Displasia do desenvolvimento do quadril – Parte 1

Susana Reis Braga; Amâncio Ramalho Júnior; Miguel Akkari; Marina Juliana Pita Sassioto Silveira Figueiredo; Gilberto Waisberg; Claudio Santili

doi:10.1055/s-0042-1758371

Revista Brasileira de Ortopedia, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(06): e839-e846
DOI: 10.1055/s-0042-1758371

Artigo de Atualização

Ortopedia Pediátrica

Developmental Dysplasia of the Hip – Part 1

Artikel in mehreren Sprachen: português | English

Susana Reis Braga

¹Médico assistente, Grupo de Ortopedia Pediátrica, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

²Médico assistente, Grupo de Ortopedia Pediátrica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

,

Amâncio Ramalho Júnior

²Médico assistente, Grupo de Ortopedia Pediátrica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

,

Miguel Akkari

¹Médico assistente, Grupo de Ortopedia Pediátrica, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

²Médico assistente, Grupo de Ortopedia Pediátrica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

,

Marina Juliana Pita Sassioto Silveira Figueiredo

³Médica ortopedista e traumatologista, Hospital Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil

,

Gilberto Waisberg

¹Médico assistente, Grupo de Ortopedia Pediátrica, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

⁴Médico ortopedista e traumatologista, Grupo de Ortopedia e Traumatologia Pediatrica, Hospital Mario Covas, Faculdade de Medicina do ABC, Santo André, SP, Brasil

,

Claudio Santili

¹Médico assistente, Grupo de Ortopedia Pediátrica, Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

› Institutsangaben

Abstract

Developmental dysplasia of the hip (DDH) is a condition characterized by changes in joint formation within the last months of intrauterine life or the first months after birth. Developmental dysplasia of the hip presentation ranges from femoroacetabular instability to several stages of dysplasia up to complete dislocation. Early diagnosis is essential for successful treatment. Clinical screening, including appropriate maneuvers, is critical in newborns and subsequent examinations during the growth of the child.

Infants with suspected DDH must undergo an ultrasound screening, especially those with a breech presentation at delivery or a family history of the condition. A hip ultrasound within the first months, followed by pelvic radiograph at 4 or 6 months, determines the diagnosis and helps follow-up.

Treatment consists of concentric reduction and hip maintenance and stabilization with joint remodeling. The initial choices are flexion/abduction orthoses; older children may require a spica cast after closed reduction, with or without tenotomy. An open reduction also can be indicated. After 18 months, the choices include pelvic osteotomies with capsuloplasty and, eventually, acetabular and femoral osteotomies.

The follow-up of treated children must continue throughout their growth due to the potential risk of late dysplasia.

Keywords

developmental dsysplasia of the hip - hip dislocation, congenital - diagnosis - treatment

