• Journal of the Korean Orthopaedic Association
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• v.55 no.5
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• pp.359-365
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• 2020

Developmental dysplasia of the hip broadly includes inadequate development of the hip joint involving the acetabulum or proximal femur, or both. Although ultrasonographic studies in neonates have greatly lowered the frequency of neglected or operatively treated cases, its sensitivity is less than desired. Hip dysplasia without subluxation is commonly diagnosed incidentally and strongly related to degenerative arthritis in females after the 4th decade. Hip dysplasia with subluxation shows symptoms through various periods, depending on its severity, especially for women with onset during pregnancy. A complete physical examination and early treatment for neonates are extremely important for obtaining satisfactory outcomes. To avoid underdiagnosis and to serve appropriate treatment on time, the authors recommend examining any suspicious hips in infants under two years of age. The study will discuss the diagnosis and primary treatment of developmental dysplasia of the hip.

• Physical Therapy Korea
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• v.6 no.2
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• pp.77-86
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• 1999

Developmental dysplasia or dislocation of the hip is the most pronounced form of a condition in which the femoral heads tends progressively to leave the acetabulum. In the young child the variability of findings and course suggest a spectrum of conditions in which there are a number of common features: restriction of movement, particularly of abduction in flexion; shortening; and abnormal radiology, including a sloping or dysplastic acetabulum and delay in the appearance of the upper femoral epiphysis. It is vital to make the diagnosis of a congenital dislocation as soon after birth as possible. Conservative treatment with an abduction brace before the child run begins to walk is completely adequate, but after the age of 4 even surgical repositioning is difficult and after the age of 7 it is almost impossible. The aim of the study was to gain insight into the value of physical therapy of developmental dysplasia or dislocation after operation.

• Journal of Korean Medicine Rehabilitation
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• v.30 no.2
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• pp.165-171
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• 2020

The purpose of this study is to report the effect of korean medicine treatment for developmental dysplasia of the hip (DDH) in adults. A patient diagnosed with DDH had been treated with acupuncture, electroacupuncture, cupping therapy and chuna manual therapy for 8 weeks. The patient was evaluated by using range of motion (ROM) of hip joint, muscle strength of lower extremity, leg length, numeric rating scale (NRS) and Korean version of hip disability and osteoarthritis outcome score (K-HOOS). After the treatment, the patient had an improvement in the symptoms, pain, and activities of daily living of K-HOOS, especially the quality of life. In addition, NRS decreased from 7 to 4 points, and ROM and muscle strength also improved. The results of this study show that korean medicine treatment is effective and meaningful as one of the conservative treatment for DDH in adults.

• Journal of Korean Physical Therapy Science
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• v.30 no.1
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• pp.1-9
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• 2023

Background: The advantages of robotic therapy have recently been attempted several times in the rehabilitation of total hip arthroplasty (THA) patients. Therefore, this study also aims to report a case of how robot therapy affects the function of THA patients due to developmental dysplasia of the hip (DDH). Design: Case Study. Method: This study used the A-B-A' design. Period A is before robotic therapy, period B is robotic therapy, and period A' is after robotic therapy. The subjects performed physical therapy and occupational therapy for five days each during the baseline period A and A'. In intervention period B, robotic therapy was performed for five days along with the baseline intervention. This study was conducted for a total of fifteen days. The subjects' sit to stand (STS), timed up and go (TUG), and 10 metre walk (10MW) were evaluated. Result:: STS and TUG were significantly improved in periods B and A' compared to period A (p<0.05), and STS was significantly improved in period A' compared to period B (p<0.05). 10MW showed no significant improvement in periods B and A' compared to period A. Conclusions: This study confirmed that robot therapy was an effective intervention in improving the function of women in their 30s who underwent THA due to DDH. In the future, a study comparing the control group should be performed.

• Clinical and Experimental Pediatrics
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• v.65 no.5
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• pp.262-268
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• 2022

Background: The delayed diagnosis of developmental dysplasia of the hip (DDH) requires complex treatment and sometimes progresses to hip osteoarthritis. Purpose: This study aimed to evaluate the risk factors and screening time for DDH in preterm infants. Methods: A total of 155 preterm infants with a gestational age <32 weeks screened for DDH with ultrasonography were enrolled in this retrospective chart review. Results: The incidence of DDH was 6.45% (10 of 155). Gestational age, birth weight, sex ratio, and breech presentation did not differ significantly between infants treated for DDH (n=10) and nontreated infants (n=145) (gestational age, 29.2±1.4 weeks vs. 29.6±2.0 weeks, P=0.583; birth weight, 1,240±237 g vs. 1,295±335 g, P=0.607; female sex, 7 of 10 (70.0%) vs. 77 of 145 (53.1%), P=0.346; and breech presentation, 5 of 10 (50.0%) vs. 43 of 145 (29.7%), P=0.286, respectively). Performing the first ultrasonography earlier than 38 weeks of postmenstrual age (PMA) increased the risk of an abnormal finding by 3.76 times compared to performing it at ≥38 weeks of PMA. These abnormal findings on ultrasonography resolved spontaneously. Breech presentation increased the risk of minor abnormal findings on the first ultrasonography by 3.11 times versus nonbreech presentation and resolved spontaneously. DDH in preterm infants did not occur predominantly on the left side or in infants born with breech presentation. Conclusion: Performing ultrasonography screening earlier than 38 weeks of PMA caused unnecessary subsequent ultrasonography and overtreatment. Breech presentation was not a risk factor for DDH in preterm infants. However, breech presentation could increase the risk of minor abnormal findings at the 1st ultrasonography compared to nonbreech presentation, which resolved spontaneously. The etiology and risk factors for DDH in preterm infants are somewhat different from those for DDH in term infants.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.1
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• pp.31-39
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• 2008

