Displasia do desenvolvimento do quadril – Parte 1

Resumo

O termo displasia do desenvolvimento quadril (DDQ) refere-se à condição na qual a articulação sofre alterações na sua formação durante os últimos meses da vida intrauterina ou nos primeiros meses após o nascimento. No espectro de apresentação, varia desde a instabilidade femuroacetabular, passando por estádios de displasia até a completa luxação. O diagnóstico precoce é fundamental para o sucesso do tratamento. A triagem através do exame clínico incluindo manobras apropriadas é imprescindível nos recém-nascidos e nas avaliações subsequentes durante o crescimento da criança.

O rastreamento ultrassonográfico é indicado nos bebês sob suspeita clínica e muito mais recomendável naqueles que tiveram apresentação pélvica para o parto ou que tenham antecedentes familiares. A ultrassonografia do quadril nos primeiros meses seguida da radiografia da bacia após o 4° ou 6° mês de vida são os exames que determinam o diagnóstico e auxiliam o seguimento.

O tratamento está baseado na obtenção de uma redução concêntrica e na manutenção e estabilização do quadril, propiciando a remodelação articular. Inicialmente, as órteses de flexão/abdução são a escolha; em crianças maiores pode ser necessário o uso de gesso após redução incruenta com ou sem tenotomia; redução aberta pode ser indicada e após os 18 meses as osteotomias pélvicas associadas a capsuloplastia e eventuais osteotomias acetabular e femoral.

Crianças tratadas devem ser acompanhadas durante todo o seu crescimento pelo eventual risco de displasias tardias.

Palavras-chave

displasia do desenvolvimento do quadril - luxação congênita de quadril - diagnóstico - tratamento

Estudo desenvolvido no Departamento de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil.

