Edward H. Bennett

On congenital dislocation of the hip

This article reviews changes that have occurred in the understanding and treatment of congenital dislocation of the hip (CDH). It is now recognized that CDH is a spectrum of diseases with differing etiologies, pathologies, and natural histories that, as a result, require different treatment approaches. The etiology of CDH involves genetic, hormonal, mechanical, and environmental influences. This recognition of mechanical factors that predispose to CDH has allowed the identification of high-risk patients. Screening for CDH in the newborn has resulted in many more patients being diagnosed earlier. Ultrasonography has added a new dimension to CDH diagnosis, since it has demonstrated abnormal hips in otherwise normal children. In the newborn, the use of ultrasonography may be the single most important recent contribution to the study of this disease. The natural history of CDH is well-known: The disease often can lead to early coxarthrosis. However, avascular necrosis is a complication of treatment and results in a hip that may be worse than one not treated at all. Treatment of CDH includes gentle closed reduction in the majority of patients. In patients under six months of age, this can usually be achieved with the Pavlik harness. Up to the age of three years, gentle manipulative closed reduction after traction is successful in the majority of pa-