International Orthopaedics - 2026-08-22 - Journal Article
A historical journey through developmental dysplasia of the hip (DDH): from prehistoric evidence to the rise of modern diagnostic and therapeutic concepts.
Biz C, Cerchiaro M, Sbrissa I, Andreotti M, Maso G, Ruggieri P
Topics
Key Takeaway
This narrative review traces DDH management from Hippocratic descriptions through Graf ultrasonographic classification and Pavlik harness adoption, identifying no new quantitative findings.
Summary Depth
Choose how much analysis to show on this article page.
Summary
The authors performed an electronic and manual search of medical, archaeological, artistic, and literary sources to trace the conceptual evolution of DDH from prehistoric palaeopathological evidence to contemporary screening and surgical practice. Key milestones identified include Ortolani and Barlow neonatal instability testing, Graf ultrasound classification, Pavlik harness adoption, and Salter/Chiari osteotomies. No original patient data or outcomes are reported; the paper is purely historical synthesis.
Key Limitation
The absence of a structured search methodology or defined inclusion criteria means significant historical contributions may have been omitted without transparent justification.
Original Abstract
PURPOSE
To review the historical evolution of developmental dysplasia of the hip (DDH), tracing the progressive development of its anatomical, clinical, diagnostic, and therapeutic concepts from prehistoric evidence to contemporary practice.
METHODS
An extensive electronic search of the medical and historical literature was performed and complemented by manual review of archaeological, artistic, literary, and scientific sources. Historical reports describing congenital hip dislocation, neonatal instability, diagnostic methods, and treatment strategies were critically analysed within their scientific, cultural, and chronological contexts.
RESULTS
The history of DDH represents a continuous process of conceptual evolution rather than a succession of isolated discoveries. Palaeopathological evidence demonstrates the antiquity of the disorder, while the Hippocratic Corpus first distinguished congenital from traumatic hip dislocation. This knowledge was preserved through late antiquity and the medieval period before anatomical investigations by Ambroise Paré, Theodor Kerckring, Giovanni Battista Palletta, Guillame Dupuytren, and Willem Vrolik established its structural and pathological basis. During the nineteenth century, Wilhelm Roser and Friedrich Trendelenburg transformed DDH into a functional clinical disorder, whereas the introduction of radiography established its clinic-radiological identity. In the twentieth century, pioneering contributions by Codivilla, Putti, Hilgenreiner, Ortolani, and Barlow shifted attention towards neonatal instability, early diagnosis, and preventive treatment. Subsequently, Graf's ultrasonographic classification revolutionised imaging, while the Pavlik harness, and modern reconstructive surgery, such as the Chiari and Salter osteotomies, established the foundations of contemporary DDH management.
CONCLUSIONS
The historical evolution of DDH illustrates the progressive integration of empirical observation, anatomy, clinical examination, imaging, and surgery into a preventive, evidence-based discipline. Understanding this historical pathway provides valuable perspective on the principles that continue to guide modern diagnosis, treatment, and neonatal screening.