Hip dysplasia

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Hip dysplasia
Other namesDevelopmental dysplasia of the hip (DDH), [1] developmental dislocation of the hip, [1] congenital dysplasia of the hip (CDH) [2]
Congenitaldislocation10.JPG
Congenital dislocation of the left hip in an elderly person. Closed arrow marks the acetabulum, open arrow the femoral head.
Specialty Pediatrics, orthopedics
Symptoms None, hip aches, one leg shorter, limping [1]
Complications Arthritis [3]
Risk factors Family history, swaddling, breech birth [3]
Diagnostic method Physical exam, ultrasound [3]
Treatment Bracing, casting, surgery [3]
Prognosis Good (if detected early) [1]
Frequency1 in 1,000 (term babies) [3]

Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. [1] Hip dysplasia may occur at birth or develop in early life. [1] Regardless, it does not typically produce symptoms in babies less than a year old. [3] Occasionally one leg may be shorter than the other. [1] The left hip is more often affected than the right. [3] Complications without treatment can include arthritis, limping, and low back pain. [3] Females are affected more often than males. [1] Risk factors for hip dysplasia include female sex, family history, certain swaddling practices, and breech presentation whether an infant is delivered vaginally or by cesarean section. [3] If one identical twin is affected, there is a 40% risk the other will also be affected. [3] Screening all babies for the condition by physical examination is recommended. [3] Ultrasonography may also be useful. [3]

Contents

Many of those with mild instability resolve without specific treatment. [3] In more significant cases, if detected early, bracing may be all that is required. [3] In cases that are detected later, surgery and casting may be needed. [3] About 7.5% of hip replacements are done to treat problems which have arisen from hip dysplasia. [3]

About 1 in 1,000 babies have hip dysplasia. [3] Hip instability of meaningful importance occurs in one to two percent of babies born at term. [3] Females are affected more often than males. [1] Hip dysplasia was described at least as early as the 300s BC by Hippocrates. [4]

Signs and symptoms

Types of misalignments of femur head to socket in hip dysplasia. A: Normal. B: Dysplasia. C: Subluxation. D: Luxation Hip dysplasia - schematic.jpg
Types of misalignments of femur head to socket in hip dysplasia. A: Normal. B: Dysplasia. C: Subluxation. D: Luxation

Hip dysplasia can range from barely detectable to severely malformed or dislocated. The congenital form, teratologic or non-reducible dislocation occurs as part of more complex conditions.[ citation needed ]

The condition can be bilateral or unilateral:

If the joint is fully dislocated a false acetabulum often forms (often higher up on the pelvis) opposite the dislocated femoral head position.

In acetabular dysplasia, the acetabulum (socket) is too shallow or deformed. The center-edge angle is measured as described by Wiberg. [6] Two forms of femoral dysplasia are coxa vara, in which the femur head grows at too narrow an angle to the shaft, and coxa valga, in which the angle is too wide.

A rare type, the "Beukes familial hip dysplasia" is found among Afrikaners that are members of the Beukes family. The femur head is flat and irregular. People develop osteoarthritis at an early age. [7]

Causes

Hip dysplasia is considered to be a multifactorial condition. That means that several factors are involved in causing the condition to manifest. [8]

The cause of the condition is unknown; however, some factors of congenital hip dislocation are through heredity and racial background. It is also thought that the higher rates in some ethnic groups (such as some Native American groups) is due to the practice of swaddling of infants, which is known to be a potential risk factor for developing dysplasia. It also has a low risk in African Americans and southern Chinese.[ citation needed ]

Congenital

Some studies suggest a hormonal link. [9] Specifically, the hormone relaxin has been indicated. [10]

Female sex, alone without other known risk factors, accounts for 75%. [11] A genetic factor is indicated since the trait runs in families and there is an increased occurrence in some ethnic populations (e.g., Native Americans, [12] Sami people [13] [14] ). A locus has been described on chromosome 13. [15] Beukes familial dysplasia, on the other hand, was found to map to an 11-cM region on chromosome 4q35, with nonpenetrant carriers not affected. [16] Further risk factors include, gender, genetics (family history), [17] [18] and firstborns. [19]

Acquired

In the breech position the femoral head tends to get pushed out of the socket and the breech position is probably the most important single risk factor, whether an infant is delivered vaginally or by cesarean section. [3]

