2022 Chinese Expert Consensus on the Diagnosis and Treatment of Borderline Developmental Dysplasia of the Hip (2022 Edition)

Core Definition & Diagnostic Criteria

1. Definition
   • BDDH refers to a hip status between normal hips and overt adult DDH, defined by a lateral center - edge angle (LCEA) of 20° - 25° on weight - bearing anteroposterior pelvic radiographs (measured via Wiberg’s method).
   • Symptomatic BDDH is diagnosed when LCEA is 20° - 25° along with hip pain, limited mobility, and/or instability.
    
2. Key Diagnostic Workup

   Component	Recommendations	Evidence Level
   Clinical Assessment	Collect history of pain, mechanical symptoms, and instability; perform impingement/instability tests (e.g., flexion - abduction - external rotation, pivot shift)	Strong, Moderate
   Imaging	Weight - bearing AP pelvis X - ray for LCEA; MRI for labral/cartilage lesions and microinstability; CT for acetabular morphology (optional)	Strong, Moderate
   Instability Evaluation	Use the term “hip instability” (avoid “microinstability”); diagnose via clinical signs + imaging + dynamic tests	Good Practice Statement

    

Non - Surgical Management

1. Indications: Symptomatic BDDH without severe instability, no advanced joint degeneration, and no prior standardized conservative treatment.
2. Core Measures
   • Rehabilitation: Focus on hip abductor/core strengthening, gait training, and activity modification to enhance dynamic stability.
   • Pharmacotherapy: Short - term NSAIDs for pain relief; avoid long - term use to prevent adverse effects.
   • Injections: Intra - articular corticosteroids or hyaluronic acid for refractory pain (selective use); ultrasound - guided for safety.
    
3. Response Evaluation: Reassess after 3 - 6 months. If symptoms persist or instability worsens, consider surgical intervention.

Surgical Intervention

1. Indications
   • Persistent symptoms despite ≥6 months of conservative treatment.
   • Confirmed labral tears, chondral lesions, or hip instability affecting function.
    
2. Surgical Options & Recommendations

   Procedure	Indications	Recommendations	Evidence Level
   Hip Arthroscopy	Labral tears, chondral injury, femoroacetabular impingement (FAI), mild - moderate instability	Labral repair + rim trimming; address FAI (Cam/Pincer) simultaneously	Strong, Low
   Periacetabular Osteotomy (PAO)	Young patients with LCEA 20° - 22°, poor acetabular coverage, and no advanced OA	Improve coverage while preserving joint function	Conditional, Low
   Capsular Plication	Isolated instability without severe acetabular dysplasia	Reinforce capsule to enhance static stability	Conditional, Very Low

    
3. Postoperative Care: Early mobilization with protected weight - bearing; rehabilitation to restore strength and motion; avoid high - impact activities for 6 - 12 months.

Special Populations & Follow - up

1. Young Adults: Prioritize joint - preserving surgery (arthroscopy/PAO) to delay OA progression.
2. Elderly Patients: Non - surgical treatment first; arthroplasty for advanced OA.
3. Follow - up Protocol: Clinical assessment + X - ray at 3, 6, 12 months post - treatment; annual long - term follow - up to monitor LCEA, pain, and OA changes.

Core Treatment Principles

• Individualize treatment based on symptoms, imaging, age, and activity level.
• Non - surgical treatment is the first - line for symptomatic BDDH; surgery is reserved for refractory cases.
• Joint - preserving surgery is preferred for young patients to maintain hip function.