Skip to main content
SpringerLink
Log in

Hüftdysplasie

Hip dysplasia

  • Leitthema
  • Published:
Die Radiologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Hüftdysplasie ist eine der häufigsten Fehlbildungen im Kindesalter, die sich maßgeblich auf das weitere Leben der Betroffenen auswirkt. Unterschieden werden muss die kongenitale von der viel selteneren erworbenen Dysplasie. Eine frühzeitige Diagnose und Therapie sind wichtig für die weitere Entwicklung.

Ziel der Arbeit

Die Arbeit gibt eine Übersicht zur aktuellen radiologischen Diagnostik mit Fokus auf die kongenitale Hüftdysplasie, ergänzt um Einblicke in die therapeutischen Verfahren.

Material und Methoden

Grundlagen- und Übersichtsarbeiten wurden analysiert.

Ergebnisse

Die klinische Untersuchung des Neugeborenen hat eine geringe Sensitivität und Spezifität bei der Diagnostik der Hüftdysplasie. Durch die Einführung des Ultraschallscreenings nach Graf konnte eine deutliche Verbesserung der frühen Detektion dysplastischer Hüften erreicht werden. Mit Hilfe der Sonographie, aber auch der Magnetresonanztomographie (MRT) kann die Form der Hüftpfanne sowie Position des Hüftkopfes in der Pfanne präzise und schnell bestimmt werden, während Röntgenuntersuchungen ihren Stellenwert insbesondere im Rahmen der Verlaufsuntersuchungen nach der Behandlung ab dem 1. Lebensjahr sowie in der Diagnostik der sekundären Dysplasie haben. Die therapeutischen Möglichkeiten reichen von Spreizbehandlung bis zur offenen Reposition mit Fixation im Neugeborenenalter sowie der Umstellungsosteotomie bei älteren Kindern.

Schlussfolgerung

Eine zeitnahe Detektion der Hüftgelenkdysplasie ist entscheidend für den Behandlungsverlauf. Die richtige Wahl der Untersuchungsmethode und die korrekte Durchführung sind essenziell für die weitere Behandlung.

Abstract

Background

Hip dysplasia is one of the most common malformations in childhood and has a significant impact on the further life of those affected. A distinction must be made between congenital and the much rarer acquired dysplasia. Early diagnosis and therapy are pivotal for further development of patients.

Objectives

The paper gives an overview of current radiological possibilities of diagnosis with focus on congenital hip dysplasia supplemented by insights into therapeutic options.

Materials and methods

Basic and review papers were analyzed.

Results

Clinical examination of the newborn has low sensitivity and specificity in the diagnosis of hip dysplasia. The introduction of Graf ultrasound screening has significantly improved the early detection of dysplastic hips. With the help of sonography, but also magnetic resonance imaging (MRI), the shape of the acetabulum and the position of the femoral head in the socket can be precisely and quickly determined, while X‑ray examinations have their place especially in the context of follow-up examinations after treatment from the age of 1 year and in the diagnosis of secondary dysplasia. Therapeutic options range from spreading treatment to open reduction with fixation in the newborn as well as conversion osteotomy in older children.

Conclusion

Early detection of hip dysplasia is critical to the course of treatment. The right choice of examination method and correct performance are essential for further treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Lehmann HP, Hinton R, Morello P et al (2000) Developmental dysplasia of the hip practice guideline: technical report. Committee on Quality Improvement, and Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 105(4):E57

    Article  CAS  PubMed  Google Scholar 

  2. Tonnis D, Storch K, Ulbrich H (1990) Results of newborn screening for CDH with and without sonography and correlation of risk factors. J Pediatr Orthop 10(2):145–152

    Article  CAS  PubMed  Google Scholar 

  3. Partenheimer A, Scheler-Hofmann M, Lange J et al (2006) Correlation between sex, intrauterine position and familial predisposition and neonatal hip ultrasound results. Ultraschall Med 27(4):364–367

    Article  CAS  PubMed  Google Scholar 

  4. Loder RT, Skopelja EN (2011) The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011:238607

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tönnis D (1984) Ergebnisberichte über die Frühdiagnose und Frühbehandlung der Hüftluxation. In: Tönnis D (Hrsg) Die angeborene Hüftdysplasie und Hüftluxation im Kindes- und Erwachsenenalter: Grundlagen, Diagnostik, konservative und operative Behandlung. Springer, Berlin, Heidelberg, S 240–245 https://doi.org/10.1007/978-3-662-06621-8_19

    Chapter  Google Scholar 

  6. Fox AE, Paton RW (2010) The relationship between mode of delivery and developmental dysplasia of the hip in breech infants: a four-year prospective cohort study. J Bone Joint Surg Br 92(12):1695–1699

    Article  CAS  PubMed  Google Scholar 

  7. Carroll KL, Schiffern AN, Murray KA et al (2016) The occurrence of occult acetabular dysplasia in relatives of individuals with developmental dysplasia of the hip. J Pediatr Orthop 36(1):96–100

    Article  PubMed  Google Scholar 

  8. Eberhardt O (2020) Hüftdysplasie. In: Engelhardt M, Raschke M (Hrsg) Orthopädie und Unfallchirurgie. Springer, Berlin, Heidelberg, S 1–15 https://doi.org/10.1007/978-3-642-54673-0_119-1

    Chapter  Google Scholar 

  9. Lange AE, Lange J, Ittermann T et al (2017) Population-based study of the incidence of congenital hip dysplasia in preterm infants from the Survey of Neonates in Pomerania (SNiP). BMC Pediatr 17(1):78