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Referenzen

Referências
1 Musielak B, Idzior M, Jóźwiak M. Evolution of the term and definition of dysplasia of the hip - a review of the literature. Arch Med Sci 2015; 11 (05) 1052-1057
2 Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011; 2011: 238607
3 Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. Proc R Soc Med 1963; 56 (09) 804-806
4 Guarniero R, Montenegro NB, Vieira PB, Peixinho M. Sinal de Ortolani: resultado do exame ortopétido em 9.171 recém-nascidos na Associaçäo Maternidade de Säo Paulo. Rev Bras Ortop 1988; 23 (05) 125-128
5 Motta GGB, Chiovatto ARS, Chiovatto ED, Duarte ML, Rodrigues NVM, Iared W. Prevalence of Developmental Dysplasia of the Hip in a Maternity Hospital in São Paulo, Brazil. Rev Bras Ortop (Sao Paulo) 2021; 56 (05) 664-670
6 Håberg Ø, Foss OA, Lian ØB, Holen KJ. Is foot deformity associated with developmental dysplasia of the hip?. Bone Joint J 2020; 102-B (11) 1582-1586
7 Oh EJ, Min JJ, Kwon SS. et al. Breech presentation in twins as a risk factor for developmental dysplasia of the hip. J Pediatr Orthop 2022; 42 (01) e55-e58
8 Koob S, Garbe W, Bornemann R, Ploeger MM, Scheidt S, Gathen M, Placzek R. Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns. Ultraschall Med 2022; Apr; 43 (02) 177-180
9 Sidharthan S, Kehoe C, Dodwell E. Post-Natal Positioning through Babywearing: What the Orthopaedic Surgeon Needs to Know. JPOSNA® 2020;2(03). Available from: https://www.jposna.org/ojs/index.php/jposna/article/view/131
10 Ulziibat M, Munkhuu B, Bataa AE, Schmid R, Baumann T, Essig S. Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial. BMC Pediatr 2021; 21 (01) 450
11 Siddicky SF, Wang J, Rabenhorst B, Buchele L, Mannen EM. Exploring infant hip position and muscle activity in common baby gear and orthopedic devices. J Orthop Res 2021; 39 (05) 941-949
12 Moon RY. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics 2016; 138 (05) e20162940
13 O'Beirne JG, Chlapoutakis K, Alshryda S. et al. International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip. Ultraschall Med 2019; 40 (04) 454-464
14 Biedermann R, Eastwood DM. Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues. J Child Orthop 2018; 12 (04) 296-301
15 Lee J, Spinazzola RM, Kohn N, Perrin M, Milanaik RL. Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants?. J Perinatol 2016; 36 (07) 552-556
16 Imrie M, Scott V, Stearns P, Bastrom T, Mubarak SJ. Is ultrasound screening for DDH in babies born breech sufficient?. J Child Orthop 2010; 4 (01) 3-8
17 Brusalis CM, Price CT, Sankar WN. Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria. J Child Orthop 2017; 11 (04) 272-276
18 Antoniak K, Lee C, Goldstein RY, Abousamra O. Is radiographic imaging necessary for identifying late developmental dysplasia of the hip in breech infants with normal ultrasounds?. Glob Pediatr Health 2021; 8: 1-5
19 Joiner ER, Andras LM, Skaggs DL. Screening for hip dysplasia in congenital muscular torticollis: is physical exam enough?. J Child Orthop 2014; 8 (02) 115-119
20 Harper P, Joseph BM, Clarke NMP. et al; International Hip Dysplasia Institute (IHDI). Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns. J Pediatr Orthop 2020; 40 (08) 408-412
21 Ortolani M. Un segno poco noto e sua importanza per la diagnosi precoce di prelussazione congenita dell'anca. Paediatria 1937; 45: 129-136
22 Humphry S, Thompson D, Price N, Williams PR. The ‘clicky hip’: to refer or not to refer?. Bone Joint J 2018; 100-B (09) 1249-1252
23 Hart VL. Congenital dislocation of the hip in the newborn and in early postnatal life. J Am Med Assoc 1950; 143 (15) 1299-1303
24 Harris LE, Lipscomb PR, Hodgson JR. Early diagnosis of congenital dysplasia and congenital dislocation of the hip. Value of the abduction test. J Am Med Assoc 1960; 173: 229-233
25 Ömeroğlu H, Tatlici E, Köse N. Significance of Asymmetry of Groin and Thigh Skin Creases in Developmental Dysplasia of the Hip Revisited: Results of a Comparative Study. J Pediatr Orthop 2020; 40 (08) e761-e765
26 Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop 1984; 4 (06) 735-740
27 Graf R, Lercher K, Scott S, Spieß T. Fundamentos da ultrassonografia do quadril infantil: segundo a técnica de Graf. Tradução de Giovanna Braga Motta e Susana dos Reis Braga. São Paulo: Pasavento; 2021
28 Sari AS, Karakus O. Is experience alone sufficient to diagnose developmental dysplasia of the hip without the bony roof (alpha angle) and the cartilage roof (beta angle) measurements?: A diagnostic accuracy study. Medicine (Baltimore) 2020; 99 (14) e19677
29 Terjesen T. Ultrasound as the primary imaging method in the diagnosis of hip dysplasia in children aged < 2 years. J Pediatr Orthop B 1996; 5 (02) 123-128
30 Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology 1985; 157 (03) 673-677
