Natural history of hip instability in infants (without subluxation or dislocation): a three year follow-up

BMC Musculoskeletal Disorders

J Richard Bowen²  Laurens Holmes¹  H Theodore Harcke³  Blazej Pruszczynski⁴ 

[1] Department of Epidemiology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, 19803 Wilmington, DE, USA;Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA;Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA;Department of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, 75 Drewnowska str, 91-002 Lodz, Poland

关键词: Natural history;    Hip dysplasia;    Hip treatment;    Hip instability;    DDH;   

Others  :  1118636
DOI  :  10.1186/1471-2474-15-355

 received in 2014-03-20, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

The natural history of hip instability (without subluxation or dislocation) and treatment in infants remain controversial. We performed a retrospective cohort case-only study with blinded, prospectively collected data to assess normalization of the acetabular index in consecutive untreated infant hips with sonography instability.

Methods

Consecutive hips meeting inclusion criteria were followed by sonography/radiography and data analyzed using tabular and regression models.

Results

In 48 hips, acetabular index measured by radiography normalized within 3 years of age without treatment. Normalization by age occurred: 7 months in 35%, 12 months in 67%, 18 months in 75%, 24 months in 81%, and 36 months in 100%. Two patterns of normalization of the acetabular index were observed: group I showed ossification in a physiological range of normal by 7 months of age, and group II had delayed ossification with later normalization of the acetabular index measurement. Breech presentation (p =0.013) and cesarean delivery (p =0.004) statistically directly correlated with a later normalization.

Conclusions

The natural history of infant hip instability (without subluxation or dislocation), which is reduced at rest and unstable with stress as diagnosed by the Harcke method of sonography, has spontaneous normalization of the acetabular index within 3 years of age. We suggest three patterns of acetabular ossification in unstable infants’ hips: (I) normal ossification, (II) delayed ossification with normalization of the acetabular index by age 3 years, and (III) defective secondary centers of ossification with an upward tilt of the lateral acetabular rim in adolescence.

【 授权许可】

   
2014 Pruszczynski et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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