DDH: Diagnosis and Treatment Strategies

Congenital hip dysplasia (CDH) has been known since early times and its characteristics have already been described by Hippocrates. The efforts to establish the earliest possible diagnosis and adequate early-stage therapy as well as recommendations for their accomplishment are predominant throughout the history of Paediatrics and Orthopaedics. The consequences of an undiagnosed dislocated hip are horrendous for the babies. In spite of adequate therapy a late diagnosis usually leads to lasting damage and in many cases to severe pain and disability, including osteoarthritis.

It has been estimated that 10% of inserted hip joint pros-theses which are currently being implanted are for treatment of disorders of hip maturation [1] including hip dislocation and hip dysplasia. Although clinical instability examinations according to Ortolani [2] have been introduced and are widely used in practice, it was established at a crucial symposium in Vienna in 1971 that 47% of completely dislocated hip joints were only diagnosed at the end of the fi rst year of age [3]. At that time the authors expressed with resignation: “this development hardly leaves hope that under the given circumstances diagnosis and therapy of hip dys-plasia can be mastered to some extent”.