Recent Advances in the Prevention, Early Diagnosis, and Treatment of Congenital Dislocation of the Hip in Japan

  title={Recent Advances in the Prevention, Early Diagnosis, and Treatment of Congenital Dislocation of the Hip in Japan},
  author={Takao Yamamuro and Kazuhiro Ishida},
  journal={Clinical Orthopaedics and Related Research},
Results of animal experiments and then of clinical study of newborn infants suggested that the main mechanical factor causing hip dislocation is prolonged tension on the hamstrings and iliopsoas and that each of these muscles has a synergistic effect in the production of hip dislocation during the perinatal period. It was, therefore, presumed that the high incidence of congenital dislocation of the hip (CDH) in Japan might be due mainly to the Japanese tradition of forcibly maintaining the legs… 
Effectiveness of screening for congenital dislocation of the hip.
The incidence of congenital dislocation of the hip (CDH) in Birmingham was measured in the period 1942-52 and again in 1950-54; it is measured now in 1974-83; there was no indication that CDH requiring prolonged treatment had declined.
Pathogeny and natural history of congenital dislocation of the hip.
The genetic theory can explain the natural history of C D H which is first, at birth a hip instability followed by two possible evolutions: either persistent luxation becoming irreducible or spontaneous stabilisation leading sometimes to complete healing or to residual abnormalities (subluxation or dysplasia).
Prevention of hip dysplasia in children and adults.
Attempts to universally prevent the disease may still be able to be incorporated into further efforts at disease prevention through education and the systematic trials of hip abduction pillows or braces similar to his wide-diaper diapering technique.
The use of ultrasound in determining the initiation of treatment in instability of the hip in neonates.
There was a marked trend towards normal development in mildly unstable hips, whereas no hips with severe instability did so spontaneously, and spontaneous resolution occurred in more than half of the unstable hips.
Published Results on the Early Diagnosis and Treatment of Congenital Hip Dislocation
The literature on the early diagnosis and treatment of congenital hip dislocation is extensive. Here we shall survey it mainly in the form of tables, limiting our attention to studies in which
Developmental dysplasia of the hip
The diagnosis, management, and screening controversies for hip dysplasia are described and a framework for early assessment is provided, based on the available literature, including studies with level 1 evidence.
Etiology of Congenital Dislocation of the Hip
There have been two main theories concerning the etiology of congenital hip dislocation, one based on mechanical pre-and postnatal factors, and the other on endogenous factors such as a primary maldevelopment of the hip.
Developmental Hip Dysplasia: What Has Changed in the Last 30 Years?
There is now about a 10-fold decrease in severe surgery of dislocated hips and the universal ultrasound screening programme has caused a reduction in the number of surgical interventions.
Closed reduction of congenital dislocation of the hip: prediction factors and results
In nonteratologic hips, a positive Barlow test with a safe zone of 20° is predictive of a successful closed reduction and in these patients, anaesthesia and arthrography might not be necessary.
Evaluating the National Screening Programme for Congenital Dislocation of the Hip
The existing evidence to support the different approaches to screening is reviewed, the research agenda of the MRC working party on congenital dislocation of the hip is described and key issues relating to trial design addressed.