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Trotter A, Maier L, Grill HJ et al (1999) Effects of postnatal estradiol and progesterone replacement in extremely preterm infants. J Clin Endocrinol Metab 84(12):4531–4535

    Article  CAS  PubMed  Google Scholar 

  11. Tschauner C (2007) The biomechanics of coxarthrosis in the young adult−prevention joint preserving and therapeutic options. Z Orthop Unfall 145(3):369–386 (quiz 387–390)

    Article  PubMed  Google Scholar 

  12. Bundesvereinigung K (1996) Leitlinie für das hüftsonographische Screening – Konsensusstatement? Dtsch Arztebl Int 93(1–2):A-58

    Google Scholar 

  13. von Kries R, Ihme N, Altenhofen L et al (2012) General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case-control study. J Pediatr 160(2):271–275

    Article  Google Scholar 

  14. Thaler M, Biedermann R, Lair J et al (2011) Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. J Bone Joint Surg Br 93(8):1126–1130

    Article  CAS  PubMed  Google Scholar 

  15. Thallinger C, Pospischill R, Ganger R et al (2014) Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program. J Child Orthop 8(1):3–10

    Article  PubMed  PubMed Central  Google Scholar 

  16. Biedermann R, Eastwood DM (2018) Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues. J Child Orthop 12(4):296–301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Dogruel H, Atalar H, Yavuz OY et al (2008) Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Int Orthop 32(3):415–419

    Article  CAS  PubMed  Google Scholar 

  18. Graf R (1997) Hip ultrasonography. Basic principles and current aspects. Orthopade 26(1):14–24

    CAS  PubMed  Google Scholar 

  19. Harcke HT, Grissom LE (1990) Performing dynamic sonography of the infant hip. AJR Am J Roentgenol 155(4):837–844

    Article  CAS  PubMed  Google Scholar 

  20. Suzuki S (1993) Ultrasound and the Pavlik harness in CDH. J Bone Joint Surg Br 75(3):483–487

    Article  CAS  PubMed  Google Scholar 

  21. Harcke HT, Pruszczynski B (2017) Hip ultrasound for developmental dysplasia: the 50 % rule. Pediatr Radiol 47(7):817–821

    Article  PubMed  Google Scholar 

  22. van Douveren FQ, Pruijs HE, Sakkers RJ et al (2003) Ultrasound in the management of the position of the femoral head during treatment in a spica cast after reduction of hip dislocation in developmental dysplasia of the hip. J Bone Joint Surg Br 85(1):117–120

    Article  PubMed  Google Scholar 

  23. Studer K, Williams N, Studer P et al (2017) Obstacles to reduction in infantile developmental dysplasia of the hip. J Child Orthop 11(5):358–366

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Westhoff B, Wild A, Seller K et al (2003) Magnetic resonance imaging after reduction for congenital dislocation of the hip. Arch Orthop Trauma Surg 123(6):289–292

    Article  CAS  PubMed  Google Scholar 

  25. Stranzinger E, Schankath A, Dobrocky T et al (2015) MRI in Hip Dysplasia: How to Shorten your MR-Protocol? Orthop Muscular Syst 4:199

    Google Scholar 

  26. Hirsch FW, Frahm J, Sorge I et al (2021) Real-time magnetic resonance imaging in pediatric radiology−new approach to movement and moving children. Pediatr Radiol 51(5):840–846

    Article  PubMed  PubMed Central  Google Scholar 

  27. Li LY, Zhang LJ, Li QW et al (2012) Development of the osseous and cartilaginous acetabular index in normal children and those with developmental dysplasia of the hip: a cross-sectional study using MRI. J Bone Joint Surg Br 94(12):1625–1631

    Article  CAS  PubMed  Google Scholar 

  28. Li Y, Guo Y, Li M et al (2018) Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop 42(3):631–640

    Article  PubMed  Google Scholar 

  29. Pavlik A (1953) A harness for treatment of congenital hip dislocation in infants. Acta Chir Orthop Traumatol Cech 20(5–6):93–100

    CAS  PubMed  Google Scholar 

  30. Tschauner C, Furntrath F, Saba Y et al (2011) Developmental dysplasia of the hip: impact of sonographic newborn hip screening on the outcome of early treated decentered hip joints‑a single center retrospective comparative cohort study based on Graf’s method of hip ultrasonography. J Child Orthop 5(6):415–424

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kubo H, Pilge H, Nepp K et al (2018) Development of unstable hips after treatment with the Tubingen splint: mid-term follow-up of 83 hip joints. Arch Orthop Trauma Surg 138(5):629–634

    Article  PubMed  Google Scholar 

  32. Zajonz D, Strobel S, Wojan M et al (2016) Pavlik harness for the treatment of congenital hip dysplasia types D III and IV. Orthopade 45(1):72–80

    Article  CAS  PubMed  Google Scholar 

  33. Wenger D, Duppe H, Tiderius CJ (2013) Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip. Acta Orthop 84(5):483–488

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Section Paediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Deutschland

    Paul-Christian Krüger & Hans-Joachim Mentzel

  2. German Centre for Orthopaedics, Paediatric Department, Waldkliniken Eisenberg, Eisenberg, Deutschland

    André Sachse

Authors
  1. Paul-Christian Krüger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. André Sachse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans-Joachim Mentzel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul-Christian Krüger.

Ethics declarations

Interessenkonflikt

P.-C. Krüger, A. Sachse und H.-J. Mentzel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krüger, PC., Sachse, A. & Mentzel, HJ. Hüftdysplasie. Radiologie 63, 722–728 (2023). https://doi.org/10.1007/s00117-023-01194-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-023-01194-9

Schlüsselwörter

Keywords

Search

Navigation