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Hip Sonography: Diagnosis and Management of Infant Hip Dysplasia

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Orthopaedic surgeons, paediatricians and radiologists all deal with the problem of dislocation and dysplasia of the infant hip. If dysplasia and displacement of the infant hip are described together under the heading “Disorders of Hip Maturation” then together they constitute the commonest disease of the musculoskeletal system. These disorders have implications not only for the child itself and its entire family, but they are of enormous consequence for public health.

It is currently thought that 9%–10% of all hip replacements carried out are necessary because of a hip maturation disorder. Hence the importance of early detection. Generally, authors agree that early detection of dysplasia or displacement is fundamental for adequate treatment. However, opinion differs widely as to what requires treatment. Should only displaced or dislocated hips be treated or should a dysplastic bony acetabulum without any displacement be treated? How many resolve spontaneously without treatment? Should “unstable” hip joints be treated? There is no consensus about how “instability” should be defined. Does instability require treatment only if the femoral head can be dislocated out of the socket or if, under pressure, the femoral head shifts within the socket?

Hip ultrasonography with its ability not only to visualise the unossified parts of the newborn hip but also to show movement of the femoral head within the socket has brought about an enormous improvement in infant hip diagnosis. Hip ultrasound is practicable, reproducible, and able to be taught and learnt.

It is easy to be impressed by observing with ultrasound the movements of the femoral head in the acetabulum. However, these observations are purely subjective and can lead to misdiagnosis. The cartilaginous and bony parts of the hip joint must be objectively measured and quantified in relation to the age of the baby, otherwise sonography ends in catastrophe.
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