Congenital dysplasia and dislocation of the hip. Proven and new procedures in diagnostics and therapy

As developmental dysplasia of the hip (DDH) is the most common congenital muskuloskeletal anomaly, it seems necessary to give an update on the normal growth, pathoanatomy, diagnostic and therapeutic procedures. Which investigations or procedures have withstood the test of time? What are new therapeutic strategies and considerations? What are the problems? Review of the current literature on DDH supplemented by several years experience in the treatment of this condition by the authors. We have still a long way to achieve the goal of agreement on universal standardization of assessment and treatment methods based on age and staging regarding DDH, as in the Ponseti treatment procedure for clubfoot. Our experiences, as well as the literature suggest the use of Graf's nomenclature for classification of DDH in the first year of life. If dynamic ultrasound (US) shows at least a partial relocation of a decentered hip in the first 6 weeks of life, splinting in human position is advocated. The treatment of a Graf type IV hip joint is very difficult and often need surgery. The established surgical procedures in the literature are still up to date. Radiological follow-up of the affected as well as the unaffected side until the end of the growth phase is mandatory due to the risk of residual dysplasia.