As an acquired condition it has been linked to traditions of swaddling infants, [20] use of overly restrictive baby seats, carriers and other methods of transporting babies, [21] or use of a cradle board which locks the hip joint in an "adducted" position (pulling the knees together tends to pull the heads of the femur bone out of the sockets or acetabulae) for extended periods. Modern swaddling techniques, such as the 'hip healthy swaddle' have been developed to relieve stress on hip joints caused by traditional swaddling methods. [22]

A narrow uterus also facilitates hip joint dislocation during fetal development and birth.[ citation needed ]

Screening and diagnosis

a and b angles used in hip ultrasound Hip dysplasia ultrasound.svg
α and β angles used in hip ultrasound
Hip ultrasound Ultrasound Scan ND 0114142455 1429140 crop.png
Hip ultrasound
X-Ray Image showing hip dysplasia in a baby Dislocated hip.jpg
X-Ray Image showing hip dysplasia in a baby

All newborns should be screened for congenital hip dysplasia. The screening examination techniques to detect hip dysplasia in newborns include observation for

Sometimes during an exam a "click" or more precisely "clunk" in the hip may be detected [24] (although not all clicks indicate hip dysplasia). [25] When a hip click (also known as "clicky hips" in the UK) is detected, the child's hips are tracked with additional screenings [26] to determine if developmental dysplasia of the hip is caused. [27] However, new UK guidelines published in April 2021 have stated that isolated clicks are no longer considered clinically significant and therefore do not meet the screen positive criteria. [28]

Two maneuvers commonly employed for diagnosis in neonatal exams are the Ortolani maneuver and the Barlow maneuver. [29] [30]

In order to do the Ortolani maneuver it is recommended that the examiner put the newborn baby in a position in which the opposite hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. If a "clunk" is heard (the sound of the femoral head moving over the acetabulum), the joint is normal, but absence of the "clunk" sound indicates that the acetabulum is not fully developed. The next method that can be used is called the Barlow maneuver. It is done by adducting the hip while pushing the thigh posteriorly. If the hip goes out of the socket it means it is dislocated, and the newborn has a congenital hip dislocation. The baby is laid on its back for examination by separation of its legs. If a clicking sound can be heard, it indicates that the baby may have a dislocated hip. It is highly recommended that these maneuvers be done when the baby is not fussing, because the baby may inhibit hip movement.[ citation needed ]. Overall, the latest evidence suggests that clinical screening tests are not sufficiently reliable for diagnosing developmental dysplasia of the hip. [31]

There is some evidence suggesting that hip examinations in newborns are painful and pain relief in the form of oral glucose has been suggested but is not yet widely accepted. [32] [33]

Most vexingly, many newborn hips show a certain ligamentous laxity, on the other hand severely malformed joints can appear stable. That is one reason why follow-up exams and developmental monitoring are important. Physical examination of newborns followed by appropriate use of hip ultrasound is widely accepted. [34]

The Harris hip score [35] (developed by William H. Harris MD, an orthopedist from Massachusetts) is one way to evaluate hip function following surgery. Other scoring methods are based on patients' evaluation like e.g. the Oxford hip score, HOOS and WOMAC score. [36] Children's Hospital Oakland Hip Evaluation Scale (CHOHES) is a modification of the Harris hip score that is currently being evaluated. [37]

Hip dysplasia can develop in older age. Adolescents and adults with hip dysplasia may present with a waddling gait, Trendelenburg's sign, decreased hip abduction, hip pain and in some cases hip labral tears. X-rays are used to confirm a diagnosis of hip dysplasia. CT scans and MRI scans are occasionally used too. [38] [39]

Terminology

Some sources prefer "developmental dysplasia of the hip" (DDH) to "congenital dislocation of the hip" (CDH), finding the latter term insufficiently flexible in describing the diversity of potential complications. [40]

The use of the word congenital can also imply that the condition already exists at birth. This terminology introduces challenges, because the joint in a newborn is formed from cartilage and is still malleable, making the onset difficult to ascertain. The newer term DDH also encompasses occult dysplasia (e.g. an underdeveloped joint) without dislocation and a dislocation developing after the "newborn" phase.[ citation needed ]

The term is not used consistently. In pediatric/neonatal orthopedics it is used to describe unstable/dislocatable hips and poorly developed acetabula. For adults it describes hips showing abnormal femur head or acetabular x-rays. [41] [42]

Some sources prefer the term "hip dysplasia" over DDH, considering it to be "simpler and more accurate", partly because of the redundancy created by the use of the terms developmental and dysplasia. [43] Types of DDH include subluxation, dysplasia, and dislocation. The main types are the result of either laxity of the supporting capsule or an abnormal acetabulum.

