In his brief report in JBJS-Br, January 1989, Klisic emphasized that
congenital dislocation of the hip is a misleading term when used for the
total spectrum of infant hip deformities (1). Instead he recommended the
use of the term ‘developmental displacement’. Though many authors and the
American Academy of Orthopaedic Surgeons, accepted the wording change of
congenital to developmental, on the other hand, they replaced the wording
of displacement with that of dyspalsia, and a new term ‘developmental
dyspalsia of the hip’ was established. Nonetheless, despite the latest
effort for an appropriate definition covering the total spectrum of the
disease, inaccuracies still persist, reflecting the confusion as to the
original cause. Specifically, the term developmental is not descriptive of
the congenital nature of the deformity, while an undiscriminate use of the
term dyspalsia does not reflect the variety of underlying pathology. Thus,
unfortunately from a deficient term ‘congenital dislocation of the hip’ we
ended up with a non specific and unsuitable one ‘developmental dysplasia
of the hip’ without convincing arguments for the change.
However, for better communication, treatment planning, and evaluation
of results of various treatments, an agreed term is needed to cover the
entire pathology of congenital hip deformities. Furthermore, a generally
accepted classification of the deformities is necessary. The term
‘congenital hip disease’, covering all types of congenital abnormalities
of the hip joint (2), appears to be more accurate as a general term,
especially when reporting the results of total hip replacement (3). As for
the classification of the deformity in infancy, that, in three
radiographic types, dysplasia, subluxation, and complete dislocation (4),
detected after three months of age, seems to be most effective. In
dysplasia there is a poor development of the acetabulum and of the femoral
head, with an intact Shenton’s line. In subluxation the Senton’s line is
broken due to the proximal and lateral migration of the femoral head,
without the latter overpassing the upper edge of the acetabulum. In
dislocation the femoral head is completely out of the acetabulum.
Untreated or uncompletely treated congenital hip disease at infancy leads
to the adult congenital hip disease, followed by secondary osteoarthritis
(Table 1). This author, based on the underlying pathology of the
deformity, has described three types of congenital hip disease in adults
(5). Type-1 hips are those with dyplasia, where the femoral head remains
within the true acetabulum, regardless of the degree of subluxation. Type-
2 hips are those with low dislocation, where the femoral head articulates
with a false acetabulum, partially covering the true acetabulum. Type-3
hips are those with high dislocation, where the femoral head has migrated
superiorly and posteriorly in relation to the true acetabulum. Other
classification systems of congenital hip disease in adults are those of
Crowe et al and Eftecar.
In summary, we strongly suggest the use of the general term
congenital hip disease for the entire spectrum of related deformities,
with the classification in dysplasia, subluxation, dislocation in infancy,
and dysplasia, low dislocation, high dislocation in adults.
References
1. Klisic P.J. Congenital dislocation of the hip. A misleading
term. Brief report. J Bone Join Surg (Br) 1989 ; 71-B : 136.
2. Wedge J.H, Wasylenko MJ. The natural history of congenital disease
of the hip. J Bone Joint Surg (Br) 1979 ; 61-B : 334-338.
3. Hartofilakidis G, Karachalios Th. Total hip arthroplasty for
congenital hip disease. J Bone Joint Surg 2004 ; 86-A : 242-250.
4. Weinstein S.L, Mubarak S.J, Wenger D.R. Developmental hip
dysplasia and dislocation. J Bone Joint Surg (Am) 2003 ; 85 : 1824-1832.
5. Hartofilakidis G, Karachalios Th, Stamos K. Epidemiology
demographics and natural history of congenital hip disease in adults.
Orthopaedics 2000 ; 23 : 823-827.
Infancy Adult life
Dysplasia Dysplasia
Subluxation Low dislocation
Dislocation High dislocation
Table 1. Classification of Congenital Hip Disease
in Infancy and in Adult life.
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