Pediatric hip disorders

Purpose of review: To critique the literature over the past year and determine whether advances have been made or alterations in management are warranted. Recent findings: A prospective trial of more than 15,000 newborns found that routine ultrasound screening for developmental dysplasia of the hip is unnecessary. Delaying treatment of the unstable hip in the newborn may be preferable to allow self-selection. The presence of an ossific nucleus does not protect against osteonecrosis in hips requiring reduction, but a delay in reducing dislocated hips makes further surgery more likely. A review found that use of the lateral pillar classification too early in the disease course of Legg-Calvé-Perthes Disease may lead to mistaken prognosis. Decision analysis was used to determine the utility of prophylactic pinning of the contralateral normal hip in patients with a unilateral slipped capital femoral epiphysis (SCFE). Two reports were published on the technical aspects of fixation for SCFE. Patients with renal osteodystrophy and SCFE require medical treatment for an optimal outcome. A 34-year review found an incidence of AVN of 58% with unstable SCFE, but none occurred in stable SCFE. Summary: A more conservative approach to hip instability in the newborn is warranted. Long term follow-up of patients with pediatric hip disorders continues to be useful to determine optimal management. Case series and reports have provided invaluable technical information and insight into complications of conditions and of treatment.