developmental dysplasia of hip

Question 1

define

Answer 1

Developmental dysplasia of the hip

Developmental dysplasia of the hip (DDH) is gradually replacing the old term ‘congenital dislocation of the hip’ (CDH). It affects around 1-3% of newborns.

Question 2

Risk factors

Answer 2

female sex: 6 times greater risk

breech presentation

positive family history

firstborn children

oligohydramnios

birth weight > 5 kg

congenital calcaneovalgus foot deformity

DDH is slightly more common in the left hip. Around 20% of cases are bilateral.

Question 3

diagnosis

Answer 3

Clinical examination is made using the Barlow and Ortolani tests:

• Barlow test: attempts to dislocate an articulated femoral head
• Ortolani test: attempts to relocate a dislocated femoral head

Ultrasound is used to confirm the diagnosis if clinically suspected

Question 4

Management

Answer 4

• most unstable hips will spontaneously stabilise by 3-6 weeks of age
• Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
• older children may require surgery