31 van Douveren FQ, Pruijs HE, Sakkers RJ, Nievelstein RA, Beek FJ. Ultrasound in the management of the position of the femoral head during treatment in a spica cast after reduction of hip dislocation in developmental dysplasia of the hip. J Bone Joint Surg Br 2003; 85 (01) 117-120
32 Bone CM, Hsieh GH. The risk of carcinogenesis from radiographs to pediatric orthopaedic patients. J Pediatr Orthop 2000; 20 (02) 251-254
33 Hudak KE, Faulkner ND, Guite K. et al. Variations in AP and frog-leg pelvic radiographs in a pediatric population. J Pediatr Orthop 2013; 33 (02) 212-215
34 Kumar A, Chau WW, Hung AL, Wong JK, Ng BKW, Cheng JCY. Gonadal shield: is it the Albatross hanging around the neck of developmental dysplasia of the hip research?. J Child Orthop 2018; 12 (06) 606-613
35 Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin: Springer-Verlag; 1987
36 Novais EN, Pan Z, Autruong PT, Meyers ML, Chang FM. Normal percentile reference curves and correlation of acetabular index and acetabular depth ratio in children. J Pediatr Orthop 2018; 38 (03) 163-169
37 Roovers EA, Boere-Boonekamp MM, Mostert AK, Castelein RM, Zielhuis GA, Kerkhoff TH. The natural history of developmental dysplasia of the hip: sonographic findings in infants of 1-3 months of age. J Pediatr Orthop B 2005; 14 (05) 325-330
38 Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am 1976; 58 (07) 1000-1004
39 De Pellegrin M, Damia CM, Marcucci L, Moharamzadeh D. Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips. Children (Basel) 2021; 8 (03) 179
40 Sierra-Silvestre E, Bosello F, Fernández-Carnero J, Hoozemans MJM, Coppieters MW. Femoral nerve excursion with knee and neck movements in supine, sitting and side-lying slump: An in vivo study using ultrasound imaging. Musculoskelet Sci Pract 2018; 37: 58-63
41 Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am 2011; 93 (05) 493-499
42 Mubarak S, Garfin S, Vance R, McKinnon B, Sutherland D. Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip. J Bone Joint Surg Am 1981; 63 (08) 1239-1248
43 Maclean JG, Hawkins A, Campbell D, Taylor MA. A simple modification of the Pavlik harness for unstable hips. J Pediatr Orthop 2005; 25 (02) 183-185
44 Lyu X, Chen T, Yang Z. et al. Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months. Bone Joint J 2021; 103-B (05) 991-998
45 Ran L, Chen H, Pan Y, Lin Q, Canavese F, Chen S. Comparison between the Pavlik harness and the Tübingen hip flexion splint for the early treatment of developmental dysplasia of the hip. J Pediatr Orthop B 2020; 29 (05) 424-430
46 Bram JT, Gohel S, Castañeda PG, Sankar WN. Is There a Benefit to Weaning Pavlik Harness Treatment in Infantile DDH?. J Pediatr Orthop 2021; 41 (03) 143-148
47 Massa BSF, Guarniero R, Godoy Jr RM, Rodrigues JC, Montenegro NB, Cordeiro FG. Use of inlet radiographs in the assessment of reduction after the surgical treatment of developmental dysplasia of the hip. Bone Joint J 2017; 99-B (05) 697-701
48 Ranawat V, Rosendahl K, Jones D. MRI after operative reduction with femoral osteotomy in developmental dysplasia of the hip. Pediatr Radiol 2009; 39 (02) 161-163
49 Rosenbaum DG, Servaes S, Bogner EA, Jaramillo D, Mintz DN. MR imaging in postreduction assessment of developmental dysplasia of the hip: goals and obstacles. Radiographics 2016; 36 (03) 840-854
50 Herring JA. Developmental Dysplasia of the hip. In: Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children. 5 ^th ed. Philapdelphia: Elsevier; 2014: 483-579
51 Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years?. World J Orthop 2015; 6 (11) 886-901
52 Lindstrom JR, Ponseti IV, Wenger DR. Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am 1979; 61 (01) 112-118
53 Kothari A, Grammatopoulos G, Hopewell S, Theologis T. How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia?. Clin Orthop Relat Res 2016; 474 (05) 1199-1208
54 Wakabayashi K, Wada I, Horiuchi O, Mizutani J, Tsuchiya D, Otsuka T. MRI findings in residual hip dysplasia. J Pediatr Orthop 2011; 31 (04) 381-387
55 Walbron P, Müller F, Mainard-Simard L, Luc A, Journeau P. Bone maturation of MRI residual developmental dysplasia of the hip with discrepancy between osseous and cartilaginous acetabular index. J Pediatr Orthop B 2019; 28 (05) 419-423
56 Salter RB. Innominate osteotomy in the treatment of congenital hip dislocation and subluxation of the hip. J Bone Joint Surg Br 1961; 43 (03) 518-539
57 Rab GT. Biomechanical aspects of Salter osteotomy. Clin Orthop Relat Res 1978; (132): 82-87
58 Airey G, Shelton J, Dorman S, Bruce C, Wright DM. The Salter innominate osteotomy does not lead to acetabular retroversion. J Pediatr Orthop B 2021; 30 (06) 515-518
59 Pemberton PA. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 1965; 47: 65-86
60 Czubak J, Kowalik K, Kawalec A, Kwiatkowska M. Dega pelvic osteotomy: indications, results and complications. J Child Orthop 2018; 12 (04) 342-348