Developmental dysplasia of the hip (DDH) encompasses conditions ranging from irreducible neonatal dislocation to asymptomatic acetabular dysplasia in the adult. The age at diagnosis and the severity of displacement influence the procedures selected by the treating surgeon. Treatment modalities include abduction splintage, closed or open reduction with casting, pelvic osteotomies, femoral osteotomies, complex reconstruction and salvage procedures. The consequences of management of children with DDH affect our patients for a life time. Sadly, there are few long-term outcome studies of DDH management published. A literature review reveals only nine well documented and clinically relevant studies, which follow patients beyond the age of 30 years. Several classification systems have been used to assess functional and radiological outcomes which makes comparison of the results unreliable.
Most studies report 70% of good or excellent radiographic and functional results where the study period is less than 20 years. When the average follow-up is 30 years, however, the percentage of good or excellent radiographic results decreases to 45%.
Natural history studies have shown that untreated congenital hip dislocation is not invariably associated with a poor functional result. Children we treat for DDH must have an outcome better than if we had not treated them.
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