction with the Pavlik Harness occurs passively in deep sleep under the combined effects of gravity and the constraints of the Pavlik Harness.

• #64 Mechanism of Hip Dysplasia and Identification of the Least Energy Path for its Treatment by using the Principle of Stationary Potential Energy

  https://stars.library.ucf.edu/etd/1418/

  Results confirm the clinical observations of two different pathways for closed reduction. […] The path of least energy closely approximated the modified Hoffman-Daimler method. […] However, the indirect path requires less energy and may be an alternative to direct manual reduction of Grade IV infantile hip dislocations. […] Of great importance, as a result of this work, identifying the minimum energy path that the femoral head would travel would provide a non-surgical tool that effectively aids the surgeon in treating DDH.

• #65 Developmental Dysplasia of the Hip in Childhood – Etiology, Diagnostics and Conservative Treatment | IntechOpen

  https://www.intechopen.com/chapters/54362

  Although the cause of disease is found to be multifactorial, still there are certain conditions that can be extracted, characteristics of medical history and risks that show a significant correlation with the incidence of DDH. […] Continuous traction aims to gradually progressively stretch the shortened soft tissues and to center the hip head in acetabulum, with the gradual adaptation of vascular and neurological elements. […] Continuous traction is always carried out at the hospital. […] Here we should mention the position in which the reposition always takes place, and that is abduction and internal rotation. […] We emphasize that the cast immobilization is done in the human position, which is the position of the upper leg abduction of 45, 100 degrees of flexion with neutral rotation.

• #66 Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj220101/sicotj220101.html

  Approximately 25-50% of patients with hip dysplasia develop radiographic osteoarthritis by 50 years of age. […] In comparison with a normal hip, if hip instability is present at birth, the relative risk of total hip arthroplasty (THA) is 2.6. […] Late diagnosis of DDH or late presenting DDH in adolescence or adulthood requires complex surgical intervention demanding greater resources from the healthcare system for management. […] Early diagnosis of DDH (3 months of age) can be successfully managed non-operatively with a Pavlik harness or abduction braces, while the late diagnosis of DDH (3 months of age) increases the need for surgical intervention such as a closed or open reduction or a hip preservation surgery including pelvic, acetabular or femoral osteotomy. […] Overall, despite the universal clinical screening programme with selective ultrasound screening, the prevalence of DDH is over 40% in the adult population examined in this study, as determined by radiographic analysis of patients below 50 years of age undergoing THA. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge of the prevalence of DDH in the adult population. Ultimately, early detection and treatment of DDH will reduce the onset of secondary osteoarthritis, thereby decreasing the need for expensive THA techniques and financially benefiting the healthcare system.

• #67 Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj220101/sicotj220101.html

  Developmental dysplasia of the hip (DDH) refers to congenital and/or developmental hip instability that can result in hip joint subluxation or dislocation. […] Missed detection of DDH in the neonatal period or late development of DDH often requires surgical intervention to correct the abnormal anatomy. Furthermore, despite surgical intervention, residual sequelae may persist leading to early osteoarthritis of the hip joint requiring joint replacement surgery. […] Despite treatment, residual sequelae of DDH persist in a portion of the patients. Residual dysplasia is present in up to 19% of patients treated successfully with a Pavlik harness and 22-33% of patients treated with a closed or open reduction. […] Although the causal mechanism between hip dysplasia and early osteoarthritis has not been established, leading theories suggest abnormal biomechanics and shear forces.

• #68 Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50 years of age | SICOT-J

  https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj220101/sicotj220101.html

  Approximately 25-50% of patients with hip dysplasia develop radiographic osteoarthritis by 50 years of age. […] In comparison with a normal hip, if hip instability is present at birth, the relative risk of total hip arthroplasty (THA) is 2.6. […] Late diagnosis of DDH or late presenting DDH in adolescence or adulthood requires complex surgical intervention demanding greater resources from the healthcare system for management. […] Early diagnosis of DDH (3 months of age) can be successfully managed non-operatively with a Pavlik harness or abduction braces, while the late diagnosis of DDH (3 months of age) increases the need for surgical intervention such as a closed or open reduction or a hip preservation surgery including pelvic, acetabular or femoral osteotomy. […] Overall, despite the universal clinical screening programme with selective ultrasound screening, the prevalence of DDH is over 40% in the adult population examined in this study, as determined by radiographic analysis of patients below 50 years of age undergoing THA. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge of the prevalence of DDH in the adult population. Ultimately, early detection and treatment of DDH will reduce the onset of secondary osteoarthritis, thereby decreasing the need for expensive THA techniques and financially benefiting the healthcare system.

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