Diagnostic criteria for developmental dislocation of the hip in human skeletal remains

Abstract

Abstract Dislocation is the most severe form of developmental dysplasia of the hip (DDH). It significantly impairs hip function in the young, and may lead to debilitating early‐onset osteoarthritis in adults. To our knowledge no thorough study of a large skeletal population has ever been undertaken to determine the wide range of diagnostic criteria for this condition in pathological specimens. To identify these criteria we have analysed the cases of developmental dislocation from a large series of 6000 individuals (6580 hips) from the medieval cemetery at Spitalfields in London, UK. We describe the changes at the true acetabulum, and have created a four‐stage classification of the false acetabulum. The skeletal response to the altered biomechanics and limb shortening that occurs in developmental dislocation is described in the pelvis, lower limb and spine. This includes asymmetric growth in childhood, and asymmetric degenerative change in adulthood. We conclude with a discussion of the clinical literature on developmental dislocation of the hip that will aid palaeopathologists to estimate the symptoms that an excavated individual may have experienced during their lifetime. Copyright © 2007 John Wiley & Sons, Ltd.

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