Imaging

Hip dysplasia can be diagnosed by ultrasound [44] and projectional radiography ("X-ray"). [45] Ultrasound imaging is generally preferred at up to 4 months due to limited ossification of the femoral head up until then, and is the most accurate method for imaging of the hip during the first few months after birth. However, in most instances, ultrasound screening should not be performed before 3 to 4 weeks of age because of the normal physiologic laxity. [46] [notes 1] When universal with targeted ultrasound screening was compared, the former results in an insignificant reduction in the late diagnosis of hip dysplasia, which is why universal ultrasonographic screening of newborn infants is not recommended by the American Academy of Pediatrics. [11]

Despite the widespread use of ultrasound, pelvis X-ray is still frequently used to diagnose or monitor hip dysplasia or for assessing other congenital conditions or bone tumors. [47]

American College of Radiology Appropriateness Criteria for hip dysplasia [46]
AgeScenarioUsual appropriate initial imaging
<4 weeksEquivocal physical examination or risk factorsNo imaging
Physical findings of DDHUltrasonography
4 weeks - 4 monthsEquivocal physical examination or risk factorsUltrasonography
4 – 6 monthsConcern for DDHX-ray. Ultrasonography may be appropriate [notes 1]
>6 monthsX-ray

The most useful lines and angles that can be drawn in the pediatric pelvis assessing hip dysplasia are as follows: [47] Different measurements are used in adults. [47]

Treatment

Hip dysplasia presents a nearly perfect equilibrium between the arthritis, movement/mobility problems and pain associated with the developmental malformation, and the arthritis, movement/mobility problems and pain that are, as often as not in moderate to severe cases, inflicted by the treatment itself.[ citation needed ]

However, given the very real possibility of a limp, constant and/or debilitating pain, complicated treatment and impaired mobility later in life, careful developmental monitoring is indicated and early intervention is often the best result. The worst possible consequence of non treatment is developing early arthritis, sometimes even during teenage years. All treatment aims to delay the onset of arthritis, but no treatment is fully successful in avoiding it; and, all available treatments bear the risk of inflicting equivalent damage. Most unfortunately, studies have as yet been unable to find a method of predicting outcomes in either the surgical/orthopedic treatment of the condition in infants and young children, or the surgical treatment of these early treatments' negative outcomes later in life (such as arthritis, avascular necrosis, trochanteric bursitis, and bone spurs of up to 3.5 cm just medial of the gluteus maximus insertion point on the greater trochanter due to excessive friction).[ citation needed ]

Harnesses, casts, and traction

Early hip dysplasia can often be treated using a Pavlik harness [48] (see photograph) or the Frejka pillow/splint [49] in the first year of life with usually normal results. Complications can occur when using the Pavlik harness. Cases of femoral nerve palsy [50] and avascular necrosis of the femoral head have been reported with the use of the Pavlik harness, [51] but whether these cases were due to improper application of the device or a complication encountered in the course of the disorder remains unresolved. Complications arise mainly because the sheet of the iliopsoas muscle pushes the circumflex artery[ specify ] against the neck of the femur and decreases blood flow to the femoral head, so the Frejka pillow is not indicated in all the forms of the developmental dysplasia of the hip. [ citation needed ]

Other devices employed include the spica cast, [52] particularly following surgical closed reduction, open reduction, or osteotomy in babies and young children. Traction is sometimes used in the weeks leading up to a surgery to help stretch ligaments in the hip joint, although its use is controversial and varies amongst physicians. [53]

Surgery

In older children the adductor and iliopsoas muscles may have to be treated surgically because they adapt to the dislocated joint position (contracture). Braces and splints are often used following either of these methods to continue treatment. Although some children "outgrow" untreated mild hip dysplasia [42] and some forms of untreated dysplasia cause little or no impairment of quality of life, studies have as yet been unable to find a method of predicting outcomes. On the other hand, it has often been documented that starting treatment late leads to complications and ends in poor results.[ citation needed ]