After the introduction of ultrasound enabling a detailed view of both neonatal hip instability and morphology, two different streams have developed: one arguing that neonatal hip instability is the major pathology warranting treatment, the other including acetabular dysplasia as an important feature. Graf's method including the acetabular dysplasia led to higher treatment and follow-up rate than that based upon neonatal hip instability only. Recent report suggested that improved examination techniques and a better understanding of the findings have enabled a more tailored approach, and no differences in treatment rates exist due to different ultrasound techniques. I'd like to emphasize that enough experiences and the understanding enabling standardized examination and high repeatbility is more important than the choice of different techniques. Here the mothods and meanings of different techniques of ultrasound and its usefulness in the diagnosis and treatment of DDH is discussed.

• The Journal of the Acoustical Society of Korea
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• v.42 no.5
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• pp.460-468
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• 2023

Developmental Dysplasia of the Hip (DDH) is a pathological condition commonly occurring during the growth phase of infants. It acts as one of the factors that can disrupt an infant's growth and trigger potential complications. Therefore, it is critically important to detect and treat this condition early. The traditional diagnostic methods for DDH involve palpation techniques and diagnosis methods based on the detection of keypoints in the hip joint using X-ray or ultrasound imaging. However, there exist limitations in objectivity and productivity during keypoint detection in the hip joint. This study proposes a deep learning model-based keypoint detection method using X-ray and ultrasound imaging and analyzes the performance of keypoint detection using various deep learning models. Additionally, the study introduces and evaluates various data augmentation techniques to compensate the lack of medical data. This research demonstrated the highest keypoint detection performance when applying the residual network 152 (ResNet152) model with simple & complex augmentation techniques, with average Object Keypoint Similarity (OKS) of approximately 95.33 % and 81.21 % in X-ray and ultrasound images, respectively. These results demonstrate that the application of deep learning models to ultrasound and X-ray images to detect the keypoints in the hip joint could enhance the objectivity and productivity in DDH diagnosis.

• Hip & pelvis
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• v.30 no.4
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• pp.260-268
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• 2018

Purpose: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). Materials and Methods: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was $11.02{\pm}3.43$ years. According to the Tonnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). Results: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. Conclusion: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

• Korean Journal of Radiology
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• v.22 no.4
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• pp.612-623
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• 2021

Objective: To evaluate the diagnostic performance of a deep learning algorithm for the automated detection of developmental dysplasia of the hip (DDH) on anteroposterior (AP) radiographs. Materials and Methods: Of 2601 hip AP radiographs, 5076 cropped unilateral hip joint images were used to construct a dataset that was further divided into training (80%), validation (10%), or test sets (10%). Three radiologists were asked to label the hip images as normal or DDH. To investigate the diagnostic performance of the deep learning algorithm, we calculated the receiver operating characteristics (ROC), precision-recall curve (PRC) plots, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared them with the performance of radiologists with different levels of experience. Results: The area under the ROC plot generated by the deep learning algorithm and radiologists was 0.988 and 0.988-0.919, respectively. The area under the PRC plot generated by the deep learning algorithm and radiologists was 0.973 and 0.618-0.958, respectively. The sensitivity, specificity, PPV, and NPV of the proposed deep learning algorithm were 98.0, 98.1, 84.5, and 99.8%, respectively. There was no significant difference in the diagnosis of DDH by the algorithm and the radiologist with experience in pediatric radiology (p = 0.180). However, the proposed model showed higher sensitivity, specificity, and PPV, compared to the radiologist without experience in pediatric radiology (p < 0.001). Conclusion: The proposed deep learning algorithm provided an accurate diagnosis of DDH on hip radiographs, which was comparable to the diagnosis by an experienced radiologist.

• Journal of the Korean Society of Radiology
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• v.85 no.3
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• pp.531-548
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• 2024

Developmental dysplasia of the hip is a condition characterized by hip joint instability due to acetabular dysplasia in infancy, necessitating precise ultrasound examination. Legg-Calvé-Perthes disease is caused by a temporary disruption in blood flow to the femoral head during childhood, progressing through avascular, fragmentation, re-ossification, and residual stages. Slipped capital femoral epiphysis is a condition where the femoral head shifts medially along the epiphyseal line during adolescence due to stress, such as weight-bearing. Differentiating between transient hip synovitis and septic arthritis may require joint fluid aspiration. Osteomyelitis can be associated with soft tissue edema and osteolysis. When multiple lesions are present, it is essential to distinguish between Langerhans cell histiocytosis and metastatic neuroblastoma. This review will introduce imaging techniques and typical findings for these conditions.