Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip”...
Transcript of Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip”...
![Page 1: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/1.jpg)
““Developmental Dysplasia Developmental Dysplasia of the Hip ”of the Hip ”
An unsuitable term
G.Hartofilakidis
![Page 2: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/2.jpg)
Before the application of roentgenograms,Dupuytren, in 1826, observed that some
new born infants presented withdisplacement of the head of the femur from
the acetabulum
![Page 3: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/3.jpg)
He named the condition
“ “ Congenital Dislocation of the Hip ” Congenital Dislocation of the Hip ”
![Page 4: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/4.jpg)
Although the accuracy of the term became questionable, nonetheless it
persisted causing considerable confusion in understanding and
communication
![Page 5: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/5.jpg)
Thus, in following years the literature on pathogenesis and terminology of CDH
is replete with contradiction and uncertainty
![Page 6: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/6.jpg)
Congenital dislocationCongenital dysplasia Idiopathic infantile displacementCongenital hip disease Infantile displacement
A variety of terminologies appeared describing the pathology of the deformity :
![Page 7: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/7.jpg)
In 1989, Klisic, emphasized that congenital dislocation of the hip is a
misleading term, when used for the total spectrum of infant hip deformities
![Page 8: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/8.jpg)
““Developmental Displacement of the Hip”Developmental Displacement of the Hip”
He recommended the use of the term :
![Page 9: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/9.jpg)
The change of the term “congenital” to “developmental”was surprisingly accepted by the
majority of authors
![Page 10: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/10.jpg)
On the other hand, the wording of “displacement”
was replaced with that of “dysplasia”
![Page 11: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/11.jpg)
A new term was established:
“Developmental Dysplasia of the Hip”
![Page 12: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/12.jpg)
From a deficient term“Congenital dislocation of the Hip”
we ended up with the non specific and unsuitable term
“Developmental dysplasia of the Hip”without convincing arguments for the
change
![Page 13: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/13.jpg)
The term “Developmental” is not descriptive of the congenital
nature of the deformity
“Developmental” has the meaning of evolving, gradually changing,
progressing
“Dysplasia” bears the meaning of abnormally formed
![Page 14: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/14.jpg)
A possible explanation for that change:To avoid malpractice for late diagnosis
“Pediatrics” Vol 105, April 2000
![Page 15: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/15.jpg)
An agreed term is needed to cover the entire
pathology of congenital hip deformities,
and furthermore a generally accepted
classification of the deformities is
necessary
![Page 16: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/16.jpg)
1. To accept the general term :
“Congenital Hip Disease”
covering all types of congenital deformities of the hip joint
Our suggestion
![Page 17: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/17.jpg)
Our suggestion
Infants(proposed by various authors)
Dysplasia Subluxation Dislocation
Adults(Hartofilakidis et al)
Dysplasia Low dislocation High dislocation
2. To use the following classification
![Page 18: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/18.jpg)
Congenital Hip Disease - Infants
Dysplasia
Poor development acetabulum and
femoral head
Shenton’s line intact
![Page 19: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/19.jpg)
Congenital Hip Disease - Infants
Subluxation Proximal and lateral
migration of the femoral head
(without overpassing the upper edge of the
acetabulum)
Shenton’s line broken
![Page 20: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/20.jpg)
Congenital Hip Disease - Infants
Dislocation
Femoral head completely
out of the acetabulum
![Page 21: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/21.jpg)
Congenital Hip Disease - Adults
Dysplasia Type 1
Femoral head articulates with the true acetabulum
![Page 22: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/22.jpg)
Congenital Hip Disease - Adults
Low dislocationType 2
Femoral head articulates with a false acetabulum,
partially covering the true acetabulum
![Page 23: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/23.jpg)
Congenital Hip Disease - Adults
High dislocationType 3
Femoral head hasmigrated superiorly
and posteriorly to thetrue acetabulum
![Page 24: Developmental Dysplasia of the Hip - OrthoSurgery · “Developmental dysplasia of the Hip” without convincing arguments for the change. The term “Developmental” is not descriptive](https://reader033.fdocuments.in/reader033/viewer/2022052801/5f11765b0aba083d7f3aebef/html5/thumbnails/24.jpg)
We strongly suggest:
Avoid the term
Developmental Dysplasia of the Hip
The term is unsuitable and misleading