The 2018 Nicholas Andry Award: The Evidence Base for the Treatment of Developmental Dysplasia of the Hip: The Iowa Contribution.

This review summarizes evidence developed at the University of Iowa concerning the management and outcomes of developmental dysplasia of the hip beginning with the observations and analyses of Dr Arthur Steindler in the early 1900s. The strong evidence-based practice tradition established by Steindler 100 years ago continues as we critically evaluate our procedures and patient outcomes, only altering approaches when warranted by strong personal and research evidence. Our practice continues to be conservative in that we strive to produce the best environment possible for the hip to develop on its own and operate only when less invasive methods have failed.

In search of Ortolani: the man and the method.

Dr Marino Ortolani was an Italian pediatrician who developed a test for hip instability in the infant (1936) and then promoted early diagnosis of this condition to the medical community. He studied the pathoanatomy of hip instability in the 1940s. He wrote his textbook in 1948 and in 1952 he produced a movie about the examination and treatment of hip dysplasia which was translated into many languages to promote early diagnosis and treatment of developmental dysplasia of the hip (DDH). In his career, he wrote a monograph and 31 articles on the subject of hip dysplasia and besides his classic test he developed various braces to treat the infants with hip instability. A remarkable achievement for this early clinician-scientist.

[François Humbert, an unknown orthopedist, initiator of cures for the "lame"]. / François Humbert, orthopédiste méconnu, initiateur du traitement curatif des "boiteux".

François Humbert (1776-1850) created in 1817 the first French orthopaedic institution, at a great turning point in orthopedics. Interested in "lame people" and "hunchbacks", he treated congenital hip dislocation and scoliosis, for about 30 years. Humbert's medical practice illustrated very well the deep transformation which occured in orthopedics at the beginning of the 19th century. As testimonies of Humbert's work, there are the books he published, his Memoirs, some buildings of his institution which have been reconverted into houses, but above all thirty-eight models of his "machines". In spite of the fact that he was the first to consider congenital hip dislocation like a curable disease, his work quickly became unknown after his death.

Developmental dysplasia of the hip: a history of innovation.

Developmental dysplasia of the hip (DDH) is a relatively common malady that has profound consequences in the infant if left untreated. Effective and early treatment of DDH has been praised as one of the most successful ventures of modern pediatric orthopedics. Yet, before the modern management of DDH came into existence, there were extensive technological developments in the field of harnesses, casts, and traction methods. This paper aims to identify the centuries-old history of advancement in DDH treatment and the many important people involved. Their devices, thoughts, and ideas continue to have a profound impact on the current practice of orthopedic surgery.

Developmental dysplasia of the hip in female adult individual: Site Tres Cruces I, Salta, Argentina (Superior formative period, 400-1000 AD).

Developmental dysplasia of the hip (DDH) is a developmental defect that prevents normal articulation between the acetabulum and the femoral head. This is an unusual condition, with a prevalence of 1-2 per thousand, and with only two poorly described skeletons documented in South American paleopathological literature. In this work we report an individual with such a condition, from the archeological site Tres Cruces I (Quebrada del Toro, Salta, Argentina). Several radiocarbon dates and associated materials date it to the Superior Formative (400-1000 AD). The remains are of an adult female, who also has tabular oblique cranial modification. Through detection of abnormalities in the morphology of the femora and ossa coxae, a differential diagnosis was carried out. On the left hip joint the formation of a well-defined false acetabulum, without connection with the true one, was observed. The latter was shallow, triangular, with an irregular base. The left os coxae showed a wider greater sciatic notch angle. The right os coxae exhibited a false acetabulum connected with the true one. Both femora presented a small femoral head, flat and mushroom-shaped, with shortening of the neck. These features were more pronounced on the right-side elements. On the basis of the aforementioned, a presumptive diagnosis of bilateral developmental dysplasia of the hip with complete dislocation on both sides was established.

Arnold Pavlik (1902-62): an autobiography.

Professor Arnold Pavlik, a Czech orthopaedic surgeon, became famous mainly for the development of a functional, active method of treating developmental dysplasia of the hip, in his time called congenital dislocation of the hip. A translation is presented of the autobiography Pavlik prepared to achieve his doctorate in medical sciences, but which his early death in February 1962 denied him.

Triple osteotomy of the innominate bone. 1973.

In forty-five patients, twenty-three with congenital dislocations and the rest with paralytic or other disturbances, this new displacement osteotomy of the hip joint was done when other iliac osteotomies were considered ineffective. The patients, seven to seventeen years old, were followed two to ten years. Of the fifty-two procedures, forty were satisfactory. Most of the unsatisfactory results were in cases of myelodysplasia, peroneal atrophy, and cerebral palsy.

[History and epidemiology of congenital hip dislocation in Brittany]. / Histoire et épidémiologie de la luxation congénitale de la hanche en Bretagne.

Brittany is a region of France with a high rate of congenital dislocations of the hip (CDH). This was shown by Le Damany, who, in 1912, did a systematic screening of newborns and compared the number of CDH in Paris and Rennes. In Paris, there was 0.8% and in Rennes 3.6% CDH. This frequency is not generalized in Brittany, however; and Setter, who did a large survey in Finistère in 1961 and 1962, showed that the epicenter was the canton of Pont l'Abbé, also called "pays Bigouden". However, this disease did not occur in this region of France in earlier times. In 1795, Cambry, according to the "Convention de la Jeune République", travelled in Finistère from village to village and did not notice any limping women. This was a very serious and precise study, and we may conclude that there was no CDH at that time; the disease occurred later in "pays Bigouden". From these basic facts, certain hypotheses are considered. From the point of view of genetics, a mutation apparently occurred in the 19th century, but there is no reliable genetic study. Autosomic heredity with incomplete penetrance, with variable penetrance according to sex may be considered: it includes a multifactorial origin of the disease involving genetics, environmental, biochemical and ethnic factors, including local customs and traditions.

[The development of early diagnosis and treatment of congenital hip dislocation in Czechoslovakia]. / Vývoj casné diagnostiky a lécení vrozeného vykloubení kyclí v Ceskoslovensku.

The author gives an account of the early diagnosis and treatment of congenital dislocation of the hip joint in Czechoslovakia since 1918. He pays more detailed attention to the period before the Second World War and the period immediately after the war when aids now used on a world-wide scale were introduced into practice such as Hanausek's apparatus, Frejka's cushion and Pavlik's stirrups. At the same time screening of neonates in some areas was started. The author mentions also methods of preventive examinations of the entire population introduced in the fifties. He also pays attention to efforts to reduce the radiation load in X-ray screening of the population.

Developmental hip dysplasia in the Medici family: Giovanna from Austria (1548-1578) and her daughter Anna (1569-1584).

The skeletal remains of Giovanna from Austria (1548-1578), first wife of the Grand Duke of Tuscany Francesco I (1541-1587), and their daughter Anna (1569-1584) were exhumed from the Medici Chapels in the Basilica of S. Lorenzo in Florence and submitted to anthropological and paleopathological study. The superior portion of the acetabulum of Giovanna is sloping, and reveals bilateral acetabular dysplasia. The same defect is also present in Anna, together with sacral spina bifida occulta. In both women the anatomical abnormality is limited to a deformation in the roof of both acetabulae and the femoral heads continued to articulate normally within the hip joint. The presence of bilateral acetabular dysplasia in the skeletal remains of Giovanna and her daughter Anna can be explained by a series of risk factors to which the two Medici women were exposed: female sex, practice of swaddling in the first months of life, as well as scoliosis and pelvic deformity for Giovanna and family history for Anna.

Shenton's line.

This paper considers the history of Shenton's line.