Hip Dysplasia is defined as the alteration in the anatomical relationship between the femoral head and the acetabulum in the developing infant hip, with such a broad spectrum of variability that it can manifest as inadequate acetabular ossification (acetabular dysplasia), a subluxated or easily dislocatable hip, or clear joint instability and dislocation. If not diagnosed and treated in a timely manner, it may lead to premature joint deterioration, resulting in pain, functional limitations, and disability.
Hip dysplasia is currently considered the most common congenital pathology at birth. Its incidence ranges from 1 to 50 cases per 1000 live births globally, and its broad diagnostic variability is almost exclusively dependent on the screening method used for detection. Over the decades, multiple risk factors have been proposed as potential links to the diagnosis of hip dysplasia. Among them, greater emphasis has been placed on the breech presentation during fetal development, female gender, twin pregnancies, infants from first pregnancies, and a family history of high lineage for hip dysplasia.
It has been observed that in developing countries where screening is conducted through clinical examination with Ortolani and Barlow maneuvers (formerly considered the diagnostic gold standard), and where only risk factors are taken into account, the diagnostic incidence of the condition reaches values no greater than 1 to 1.5 cases per 1000 live births. In contrast, in economically developed countries where universal screening is performed using hip ultrasound with the Graf method, the diagnostic value exceeds 50 cases per 1000 live births. This significant diagnostic gap results from the poor specificity (2.8-5.9%) of clinical maneuvers, as well as the low association with risk factors that has been demonstrated recently, being present in only 12% to 30% of patients with dysplasia.
Over time, the natural history of untreated hip dysplasia has shown that it leads to significant deterioration between the femoral head and the acetabulum, creating severe limitations in joint mobility, accompanied by pain and resulting in a decline in quality of life, as well as a high economic impact both personally and at the governmental level. In recent years, it has been demonstrated that in countries where hip screening is performed selectively and considers only associated risk factors, the rate of surgical procedures remains at 16 cases per 1000 patients examined.
On the other hand, it has been observed that in countries where hip screening is performed universally using ultrasound with the Graf method, such as Germany, Austria, and Mongolia, the rate of surgical treatments decreases to a range below 0.002 episodes per 1,000 patients examined and screened. Currently, the World Health Organization estimates that between 21% and 29% of all hip joint replacements in patients under 50 years old are the result of undiagnosed or late-treated hip dysplasia, most of which could have been detected if an appropriate screening protocol had been implemented. In light of this, and considering the significant consequences both in terms of health and the overall monetary value that this condition entails, it is imperative to establish adequate neonatal screening through clinical examination of all infants in the first months of life, as well as a careful and thorough follow-up screening using ultrasound of the hip with the Graf method.
