synonyms: adult DDH, developmental dysplasia of the hip in adults, adult hip dysplasia
Adult Developmental Hip Dysplasia ICD-10
Adult Developmental Hip Dysplasia Etiology / Epidemiology / Natural History
- 1/1000 live births, left hip most common
- More common in children of central European, Native Americans, Laplanders, and native Alaskan descents.
- Etiology: multifactorial, genetic, intruterine mechanical environment,
- Risk of DDH without family history = 0.2%
- Risk of DDH with a parent with DDH = 12%. First-born children are affected twice as often as subsequent siblings. Female infants have histest risk of DDH (@80% of affected infants are female).
Adult Developmental Hip Dysplasia Anatomy
- Damage from undercoverage of the femoral head is most severe in the anterior portion of the joint.
- Natural history (Hadley NA, J Orthop Res 1990;8:504)
- Lateral center-edge angle can be used to determine natural history. Normal = >15º, 15º-5º = moderate dysplasia which will eventually lead to arthritis, >5º=severe dysplasia which will lead to arthritis at a young age.
- Acetabular labral: likely supplies a key role in providing supplemental support for dysplastic hips. Labral tears may lead in significantly worsening arthritis and pain in DDH patients.
- See Hip anatomy.
Adult Developmental Hip Dysplasia Clinical Evaluation
- Hip / Groin pain, increased with activity. Generally gradually worsening over several years. May have some clicking sensations.
Adult Developmental Hip Dysplasia Xray / Diagnositc Tests
- A/P pelvis, A/P and lateralof affected hip. Demonstrates anterolateral undercoverage of the the femoral head (determined by drawing line on the anterior wall which fails to overlap the femoral head in adult hip dysplasia), high acetabular index.
- False-profile view(Lequense M, Rev Rhum Mal Osteoartic 1961;28:643)
- Lateral Center-edge angle of Wiberg: Normal = >15º, 15º-5º = moderate dysplasia, >5º=severe dysplasia. Angle is formed by the intersection of a line drawn through the center of the femoral head and extending to the lateral edge of the sourcil (dense bone along the lateral edge of the weight bearing region of the acetabulum) and a line perpendicular to one joining the two femoral head centers. Arthritis will eventually develop in hips with lateral center-edge angles <15º(Murphy SB, JBJS 1995;77A:985), (Wiberg G, Acta Chir Scandinavica 1939:58S)
- Acetabular index of Tonnis: Formed by the intersection of a horizontal line connecting the femoral head centers and a line that passes through the medial edge of the sourcil.(Tonnis D, Congenital dysplasia and dislocation of the hip in children and adults New York, Springer, 1987)
- Shentons Line: an imaginary line connecting the medial aspect of the femoral neck to the superior part of the pubic ramus. A break >5mm indicates subluxation.
- Lequesne Anterior Center-edge Angle: (Lequense M, Rev Rhum Mal Osteoartic 1961;28:643)
- Consider dGEMRIC MRI scan (Jessel RH, JBJS 2009;91A:1120)
Adult Developmental Hip Dysplasia Classification / Treatment
Adult Developmental Hip Dysplasia Associated Injuries / Differential Diagnosis
Adult Developmental Hip Dysplasia Complications
Adult Developmental Hip Dysplasia Follow-up Care
Adult Developmental Hip Dysplasia Review References
- Sanchez-Sotelo J, Trousdale RT, Berry DJ, Cabanela ME. Surgical treatment of developmental dysplasia of the hip in adults: I. Nonarthroplasty options. J Am Acad Orthop Surg. 2002 Sep-Oct;10(5):321-33.
- Lodhia P, Chandrasekaran S, Gui C, Darwish N, Suarez-Ahedo C, Domb BG. Open and Arthroscopic Treatment of Adult Hip Dysplasia: A Systematic Review. Arthroscopy. 2015 Oct 24. pii: S0749-8063(15)00647-7.