Hip replacement and osteotomy

Hip dysplasia is often cited as causing osteoarthritis of the hip at a comparatively young age. Dislocated load bearing surfaces lead to increased and unusual wear, although there are studies that contradict these findings (see [54] [55] ). Peri-acetabular osteotomy (PAO) surgery can be used to realign the hip joint in some adolescents and adults. Subsequent treatment with total hip arthroplasty (hip replacement) is complicated by a need for revision surgery (replacing the artificial joint) owing to skeletal changes as the body matures, loosening/wear or bone resorption. Hip resurfacing is another option for correcting hip dysplasia in adults. It is a type of hip replacement that preserves more bone, and may work for younger hip dysplasia patients. [56]

Osteotomies are either used in conjunction with arthroplasty or by themselves to correct misalignment.[ citation needed ]

Epidemiology

Determining the incidence can be difficult. [57] [58] In addition there is a wide margin in diagnostic results. A German study comparing two methods resulted in twice the usual rate for one method. The condition is eight times more frequent in females than in males. [9]

Native Americans are more likely to have congenital hip dislocation than any of the other races. The risk for Native Americans is about 25–50 in 1000. The overall frequency of developmental dysplasia of the hip is approximately 1 case per 1000 individuals; however, Barlow believed that the incidence of hip instability in newborns can be as high as 1 case for every 60 newborns, [59] with the rate dropping to 1:240 at one week. [60]

History

The Frejka pillow splint is named after Bedřich Frejka  [ cs ]. The Pavlik harness is named after Arnold Pavlík  [ Wikidata ]. Both were Czech orthopedic surgeons.[ citation needed ]

Society and culture

In the television program ER , Kerry Weaver uses a crutch owing to congenital hip dysplasia. In season 12, she undergoes a hip replacement to cure her dysplasia when her previously untreated joint worsens. [61]

Research

One avenue of research is using stem cells. They are applied in grafting (bone grafting) or by seeding porous arthroplasty prosthesis with autologous fibroblasts or chondrocyte progenitor cells to assist in firmly anchoring the artificial material in the bone bed.[ citation needed ]

Other animals

In dogs, hip dysplasia is an abnormal formation of the hip socket that, in its more severe form, can eventually cause crippling lameness and painful arthritis of the joints. It is a genetic (polygenic) trait that is affected by environmental factors. It is common in many dog breeds, particularly the larger breeds.[ citation needed ]

Hip dysplasia is one of the most studied veterinary conditions in dogs, and the most common single cause of arthritis of the hips.[ citation needed ] Cats are also known to have this condition, especially Siamese. [62]

Notes

  1. 1 2 Ultrasonography is the imaging method of choice up to 6 months for the nonoperative surveillance imaging in harness of known diagnosis of DDH.
    - "ACR Appropriateness Criteria - Developmental Dysplasia of the Hip (DDH)–Child". American College of Radiology . Revised 2018

Related Research Articles

<span class="mw-page-title-main">Legg–Calvé–Perthes disease</span> Osteochondrosis that results in death and fracture located in hip joint

Legg–Calvé–Perthes disease (LCPD) is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of bone mass and a weakening of the femoral head.

<span class="mw-page-title-main">Canine hip dysplasia</span> Joint abnormality in dogs

In dogs, hip dysplasia is an abnormal formation of the hip socket that, in its more severe form, can eventually cause lameness and arthritis of the joints. It is a genetic (polygenic) trait that is affected by environmental factors. It is common in many dog breeds, particularly the larger breeds, and is the most common single cause of arthritis of the hips.

An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum. The operation is done under a general anaesthetic.

<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely between different techniques and implants. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

<span class="mw-page-title-main">Joint dislocation</span> Medical injury

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.

Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

<span class="mw-page-title-main">Swaddling</span> Practice of wrapping infants so as to restrict movement

Swaddling is an ancient practice of wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favour in the 17th century.

<span class="mw-page-title-main">Dysplasia</span> Abnormal development, at macroscopic or microscopical level

Dysplasia is any of various types of abnormal growth or development of cells or organs, and the abnormal histology or anatomical structure(s) resulting from such growth. Dysplasias on a mainly microscopic scale include epithelial dysplasia and fibrous dysplasia of bone. Dysplasias on a mainly macroscopic scale include hip dysplasia, myelodysplastic syndrome, and multicystic dysplastic kidney.

