Developmental dysplasia of the hip

Question 1

Define developmental dysplasia of the hip

Answer 1

Congenital abnormality of the hip joint - where femoral head does not articulate correctly with the acetabulum
Mal-alignment results in easy joint dislocation and abnormal development

Question 2

What is the key epidemiology of development hip dysplasia?

Answer 2

UK - affects up to 2% of newborn
More common in the left hip - bilateral 20%

Question 3

What are the associated risk factors for congenital hip dysplasia?

Answer 3

Female - 4:1
Firstborn - higher risk
Family history
Frank breech presentation - buttock or feet first 17-fold higher risk
Fluid - low amniotic fluid levels, oligohydramnios

Also:
Premature
Multiple pregnancy
Neuromuscular conditions

Question 4

What are the key signs of hip dysplasia in infants?

Answer 4

Limited hip abduction - especially when flexed
Asymmetry of gluteal and thigh skin folds
Apparaent limb length discrepancy

Question 5

What of the signs of hip dysplasia in older children?

Answer 5

Galeazzi sign - unilateral femoral shortening
Walking difficulties or a limp
Delayed walking
Waddling gait in bilateral cases

Question 6

What are key presentation of bilateral development dysplasia of the hip?

Answer 6

Waddling gait with hyperlordosis
Harder to diagnosis as less obvious limb length discrepency

Question 7

What are the screening tests for developmental dysplasia of the hip?

Answer 7

During newborn physical screening exam and infant screening exam at 6 to 8 weeks
Barlow - test for posterior dislocation
Ortolani - test for relocation on hip abduction

Question 8

Which infants get an ultrasound screening scan for developmental dysplasia of the hip?

Answer 8

With risk factors - FH, breech presentation, multiple pregnancy
Done within the first 6 weeks of life.

Question 9

What imaging modality should be used to confirm developmental dysplasia of the hip?

Answer 9

Hip ultrasonography - in less than 6 months
Older infants and children - pelvic radiography.

Question 10

What is the key management of developmental dysplasia of the hip?

Answer 10

Mild - sself limiting within first few months of life
Pavlik harness - maintain hip in flexed and abducted position for 6-12w
Severe or diagnosed >6m -? surgical intervention for education and stabilisation

Question 11

What are some key complications of developmental dysplasia of the hip?

Answer 11

Degeneration of the hip joint and pain in the lower back and hip.
Responsible for approximately 1 in 3 hip replacements before age 60yrs.