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Abstract
congenital dislocation of the hip (CDH) remains a commonproblem. Although screening programs, more accurate
examinations and the introduction of ultrasonography have lead to earlierdiagnosis and treatment, still some patients escape through the screeningnet and seen for the first time at an age when treatment becomes moredifficult.
•The hip is a multiaxial joint of ball and socket variety. Stabilityof the joint in the neonatal period depends on soft tissues around thejoint, the ligaments, the capsule and the labrum. Later on, afterdevelopment of the acetabulum, bony adaptation occurs between bothcomponents of the joint and this will increase the stability.
•The pathology of CDH starts by laxity of the capsule inresponse to maternal hormones in the antenatal period. This laxity inaddition to fetal position inutero accounts for instability of the hip. Thefemoral head easily falls out of the acetabulum leaving it empty. Theacetabulum becomes occupied by increased fibrofatty tissue and capsulebecomes stretched and adherent to the floor of the acetabulum.Themuscles around the hip becomes shortened and bony changes then occursin the acetabulum which becomes shallow and the upper femur whichbecomes anteverted with coxa valga. The end result is the developmentof degenerative changes affecting both components of the joint.
•Diagnosis of CDH after one year can be made clinically andradiologically. The common symptoms that draw the attention of parentsare limping, delayed walking and asymmetery of both lower limbs. Theuniversal sign which is present in all patients is limited abduction of theflexed thigh. This sign can be better seen in unilateral cases incomparison with the other side.
•Radiological diagnosis can be made in the anteroposterior viewin the correct position, without pelvic rotation or tilt.
•Ultrasonography is safe, non-invasive and simple. It can be usedto recognize acetabular dysplasia in the older child with delayedepiphyseal ossification and to visualize the soft tissues of the joint.
•Arthrography is not used routinely. It is helpful in the childwho has unsatisfactory reduction in response to the usual treatmentmeasures or whose hip has redislocated after what appeared to be anadequate reduction.