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This case report describes the clinical reasoning used to manage chronic left hip pain in a 21-year-old woman who was recreationally active. The patient had a history of possible congenital hip dysplasia (CHD) and known recurrent lateral (external) patellar subluxations on the left side. She complained of experiencing hip pain when walking, sitting, playing soccer, and doing "step aerobics." Hip range of motion (ROM), muscle force, and joint stability problems were assessed. Abnormal movement patterns were observed during gait and step aerobics. Intervention was based on the working hypothesis that periarticular stiffness and muscle weakness from earlier trauma were superimposed on joint instability from CHD. Following intervention, the patient's hip ROM and muscle force improved concurrently with reduction of hip pain, increased ability to participate in recreational activities, and improvement in the movement pattern during step aerobics. An eclectic approach to analysis of the problem was used, combining data unique to the patient with knowledge of CHD and concepts proposed by Cyriax, Maitland, Sahrmann, and others. The clinical reasoning used to establish a basis for treatment and its limitations are discussed. [Zimny NJ. Clinical reasoning in the evaluation and management of undiagnosed chronic hip pain in a young adult. Phys Ther. 1998;78:62-731, KEY WORDS: Case report, Chronic hip pain, Clinical reasoning, Congenital hip dysplasia, Physical therapy evaluation, Physical therapy management. Hip pain in adults has many causes. It often is associated with [...]

A condition called acetabular dysplasia characterized by abnormal central bone angles in the hip socket does not appear to be a risk factor for developing osteoarthritis (OA) of the hip. Pelvic x-rays of 165 older women with hip OA and 88 older women without hip OA were evaluated for signs of acetabular dysplasia. Overall, 13.2% of the women had evidence of acetabular dysplasia. Women with OA were only 1.33 times more likely than women without OA to have acetabular dysplasia.

Chinese men from Hong Kong appear to experience hip bone arthritis less than do British men. Researchers reviewed the pelvic x-rays of 999 Chinese men in Hong Kong, and found that the Hong Kong men had half the incidence of hip bone arthritis (5.4%) of British men (11%). Chinese and British men had similar rates of abnormal tissue development in the hip joint, 14.8% vs. 12.9%. Both groups of men were 60 to 75 years old. This finding may disprove a theory that the prevalence of abnormal hip joint tissue growth varies around the world. Chinese men may experience less hip bone arthritis than do British men because Chinese men are not as prone to obesity, and because the squatting position common in Asia may protect the hip from developing arthritis.

Objective: To compare the cost-effectiveness of adding either a general or a selective ultrasound screening program to the routine clinical examination for developmental dysplasia of the hip (DDH) with use of the data from a large, randomized study of 1 1 925 newborns. Methods: Our previous study comparing the clinical outcomes of three strategies for screening infants for DDH suggested (but results were not statistically significant) that general ultrasound screening resulted in fewer children requiring hospitalization and surgery for DDH than did a strategy based on ultrasound screening of the 11.8% of infants considered to be at increased risk of DDH or one with no ultrasound screening. General ultrasound screening led to early splinting of 3.4% of the newborns compared with 2.0% for the selectively screened group and 1.8% for the group not receiving ultrasound screening. Using these data, we decided on sequences and intervals of diagnostic and therapeutic actions considered to be sufficient for each regimen. We applied estimates of the costs of screening, treatment of DDH discovered early and late, and follow-up examinations to arrive at total program costs for each strategy. Results: Total program costs were similar for each of the three screening strategies (costs varied by, Ultrasound screening of all newborn girls and boys at risk for developmental dysplasia of the hip (DDH) may be the most cost-effective method of diagnosing the disease. Cost analysis of diagnosis and treatment was performed on the results of a randomized study comparing screening methods for DDH on 11,925 Norwegian newborns. The trial compared ultrasound screening of all newborns versus selective ultrasound screening of infants at risk for DDH or with symptoms of DDH at clinical examination versus infants having clinical examination only. The average cost of diagnosis and treatment in the universal ultrasound screening group was $27.90 U.S. dollars versus $29.60 for selective ultrasound screening and $29.20 for clinical screening only. The most cost-effective approach was to screen all girls and only boys at risk because DDH is rare in boys. Assuming that 12% of newborn boys would be at risk for DDH, the cost of this approach would be $20.70 per infant.

