Does residual childhood DDH or adolescent- onset acetabular dysplasia need surgery An evidence base study

Introduction: Developmental dysplasia of the hip (DDH) is the spectrum of structuralabnormalities that involve the growing acetabulum. Persistence of hip dysplasia intoadolescence and adulthood may result in osteoarthritis.Material and method: A systematic review was performed for articles on DDHfocusing on treatment in Medline, Cochrane, EMBASE. The most commonly usedterms are residual DDH or adolescent- onset acetabular .Results: Hip dysplasia is the leading cause of early onset hip osteoarthritis before theage of 60 years. Patients under 50 years old undergoing total hip replacement forosteoarthritis, 48.4 % were found to have underlying hip dysplasia as the etiology ofhip osteoarthritis. The end result of hip dysplasia whether from residual childhoodDDH or adolescent- onset acetabular dysplasia is hip instability and increased hipcontact stresses that lead to early joint destruction. According to the literaturesthe periacetabular osteotomy (PAO) is the treatment of choice for symptomatic acetabular dysplasia in the skeletally mature patient. The short-term results show,71 % of patients after PAO are able to achieve the same or higher level of physicalactivity but long-term outcomes show only 60 % survival rate free of end-stageosteoarthritis needing total hip replacement. Risk factors for failure after PAO includeage greater than 25 years, minimum joint space less than 2 mm, and poor or fair jointcongruency.conclusion: If screening identifies an asymptomatic adolescent or young adult withacetabular dysplasia, it may be beneficial to counsel the patient regarding activitymodifications and to return for treatment when symptoms occur but before theinitiation of joint damage.