Natural history and treatment outcomes of childhood hip disorders

Normal hip joint growth and development occur as a result of a genetically determined balance of growth of the acetabular and triradiate cartilages and the presence of a well located centered spheric femoral head. The majority of acetabular development is determined by age 8 years. This is a watershed age for prognosis in many pediatric hip disorders. Hip joint growth and development and how these are affected by the disease process and treatment interventions profoundly affect outcome. Outcomes of these disease processes (congenital hip dislocation and dysplasia, Legg-Calvé-Perthes disease and slipped capital femoral epiphysis), is multifactorial but profoundly influenced by the age at the disease onset (birth to the adolescent growth spurt), and the effects of treatment on the relationship between femoral head and acetabular development. The natural history of many of these childhood hip disorders is the development of degenerative joint disease. Degenerative joint disease and clinical disability may develop in these conditions despite standard up to date treatment interventions. In most of the hip diseases discussed, patients usually do well clinically for many years regardless of treatment.