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.