Total hip arthroplasty is surgical reconstruction or replacement of a painful, degenerated hip joint performed to restore mobility to a joint with osteoarthritis or rheumatoid arthritis, or to correct a congenital anomaly. This procedure is particularly difficult to perform when the anatomy of the joint is altered as a result of congenital dislocation of the hip joint or hip dysplasia (abnormal development). A study was undertaken to evaluate the long-term results of 23 total hip arthroplasty operations performed on 18 patients who had congenital dislocation of the hip or severe congenital dysplasia. Follow-up ranged from 8 to 16.5 years (average of 14 years). Average age of the patients at the time of operation was 56 years. At most recent follow-up, seventy percent of the hips were rated good or excellent (seven hips were rated excellent and nine, good). One hip was rated fair and there were six failures (26 percent), which subsequently required revision surgery. Four of the failures were the result of fracture of the femoral stem (thigh component of the prosthesis). There were no mechanical failures when the Charnley prosthesis was used. Important improvements in technique and prosthetic materials have been made since these operations were performed in the early 1970s. These results compare well with other reported results of patients of this age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Congenital hip dysplasia is a birth defect in which the acetabulum, the cup-like depression in the hip bone which holds the knob of the thigh bone, is too shallow, causing inadequate union of the two bones. Evaluation of this deformity can be undertaken using ultrasound (which utilizes sound waves to create images). Realtime ultrasound equipment permits observation of movement of the joint. Ultrasonography is usually the first imaging study performed when congenital hip dysplasia is suspected. It is more accurate than X-rays because it can show the cartilage of the acetabulum, and with realtime techniques it can show the stability of the joint. Once the diagnosis has been established, ultrasound is used to assess the progress of treatment. The sensitivity of ultrasound should not lead to unnecessary treatment. Certain abnormalities, such as hip laxity, may be identified by ultrasound but not by physical examination. There is controversy concerning universal screening of all infants by ultrasound as well as the timing of such screening. In Europe, where ultrasound has been used more extensively than in the United States, ultrasound is routinely used to follow children with mild delayed acetabular development. Children evaluated using ultrasound avoid exposure to radiation from X-rays. The authors suggest that ultrasound should be the imaging method of choice for diagnosis and evaluation of developmental disorders of the hip. (Consumer Summary produced by Reliance Medical Information, Inc.)

A frequent complication of treatment for congenital hip displacement is avascular necrosis caused by changes in the blood supply to the upper end of the femur (pelvic end of the thigh bone). Avascular necrosis, or death of bone tissue due to lack of adequate blood supply, may be caused by varying degrees of vascular insufficiency. An alteration of the blood supply to the proximal (upper) growth plate of the femur may result in late developmental deformities of the proximal femur. A group of patients who had undergone treatment for congenital dislocation of the hip that resulted in varying degrees of vascular insufficiency to the proximal femur were studied. The X-rays of 90 patients were studied retrospectively. All patients were followed until bone-growth maturity. Patients were grouped by degree of vascular insufficiency. Patients with mild insufficiency showed little growth abnormality; those with moderate insufficiency showed partial interference with growth; and those with severe insufficiency showed complete arrest of bone growth. There was a positive correlation between initial degree of vascular insufficiency and X-ray results at latest follow-up. The key to predicting residual deformity of the head of the femur was physeal (growth plate) function. Radiologically, the most reliable factor in determining the outcome of the hip at maturity was medial bowing of the neck of the femur (the knob of thigh bone that inserts into the pelvic bone). If medial bowing appeared early, its progression or persistence indicated an adverse outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