Publication History

Received: 04 July 2022

Accepted: 15 September 2022

Article published online:
31 July 2023

• Referências

• 1 Musielak B, Idzior M, Jóźwiak M. Evolution of the term and definition of dysplasia of the hip - a review of the literature. Arch Med Sci 2015; 11 (05) 1052-1057
• 2 Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011; 2011: 238607
• 3 Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. Proc R Soc Med 1963; 56 (09) 804-806
• 4 Guarniero R, Montenegro NB, Vieira PB, Peixinho M. Sinal de Ortolani: resultado do exame ortopétido em 9.171 recém-nascidos na Associaçäo Maternidade de Säo Paulo. Rev Bras Ortop 1988; 23 (05) 125-128
• 5 Motta GGB, Chiovatto ARS, Chiovatto ED, Duarte ML, Rodrigues NVM, Iared W. Prevalence of Developmental Dysplasia of the Hip in a Maternity Hospital in São Paulo, Brazil. Rev Bras Ortop (Sao Paulo) 2021; 56 (05) 664-670
• 6 Håberg Ø, Foss OA, Lian ØB, Holen KJ. Is foot deformity associated with developmental dysplasia of the hip?. Bone Joint J 2020; 102-B (11) 1582-1586
• 7 Oh EJ, Min JJ, Kwon SS. et al. Breech presentation in twins as a risk factor for developmental dysplasia of the hip. J Pediatr Orthop 2022; 42 (01) e55-e58
• 8 Koob S, Garbe W, Bornemann R, Ploeger MM, Scheidt S, Gathen M, Placzek R. Is Prematurity a Protective Factor Against Developmental Dysplasia of the Hip? A Retrospective Analysis of 660 Newborns. Ultraschall Med 2022; Apr; 43 (02) 177-180
• 9 Sidharthan S, Kehoe C, Dodwell E. Post-Natal Positioning through Babywearing: What the Orthopaedic Surgeon Needs to Know. JPOSNA® 2020;2(03). Available from: https://www.jposna.org/ojs/index.php/jposna/article/view/131
• 10 Ulziibat M, Munkhuu B, Bataa AE, Schmid R, Baumann T, Essig S. Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial. BMC Pediatr 2021; 21 (01) 450
• 11 Siddicky SF, Wang J, Rabenhorst B, Buchele L, Mannen EM. Exploring infant hip position and muscle activity in common baby gear and orthopedic devices. J Orthop Res 2021; 39 (05) 941-949
• 12 Moon RY. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics 2016; 138 (05) e20162940
• 13 O'Beirne JG, Chlapoutakis K, Alshryda S. et al. International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip. Ultraschall Med 2019; 40 (04) 454-464
• 14 Biedermann R, Eastwood DM. Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues. J Child Orthop 2018; 12 (04) 296-301
• 15 Lee J, Spinazzola RM, Kohn N, Perrin M, Milanaik RL. Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants?. J Perinatol 2016; 36 (07) 552-556
• 16 Imrie M, Scott V, Stearns P, Bastrom T, Mubarak SJ. Is ultrasound screening for DDH in babies born breech sufficient?. J Child Orthop 2010; 4 (01) 3-8
• 17 Brusalis CM, Price CT, Sankar WN. Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria. J Child Orthop 2017; 11 (04) 272-276
• 18 Antoniak K, Lee C, Goldstein RY, Abousamra O. Is radiographic imaging necessary for identifying late developmental dysplasia of the hip in breech infants with normal ultrasounds?. Glob Pediatr Health 2021; 8: 1-5
• 19 Joiner ER, Andras LM, Skaggs DL. Screening for hip dysplasia in congenital muscular torticollis: is physical exam enough?. J Child Orthop 2014; 8 (02) 115-119
• 20 Harper P, Joseph BM, Clarke NMP. et al; International Hip Dysplasia Institute (IHDI). Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns. J Pediatr Orthop 2020; 40 (08) 408-412
• 21 Ortolani M. Un segno poco noto e sua importanza per la diagnosi precoce di prelussazione congenita dell'anca. Paediatria 1937; 45: 129-136
• 22 Humphry S, Thompson D, Price N, Williams PR. The ‘clicky hip’: to refer or not to refer?. Bone Joint J 2018; 100-B [phone]
• 23 Hart VL. Congenital dislocation of the hip in the newborn and in early postnatal life. J Am Med Assoc 1950; 143 (15) 1299-1303
• 24 Harris LE, Lipscomb PR, Hodgson JR. Early diagnosis of congenital dysplasia and congenital dislocation of the hip. Value of the abduction test. J Am Med Assoc 1960; 173: 229-233
• 25 Ömeroğlu H, Tatlici E, Köse N. Significance of Asymmetry of Groin and Thigh Skin Creases in Developmental Dysplasia of the Hip Revisited: Results of a Comparative Study. J Pediatr Orthop 2020; 40 (08) e761-e765
• 26 Graf R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop 1984; 4 (06) 735-740
• 27 Graf R, Lercher K, Scott S, Spieß T. Fundamentos da ultrassonografia do quadril infantil: segundo a técnica de Graf. Tradução de Giovanna Braga Motta e Susana dos Reis Braga. São Paulo: Pasavento; 2021
• 28 Sari AS, Karakus O. Is experience alone sufficient to diagnose developmental dysplasia of the hip without the bony roof (alpha angle) and the cartilage roof (beta angle) measurements?: A diagnostic accuracy study. Medicine (Baltimore) 2020; 99 (14) e19677
• 29 Terjesen T. Ultrasound as the primary imaging method in the diagnosis of hip dysplasia in children aged < 2 years. J Pediatr Orthop B 1996; 5 (02) 123-128
• 30 Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology 1985; 157 (03) 673-677
