Developmental hip dysplasia in a 104-year-old patient.

To cite: Knulst R, Bosman W-M, Veger HTC, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204356 DESCRIPTION A 104-year-old woman was referred to the emergency ward with a painful pelvis; the result of an unfortunate fall in the middle of the night. The on-call general practitioner visited her for an emergency consultation and suspected a fractured pelvis. On arrival at the hospital a full physical examination was performed, revealing only pelvic tenderness. A plain radiograph showed no evidence of fractures (figure 1). The most remarkable finding was a considerable dislocation of both hips with deformed femoral heads. The acetabuli were both severely dysplastic, with probably neoacetabuli formed at the iliac wing. We transferred the patient to a rehabilitation facility, after a short admission at the hospital. She was unable to regain mobility and eventually passed away due to cachexia. The spectrum of developmental dysplasia (DDH) of the hip ranges from a mild unstable or subluxatable hip joint to a highly unstable or permanently dislocated hip. It occurs in newborns when the femoral head loses contact with the acetabulum due to ‘mechanical’ factors. The abnormal contact may lead to a dysplastic acetabulum and sometimes to formation of a neoacetabulum when the joint is not reduced. Treatment today consists of reduction by means of splinting or sometimes surgery at a young age. 2 DDH is an important risk factor for developing premature osteoarthritis of the hip, often requiring total hip arthroplasty. Krych et al describe that satisfactory results of total hip arthroplasty can be obtained even in patients with Crowe type IV DDH; however, often with a greater number of (severe) complications due to difficult anatomy and the need for osteotomy. Had our patient been diagnosed in her youth, she possibly would have received a tenotomy of the adductor muscles of the thigh, often resulting in limited mobility; a treatment we would conceive as ‘brutal’ nowadays. In retrospect, our patient was maybe lucky not to be treated when she was young.