Early detection and management of developmental dysplasia of the hip (DDH) yields simpler and more effective the treatment. Diagnosis by ultrasound has changed the clinical view of the disease. However, the need and the way of ultrasound screening is still controversial. Diagnosis by ultrasound has shown that morphological abnormalities may not be associated with clinical signs.

In Hungary all newborns are screened clinically within the first and also the third week of life, and controlled at the age of four month. Clinical examination is performed by an Ortopaedic specialist. Ultrasound screening is first performed for children with clinical signs and for children at risk at three weeks of age. Radiological examination, when necessary, is first performed at the age of four month.

In the five year timeline (2001–2005) that was re-evaluated 7339 children presented 9706 times for screening for DDH at the University of Szeged (Hungary) Department of Orthopaedics. Out of these cases 6991 (95.2%) children were found to be healthy and 348 (4.8%) were diagnosed for DDH. Children with dysplasia presented 896 times for treatment and follow-up. Patient compliance in the DDH group was average 2.5 visits, while for the healthy group it was only average 1.2 visits. Because of clinical signs or risk factors 1569 (21%) children had ultrasound examination, all-together 2169 times. 84% of the initial ultrasound examination showed Graf stage Ia hip. Out of the diagnosed 348 DDH cases 31 patients (Graf IIa-IIc) were administered with Pavlik harness, and 314 (Graf Ib-IIa) were treated with splinting. Remaining 3 cases were diagnosed late, where no ultrasound examination was performed. In the DDH cases 832 ultrsonographic examination was performed during the treatment (average 2.4 examination/case).

Radiographic control of all treated children excluded avascular necrosis in all cases. For this population 14 first operative procedure was needed so far. In our experience clinical screening and selective ultrasound examination is effective in the screening and early detection of developmental dyspalsia of the hip. In our practice, we promptly treated all patients with detected morphological changes as a deficiency in hip development. This way selective screening has helped us in the management of developmental dyspalsia of the hip. Hopefully, with the selective indication the number of false positive cases was reduced, while the „silent” clinical instabilities were given a chance for better long term development.

Purpose: The purpose of this research was to evaluate the degree of polyethylene wear in the acetabular component 10 years after cemented total hip arthroplasty. In addition, with the help of the accepted standards the connection between the degree of acetabular wear and acetabular loosening was studied. Materials/Methods: 110 cases, operated with cemented arthroplasty of the hip in 1990–1992, were selected for the study. Antero-posterior (AP) and lateral radiographs were analyzed with regard to migration, radiolucent lines, pelvic osteolysis and two-dimensional linear wear of the polyethylene. The diameter of the component was measured (diameter of the wire markers imbeded in the plastic), and the distance between the central point of the femoral head component and the outer ring (T1 and T2). The ratio calculated from these distances (T1/T2) presents the linear scale of the component wear and the migration of the femoral head component. The polyethylene wear was further studied in contrast of the femoral head component size (26 and 32). In addition, the degree of acetabular loosening was measured by the De Lee and Charnley radiological score. Results: Out of the 110 cases, 23.1% of the T1/T2 ratio equaled 1, measured on the AP roentgenographs, which means that there is no wear in the acetabular component. 30.5% of the cases had a ratio of 0.96–1 (minimal wear), 30.5% of the cases had a ratio of 0.92–0.96 (intermediate wear). Severe wear (less than 0.92) was observed in 15.9% of the cases. These same ratio groups on the lateral view had the following distribution in respected order: 27.3%, 33.4%, 28.7%, 10.6%. Polyethylene wearing was found to be more evident when a 26 size femoral head was used. Advanced acetabular loosening in the radiological findings was only evident in the most deteriorated group. Conclusion: It can be concluded that the degree of the polyethylene wear of the acetabular component can be satisfactorily measured from the migration of the femoral head component on the roentgenographs. The dissimilar distribution of the ratio groups between the AP and lateral roentgenographs indicate asymmetrical wear.

The aim of the study was to determine the mid-term clinical result of the patient operated by Chiari pelvic osteotomy.

A mid-term evaluation of the Chiari pelvic osteotomy performed on 65 hips in 58 patients is presented. Indications were: 1) congenital hip dysplasia in cases where conservative or other surgical treatment had failed, 2) deformed, laterally uncovered femoral head due to Legg-Calvé-Perthes disease, 3) age between 10–40 years, 4) no signs of advanced osteoarthritis.

Patients were classified according to pain, limp, Trendelenburg sign, range of motion, abductor muscle strength, and radiographic appearance (Wiberg and Idelberger angles). A mean follow-up of five years revealed relief of pain and an increase of hip motion in many cases. However, limping and a positive Trendelenburg sign frequently persisted. The radiographic appearance showed that the Wiberg angle had increased from the preoperative average of 6 degrees to 30 degrees postoperatively. The Idelberger angle decreased from the preoperative average of 72 degrees to an average of 60 degrees postoperatively.

The Chiari osteotomy is a technically exacting procedure which provides adequate femoral head coverage. This coverage facilitates pain relief and increased function. However, the results were less consistent in the cases of Perthes disease.

Considering the indications and contra-indications, the Chiari pelvic osteotomy has good clinical results in the reduction of painful standing and walking of young adult patients with DDH.