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K Venkatadass, V Durga Prasad, Nasser Mohammed Mansor Al Ahmadi, and S Rajasekaran

osteotomy, known as San Diego acetabuloplasty, was designed initially for hip dysplasia secondary to neuromuscular disease, where the deficiency is predominantly posterosuperior or direct lateral compared to the anterolateral deficiency seen in DDH ( 11

Markus S. Hanke, Florian Schmaranzer, Simon D. Steppacher, Till D. Lerch, and Klaus A. Siebenrock

typically located superiorly. 87 Fig. 6 (A) Schematic drawing, (B) direct MR arthrography with traction at 3T of a 17-year-old woman with hip dysplasia who underwent (B) surgical hip dislocation and subsequent periacetabular osteotomy. (A–C) Static

Markus S. Hanke, Till D. Lerch, Florian Schmaranzer, Malin K. Meier, Simon D. Steppacher, and Klaus A. Siebenrock

index; LCE, lateral centre edge; AI, acetabular index. Bernese periacetabular osteotomy (PAO) The PAO is an accepted surgical technique for treatment of both hip dysplasia 78 and pincer-type FAI due to acetabular retroversion. 79

Alfonso Vaquero-Picado, Gaspar González-Morán, Enrique Gil Garay, and Luis Moraleda

acetabular anteversion was thought to be increased in hip dysplasia, 9 other studies do not detect differences in acetabular anteversion between affected and unaffected sides. 10 Several changes also occur in the proximal femur. The dysplastic

Stig Storgaard Jakobsen, Søren Overgaard, Kjeld Søballe, Ole Ovesen, Bjarne Mygind-Klavsen, Christian Andreas Dippmann, Michael Ulrich Jensen, Jens Stürup, and Jens Retpen

recent study has indicated that the risk of OA is significantly reduced following PAO. 23 Conclusions PAO is an effective treatment for symptomatic hip dysplasia. The risk of complication is relatively low if experienced surgeons perform the

Pieter Bas de Witte, Christiaan J A van Bergen, Babette L de Geest, Floor Willeboordse, Joost H van Linge, Yvon M den Hartog, Magritha (Margret) M H P Foreman-van Drongelen, Renske M Pereboom, Simon G F Robben, Bart J Burger, M Adhiambo Witlox, and Melinda M E H Witbreuk

Background and purpose

  • Diagnostics and treatment of developmental dysplasia of the hip (DDH) are highly variable in clinical practice. To obtain more uniform and evidence-based treatment pathways, we developed the ‘Dutch guideline for DDH in children < 1 year’. This study describes recommendations for unstable and decentered hips.

Materials and methods

  • The Appraisal of Guidelines for Research and Evaluation criteria (AGREE II) were applied. A systematic literature review was performed for six predefined guideline questions. Recommendations were developed, based on literature findings, as well as harms/benefits, patient/parent preferences, and costs (GRADE).


  • The systematic literature search resulted in 843 articles and 11 were included. Final guideline recommendations are (i) Pavlik harness is the preferred first step in the treatment of (sub) luxated hips; (ii) follow-up with ultrasound at 3–4 and 6–8 weeks; (iii) if no centered and stable hip after 6–8 weeks is present, closed reduction is indicated; (iv) if reduction is restricted by limited hip abduction, adductor tenotomy is indicated; (v) in case of open reduction, the anterior, anterolateral, or medial approach is advised, with the choice based on surgical preference and experience; (vi) after reduction (closed/open), a spica cast is advised for 12 weeks, followed by an abduction device in case of residual dysplasia.


  • This study presents recommendations on the treatment of decentered DDH, based on the available literature and expert consensus, as Part 2 of the first official and national evidence-based ‘Guideline for DDH in children < 1 year’. Part 1 describes the guideline sections on centered DDH in a separate article.

Ioannis Gkiatas, Anastasia Boptsi, Dimitra Tserga, Ioannis Gelalis, Dimitrios Kosmas, and Emilios Pakos

of the hip in young individuals is undetected hip dysplasia. 4 Variability in phenotypic presentation is observed in DDH-affected patients. 1 , 5 Genetic and environmental factors are both involved in the pathogenesis of DDH. 1 , 4

Bülent Atilla

deficient anterior acetabular wall. 3 Fig. 1 A 21-year-old female patient with right hip dysplasia. She had had a previous subtrochanteric femoral valgus support osteotomy at the age of 14 years. Dysplasia is never confined to the hip joint alone

Maurizio De Pellegrin, Lucrezia Montanari, Desiree Moharamzadeh, and Oliver Eberhardt

development of ultrasound (US) screening programmes in the 1980s for the evaluation of hip dysplasia, the labrum acquired an increasingly important role as a landmark in Graf’s classification and US technique. 9 – 12 The US examination allows the correct

Christiaan J A van Bergen, Pieter Bas de Witte, Floor Willeboordse, Babette L de Geest, Magritha (Margret) M H P Foreman-van Drongelen, Bart J Burger, Yvon M den Hartog, Joost H van Linge, Renske M Pereboom, Simon G F Robben, M Adhiambo Witlox, and Melinda M E H Witbreuk

consisted of immediate abduction treatment for at least 6 weeks using a Frejka pillow splint with sonographic follow-up. The control consisted of active sonographic surveillance but no treatment before 6 weeks of age. In case of persistent hip dysplasia