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Increased Diagnostic Information and Understanding Disease: Uncertainty in the Diagnosis of Developmental Hip Dysplasia¹

¹ From the Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, England (A.R.); Institute of Child Health, University College London, London, England (A.R.); Division of Orthopaedic Surgery, Child Health Evaluative Sciences Program, the Hospital for Sick Children, Toronto, Ontario, Canada (J.G.W.); and Departments of Surgery, Public Health, and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (J.G.W.). Received November 29, 2005; revision requested January 19, 2006; revision received January 28; final version accepted February 21. Address correspondence to A.R. (e-mail: a.roposch{at}ich.ucl.ac.uk).

Great advances have been made in developing strategies to improve the quality of medical care in the past decade; these advances include better diagnostic technologies, such as ultrasonography (US), computed tomography, and magnetic resonance imaging. Although these tests provide new information on many conditions, such as developmental dysplasia of the hip (DDH), the differentiation of what is normal, what is abnormal, and what is disease is no longer intuitive. Historically, the diagnosis of DDH was straightforward. The diagnosis was based primarily on clinical findings, which were often confirmed with radiography. Abnormal hips were either subluxated or dislocated and, if left untreated, adverse consequences were certain in either situation. Since the introduction of hip US, however, increased diagnostic sophistication has led to uncertainty as to how to interpret the continuous spectrum of acetabular morphology. There is no consensus on the degree of acetabular dysplasia that does or does not require treatment. Because not every abnormal finding may require treatment, the terms abnormality and disease are not synonymous.

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