People who have had congenital dislocation of the hip frequently develop subsequent osteoarthrosis with dysplasia (abnormal tissue development) in the same area. Surgical correction using partial or total hip replacement is much more difficult in these patients than in patients whose only problem is osteoarthritis. Often the socket part of the hip is shallow, and this or other changes in the bony structure necessitate particular compensations in surgical hardware and techniques. The outcomes of 74 cemented total hip replacements, in which both ball and socket were replaced, in 55 patients (C group), and of 37 cemented surface replacements of the socket portion only in 32 patients (S group) were evaluated. Patients treated with surface rather than conventional replacements tended to have less severe dysplasia and require less extensive surgical reconstruction. Short-term outcomes in both groups were favorable, and patients reported pain relief and improved hip function. However, group C had more postsurgical complications such as infection, dislocation, and partial nerve paralysis. Infection may have been related to the greater degree of surgical intervention, while nerve dysfunction was related to surgically-induced leg lengthening. All older patients in the C group did well in the long-term, while durable long-term results were not achieved in younger patients in either group. Early surgical techniques and anatomic factors contributed to difficulties with the surface replacement surgery. The major failure necessitating additional surgery or treatment was aseptic (noninfected) loosening of the socket prosthesis. The results suggest that younger patients (under age 60) with osteoarthrosis following congenital hip dislocation should receive treatment other than total or surface hip replacement surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

A routine physical performed on 2-day-old Melissa Carter uncovered evidence of congenital dislocation, or dysplasia, of the right hip. Amy and Adam Melville, fraternal twins, were born with clubbed feet. [...]

Osteoarthritis of the hip joint may not be caused by acetabular dysplasia in elderly women. Acetabular dysplasia refers to abnormal tissue development in the area where the thigh bone fits into the hip bone. A study of 393 hip joints in women aged 60 to 75 years who had x-rays in conjunction with intravenous urography found that the minimal joint space (MJS) measurements denoting osteoarthritis were not significantly associated with acetabular dysplasia. Center-edge angle and acetabular depth measurements were not associated with acetabular dysplasia. These findings agree with the findings of a previous study of acetabular dysplasia in elderly men.

Nonsurgical hope for this painful condition Hip dysplasia is a crippling condition most frequently seen in large dogs, although it can also occur in small dogs and even cats. The [...]

All newborns should be screened for developmental hip dysplasia, guidelines from the American Academy of Pediatrics say Here's a look at the recommended processes for detecting hip dysplasia at birth [...]

LAS VEGAS -- No physician can bat 1,000 in diagnosing hip dysplasia at birth, but using the management process spelled out in guidelines from the American Academy of Pediatrics should [...]

BRECKENRIDGE, COLO. -- Serious consideration should be given to universal ultrasound screening of newborns for signs of developmental dysplasia of the hip, a University of Vermont orthopedic surgeon believes. "Right [...]

Congenital hip dislocation in infants may escape detection until a child begins to walk. Some infants who are treated for hip dislocation during the first year may fail to respond to treatment. In these older children, hip dislocation may be difficult to treat successfully. Contraction of the surrounding soft tissue may make it impossible to reduce the dislocation in children older than two years of age. Femoral shortening, performed at the time of surgical reduction of the dislocated hip, was used to treat congenital hip dislocation in children older than two. This procedure was the primary treatment for the condition, and no traction was used prior to surgery. Femoral shortening was performed in 25 patients (33 hips). The average follow-up of the children was about 3.5 years. A satisfactory clinical outcome was obtained in 85 percent of the hips, and a satisfactory radiographic result was obtained in 75 percent of the hips. There were few short-term problems of pain or stiffness, however the results tend to deteriorate over time as has been found on long-term evaluation of function of major weight bearing joints. Longer follow-up periods are required. Femoral shortening is a one-stage procedure, which avoids prolonged hospitalization and the risks of skeletal traction. It also allows better decompression of the joint than can be obtained using conventional surgical release methods. The limb-length discrepancy produced by this procedure did not appear to cause any clinical problems, and elicited no complaints from either patients or parents. (Consumer Summary produced by Reliance Medical Information, Inc.)

SCOTTSDALE, ARIZ. -- The routine use of ultrasonography is not recommended as a way to detect developmental dysplasia of the hip in the newborn, Dr. M. Jeffrey Maisels said at [...]

Q Our two-year-old daughter has Down syndrome. She started walking at 17 months and, about three months later, began "clicking"--partially dislocating--her hip. She does this at will, usually while at [...]

A survey into the knowledge possessed by health visitors on the subject of congenital dislocation of the hip (CDH) has revealed that only 20 out of the 71 respondents felt that their diploma course prepared them adequately for CDH screening, while only four felt completely at ease with CDH screening. Around 70% of those questioned believed that the responsibility for screening should be shared.