<span class="mw-page-title-main">Hip</span> Anatomical region between the torso and the legs, holding the buttocks and genital region

In vertebrate anatomy, the hip, or coxa in medical terminology, refers to either an anatomical region or a joint on the outer (lateral) side of the pelvis.

<span class="mw-page-title-main">Hip dislocation</span> Orthopedic injury

A hip dislocation is when the thighbone (femur) separates from the hip bone (pelvis). Specifically it is when the ball–shaped head of the femur separates from its cup–shaped socket in the hip bone, known as the acetabulum. The joint of the femur and pelvis is very stable, secured by both bony and soft-tissue constraints. With that, dislocation would require significant force which typically results from significant trauma such as from a motor vehicle collision or from a fall from elevation. Hip dislocations can also occur following a hip replacement or from a developmental abnormality known as hip dysplasia.

<span class="mw-page-title-main">Femoral head ostectomy</span> Surgical removal of the head and neck of the femur

A femoral head ostectomy is a surgical operation to remove the head and neck from the femur. It is performed to alleviate pain, and is a salvage procedure, reserved for condition where pain can not be alleviated in any other way. It is common in veterinary surgery. Other names are excision arthroplasty of the femoral head and neck, Girdlestone's operation, Girdlestone procedure, and femoral head and neck ostectomy.

<span class="mw-page-title-main">Transient synovitis</span> Inflammation of the inner lining (synovium) of the hip joint capsule

Transient synovitis of hip is a self-limiting condition in which there is an inflammation of the inner lining of the capsule of the hip joint. The term irritable hip refers to the syndrome of acute hip pain, joint stiffness, limp or non-weightbearing, indicative of an underlying condition such as transient synovitis or orthopedic infections. In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. It should not be confused with sciatica, a condition describing hip and lower back pain much more common to adults than transient synovitis but with similar signs and symptoms.

<span class="mw-page-title-main">Ortolani test</span> Medical diagnostic method

The Ortolani test is part of the physical examination for developmental dysplasia of the hip, along with the Barlow maneuver. Specifically, the Ortolani test is positive when a posterior dislocation of the hip is reducible with this maneuver. This is part of the standard infant exam performed preferably in early infancy.The Ortolani test is named after Marino Ortolani, who developed it in 1937.

Protrusio acetabuli is an uncommon defect of the acetabulum, the socket that receives the femoral head to make the hip joint. The hip bone of the pelvic bone/girdle is composed of three bones, the ilium, the ischium and the pubis. In protrusio deformity, there is medial displacement of the femoral head in that the medial aspect of the femoral cortex is medial to the ilioischial line. The socket is too deep and may protrude into the pelvis.

The Barlow maneuver is a physical examination performed on infants to screen for developmental dysplasia of the hip. It is named for Dr. Thomas Geoffrey Barlow, an English orthopedic surgeon, who devised this test. It was clinically tested during 1957–1962 at Hope Hospital, Salford, Lancashire.

<span class="mw-page-title-main">Femoroacetabular impingement</span> Medical condition

Femoroacetabular impingement (FAI) is a condition involving one or more anatomical abnormalities of the hip joint, which is a ball and socket joint. It is a common cause of hip pain and discomfort in young and middle-aged adults. It occurs when the ball shaped femoral head contacts the acetabulum abnormally or does not permit a normal range of motion in the acetabular socket. Damage can occur to the articular cartilage, or labral cartilage, or both. The condition may be symptomatic or asymptomatic. It may cause osteoarthritis of the hip. Treatment options range from conservative management to surgery.

<span class="mw-page-title-main">Hip arthroscopy</span> Medical intervention

Hip arthroscopy refers to the viewing of the interior of the acetabulofemoral (hip) joint through an arthroscope and the treatment of hip pathology through a minimally invasive approach. This technique is sometimes used to help in the treatment of various joint disorders and has gained popularity because of the small incisions used and shorter recovery times when compared with conventional surgical techniques. Hip arthroscopy was not feasible until recently, new technology in both the tools used and the ability to distract the hip joint has led to a recent surge in the ability to do hip arthroscopy and the popularity of it.

