Una mirada actualizada a la displasia de cadera en niños y adultos

Abstract

Developmental dysplasia of the hip (DDH) is condition which substantially affects the
normal biomechanics of human walking. Previously known as congenital hip dysplasia,
reflecting a pervading view that the condition is strictly congenital, current evidence
has determined that infants previously diagnosed as “normal” have structural and functional distortions of the hip, leading towards the notion that its a disorder with
a more developmental component (1). DDH includes a wide range of alterations from
mild acetabular dysplasia to frank irreducible dislocation. When this clinical condition
isn’t intervened, it may lead to other conditions such as early-onset osteoarthritis,
pain, gait disturbances, and even an early need for complete hip arthroplasty. There
are a variety of methods to achieve an anatomical hip reduction, (1). Additionally, there
are different methods for, orthopedic management which have achieved good results,
such as pelvic/femoral osteotomies which achieve normal anatomy (3). As DDH is a
concern to general practitioner, pediatrician, radiologist and orthopedic surgeon
they must possess an in-depth knowledge of this condition. This article carries out an
updated review of the screening, diagnosis and management of DDH.
Objective: To integrate pediatric, radiological and orthopedic surgical knowledge
regarding screening, diagnosis and management of patients with developmental
dysplasia of the hip (DDH).
Methods: a total of 400 articles were compiled using databases such as PubMed,
Academic Search Complete, Science Direct, CORR, JBJS, LILACS, of which 50 were
chosen which contained updated and relevant information regarding DDH.
Conclusions: developmental dysplasia of the hip is a frequently overlooked condition
in the evaluation of newborns that can lead to deleterious outcomes in future
locomotion. DDH affects primarily pediatric patients who frequently require imaging
methods in both screening and diagnosis, and possibly a later orthopedic or surgical
intervention, as such it’s regarded as a multidisciplinary disease. Swadding is a wellknown
cultural practice in Colombia which often not subjects the patients hip to
further adduction stress and possible unfavorable outcomes. Treatment ranges from
orthopedic management using Pavlik harness, spike cast for 6-18 months in patients
non responsive to harness, pelvic or femoral osteotomies, and even complete hip
replacement.