• 31 van Douveren FQ, Pruijs HE, Sakkers RJ, Nievelstein RA, Beek FJ. 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 2003; 85 (01) 117-120
• 32 Bone CM, Hsieh GH. The risk of carcinogenesis from radiographs to pediatric orthopaedic patients. J Pediatr Orthop 2000; 20 (02) 251-254
• 33 Hudak KE, Faulkner ND, Guite K. et al. Variations in AP and frog-leg pelvic radiographs in a pediatric population. J Pediatr Orthop 2013; 33 (02) 212-215
• 34 Kumar A, Chau WW, Hung AL, Wong JK, Ng BKW, Cheng JCY. Gonadal shield: is it the Albatross hanging around the neck of developmental dysplasia of the hip research?. J Child Orthop 2018; 12 (06) 606-613
• 35 Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin: Springer-Verlag; 1987
• 36 Novais EN, Pan Z, Autruong PT, Meyers ML, Chang FM. Normal percentile reference curves and correlation of acetabular index and acetabular depth ratio in children. J Pediatr Orthop 2018; 38 (03) 163-169
• 37 Roovers EA, Boere-Boonekamp MM, Mostert AK, Castelein RM, Zielhuis GA, Kerkhoff TH. The natural history of developmental dysplasia of the hip: sonographic findings in infants of 1-3 months of age. J Pediatr Orthop B 2005; 14 (05) 325-330
• 38 Ramsey PL, Lasser S, MacEwen GD. Congenital dislocation of the hip. Use of the Pavlik harness in the child during the first six months of life. J Bone Joint Surg Am 1976; 58 (07) 1000-1004
• 39 De Pellegrin M, Damia CM, Marcucci L, Moharamzadeh D. Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips. Children (Basel) 2021; 8 (03) 179
• 40 Sierra-Silvestre E, Bosello F, Fernández-Carnero J, Hoozemans MJM, Coppieters MW. Femoral nerve excursion with knee and neck movements in supine, sitting and side-lying slump: An in vivo study using ultrasound imaging. Musculoskelet Sci Pract 2018; 37: 58-63
• 41 Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am 2011; 93 (05) 493-499
• 42 Mubarak S, Garfin S, Vance R, McKinnon B, Sutherland D. Pitfalls in the use of the Pavlik harness for treatment of congenital dysplasia, subluxation, and dislocation of the hip. J Bone Joint Surg Am 1981; 63 (08) 1239-1248
• 43 Maclean JG, Hawkins A, Campbell D, Taylor MA. A simple modification of the Pavlik harness for unstable hips. J Pediatr Orthop 2005; 25 (02) 183-185
• 44 Lyu X, Chen T, Yang Z. et al. Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months. Bone Joint J 2021; 103-B [phone]
• 45 Ran L, Chen H, Pan Y, Lin Q, Canavese F, Chen S. Comparison between the Pavlik harness and the Tübingen hip flexion splint for the early treatment of developmental dysplasia of the hip. J Pediatr Orthop B 2020; 29 (05) 424-430
• 46 Bram JT, Gohel S, Castañeda PG, Sankar WN. Is There a Benefit to Weaning Pavlik Harness Treatment in Infantile DDH?. J Pediatr Orthop 2021; 41 (03) 143-148
• 47 Massa BSF, Guarniero R, Godoy Jr RM, Rodrigues JC, Montenegro NB, Cordeiro FG. Use of inlet radiographs in the assessment of reduction after the surgical treatment of developmental dysplasia of the hip. Bone Joint J 2017; 99-B [phone]
• 48 Ranawat V, Rosendahl K, Jones D. MRI after operative reduction with femoral osteotomy in developmental dysplasia of the hip. Pediatr Radiol 2009; 39 (02) 161-163
• 49 Rosenbaum DG, Servaes S, Bogner EA, Jaramillo D, Mintz DN. MR imaging in postreduction assessment of developmental dysplasia of the hip: goals and obstacles. Radiographics 2016; 36 (03) 840-854
• 50 Herring JA. Developmental Dysplasia of the hip. In: Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children. 5 ^th ed. Philapdelphia: Elsevier; 2014: 483-579
• 51 Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years?. World J Orthop 2015; 6 (11) 886-901
• 52 Lindstrom JR, Ponseti IV, Wenger DR. Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am 1979; 61 (01) 112-118
• 53 Kothari A, Grammatopoulos G, Hopewell S, Theologis T. How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia?. Clin Orthop Relat Res 2016; 474 (05) 1199-1208
• 54 Wakabayashi K, Wada I, Horiuchi O, Mizutani J, Tsuchiya D, Otsuka T. MRI findings in residual hip dysplasia. J Pediatr Orthop 2011; 31 (04) 381-387
• 55 Walbron P, Müller F, Mainard-Simard L, Luc A, Journeau P. Bone maturation of MRI residual developmental dysplasia of the hip with discrepancy between osseous and cartilaginous acetabular index. J Pediatr Orthop B 2019; 28 (05) 419-423
• 56 Salter RB. Innominate osteotomy in the treatment of congenital hip dislocation and subluxation of the hip. J Bone Joint Surg Br 1961; 43 (03) 518-539
• 57 Rab GT. Biomechanical aspects of Salter osteotomy. Clin Orthop Relat Res 1978; (132): 82-87
• 58 Airey G, Shelton J, Dorman S, Bruce C, Wright DM. The Salter innominate osteotomy does not lead to acetabular retroversion. J Pediatr Orthop B 2021; 30 (06) 515-518
• 59 Pemberton PA. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip. J Bone Joint Surg Am 1965; 47: 65-86
• 60 Czubak J, Kowalik K, Kawalec A, Kwiatkowska M. Dega pelvic osteotomy: indications, results and complications. J Child Orthop 2018; 12 (04) 342-348