<span class="mw-page-title-main">Hip pain</span>

Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain.

X-rays of hip dysplasia are one of the two main methods of medical imaging to diagnose hip dysplasia, the other one being medical ultrasonography. Ultrasound imaging yields better results defining the anatomy until the cartilage is ossified. When the infant is around 3 months old a clear roentgenographic image can be achieved. Unfortunately the time the joint gives a good x-ray image is also the point at which nonsurgical treatment methods cease to give good results.

<span class="mw-page-title-main">Ultrasound-guided hip joint injection</span>

Ultrasound-guided hip joint injection is a joint injection in the hip, assisted by medical ultrasound. Hip and groin pain often presents a diagnostic and therapeutic challenge. The differential diagnosis is extensive, comprising intra-articular and extra-articular pathology and referred pain from lumbar spine, knee and elsewhere in the pelvis. Various ultrasound-guided techniques have been described in the hip and groin region for diagnostic and therapeutic purposes. Ultrasound has many advantages over other imaging modalities, including portability, lack of ionizing radiation and real-time visualization of soft tissues and neurovascular structures. Many studies have demonstrated the safety, accuracy and efficacy of ultrasound-guided techniques, although there is lack of standardization regarding the injectates used and long-term benefit remains uncertain.

References

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  2. ↑ "Definition: congenital dysplasia of the hip from Online Medical Dictionary".[ dead link ]
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Shaw, BA; Segal, LS; SECTION ON, ORTHOPAEDICS. (December 2016). "Evaluation and Referral for Developmental Dysplasia of the Hip in Infants". Pediatrics. 138 (6): e20163107. doi: 10.1542/peds.2016-3107 . PMID   27940740.
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  7. ↑ Cilliers HJ, Beighton P (1990). "Beukes familial hip dysplasia: an autosomal dominant entity". Am. J. Med. Genet. 36 (4): 386–90. doi:10.1002/ajmg.1320360403. PMID   2389793.
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  15. ↑ Mabuchi A, Nakamura S, Takatori Y, Ikegawa S (2006). "Familial osteoarthritis of the hip joint associated with acetabular dysplasia maps to chromosome 13q". Am. J. Hum. Genet. 79 (1): 163–8. doi:10.1086/505088. PMC   1474113 . PMID   16773577.
  16. ↑ "AJHG - Autosomal Dominant (Beukes) Premature Degenerative Osteoarthropathy of the Hip Joint Maps to an 11-cM Region on Chromosome 4q35". 6 May 2008. Archived from the original on 6 May 2008.
  17. ↑ Hashmi, Jamil; Basit, Sulman; Khoshhal, Khalid (August 2019). "Genetics of developmental dysplasia of the hip: Recent progress and future perspectives". Journal of Musculoskeletal Surgery and Research. 3 (3): 245. doi: 10.4103/jmsr.jmsr_46_19 . S2CID   199547368.
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  19. ↑ "Developmental Dislocation of the Hip - Wheeless' Textbook of Orthopaedics". 22 July 2020.
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  24. ↑ "HipDysplasia - Newborn Nursery at LPCH - Stanford University School of Medicine". 5 July 2023.
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  26. ↑ "Newborn Screening and Prevention - International Hip Dysplasia Institute". Archived from the original on 12 November 2020. Retrieved 31 August 2012.
  27. ↑ "Hip Clicks and Hip Dysplasia - International Hip Dysplasia Institute". Archived from the original on 4 December 2020. Retrieved 31 August 2012.
  28. ↑ "Newborn and infant physical examination (NIPE) screening programme handbook". GOV.UK. Retrieved 18 October 2024.
  29. ↑ "Physical Examination of Infants - International Hip Dysplasia Institute". Archived from the original on 20 October 2020. Retrieved 31 August 2012.
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  43. ↑ "eMedicine - Developmental Dysplasia of the Hip : Article by James McCarthy, MD, FAAOS". 20 October 2019.{{cite journal}}: Cite journal requires |journal= (help)
  44. ↑ "Ultrasound Detection of DDH - International Hip Dysplasia Institute". Archived from the original on 4 December 2020. Retrieved 31 August 2012.
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  46. 1 2 "ACR Appropriateness Criteria - Developmental Dysplasia of the Hip (DDH)–Child". American College of Radiology . Revised 2018
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