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The American Academy of Pediatrics (AAP), Pediatrie Orthopedic Society of North America (POSNA), and American Academy of Orthopaedic Surgeons (AAOS) currently all recognize the term developmental dysplasia of the hip (DDH) and have recommended that it replace the more traditional term congenital dislocation of the hip (CDH).1'2 The change in terminology was the culmination of decades of physician dissatisfaction with the term CDH. However, CDH was a specific entity and was easy to understand. DDH is a concept that is complex and somewhat difficult to comprehend for those who do not use it frequently. DDH is easier to understand when the change in terminology is viewed from the historical perspective.
HISTORICAL PERSPECTIVE
In 1826, a French surgeon, Dupuytren, noted in autopsy studies a type of hip dislocation in which there was "a defect in the depth or completeness of the acetabulum."3 The shallow acetabulum distinguished "this variety of dislocation," which he named "original or congenital dislocation" from acquired dislocations secondary to trauma or infection. "CDH" was accepted as a distinct clinical entity for most of the next century.
However, following the routine use of radiographs in the early 20th Century, orthopedic surgeons made a number of interesting observations concerning CDH. They often noted that a child with CDH of one hip would have a located or minimally subluxated hip, with a shallow acetabulum on the contralateral side.4 They questioned what term should they use for the contralateral hip, which clearly was not dislocated. In 1926, HiIgenreiner, a Czech orthopedic surgeon, used the term dysplasia, which literally means abnormal growth, to describe the shallow acetabulum and soft tissue changes associated with CDH.5
Putti, an Italian orthopedic surgeon from Bologna, in 1933 made the observation of "a state of pre-dislocation seen on X-ray evidenced merely by an increased tilting of the roof of the acetabulum and few clinical signs."4 He suggested that some of these might progress to a complete dislocation. Putti was one of the first physicians to realize the importance of early recognition and treatment of CDH.6 He thought CDH could possibly be diagnosed at birth not by physical exam but by x-ray. He recommended that all babies be screened for CDH with a pelvis x-ray at birth. However, radiographs are of limited use until...