title: A review of environmental factors implicated in human developmental dysplasia of the hip.
abstract: OBJECTIVE
  Developmental dysplasia of the hip (DDH) is common, and the term encompasses a spectrum of anatomical abnormalities of the hip in which the femoral head displaces from the acetabulum. These abnormalities may be congenital or develop during infancy and/or childhood. Neither the prenatal and postnatal factors that predispose to hip instability nor the determinants of its resolution or persistence are well characterised. A multifactorial pathogenesis of DDH is commonly accepted and identified risk factors include a family history, being first born, breech presentation, female gender, high birth weight and oligohydramnios 1. Further to genetic factors, a number of nutritional, hormonal and mechanical influences on ligament laxity have been hypothesised.
  
  
  METHODS
  A comprehensive search was conducted using NICE Healthcare Databases Advanced Search and Google Scholar engines, and the terms "nutrition", "environmental", "risk factors", "CDH" and "DDH". Wherever possible, evidence from randomised controlled trials, systematic reviews and expert review articles published in the medical and veterinary literature was considered.
  
  
  RESULTS
  The relationship between a number of hormones and biochemical markers of nutritional status and the development of DDH has been repeatedly hypothesised upon in the last 45 years. Of those most frequently cited are calcium, vitamins C and D, and relaxin hormone. The evidence for these potential risk factors is provided mainly by canine studies, with a paucity of consistent or strong evidence in humans.
  
  
  CONCLUSIONS
  DDH is common and remains a leading cause of hip osteoarthritis in young adults. Neonatal clinical screening programmes for this condition have been in practice since the 1950s, albeit with varying levels of sensitivity. This review summarises current understanding of some of the most frequently cited nongenetic hypothesised risk factors, the significance of which remain to be determined.
authors.affiliation: Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, England, UK.
authors.forename: Amanda M L
authors.initials: AM
authors.lastname: Rhodes
authors.forename: Nicholas M P
authors.initials: NM
authors.lastname: Clarke