The natural history of congenital dislocation of the hip: a critical review.

Studies of the natural history of congenital dislocation of the hip do not distinguish which particular features indicate a poor prognosis. In complete dislocation we have found that the development of a false acetabulum with thick sclerotic iliac bone more frequently leads to pain than those with little or no bony reaction of the ilium. Congenital dislocation leads to functional disability in all patients but only half have significant pain. Congenital subluxation and dysplasia of the hip are responsible for a high proportion of coxarthrosis. The lack of symptoms, and the subtle physical findings until irreversible degenerative changes occur, makes early diagnosis difficult. When recognized early, correction of the deranged anatomy must be done if coxarthrosis is to be prevented. Concentric hip motion and normal muscular function are essential for proper development of the joint. A reciprocal relation exists between the development of the proximal femur and the acetabulum. Structural abnormality of either eventually leads to joint dysfunction.