Developmental dysplasia of the hip (DDH)

Question 1

what is it?

Answer 1

a health problem of the hip joint. It’s when the joint hasn’t formed normally, so it doesn’t work as it should. DDH is present at birth. It is more common in girls than boys.

In a normal hip joint, the top (head) of the thighbone (femur) fits snugly into the hip socket. In a child with DDH, the hip socket is shallow. As a result, the head of the femur may slip in and out. It may dislocate. This means it moves partly or completely out of the hip socket

Question 2

forms of DDH

Answer 2

mild: the ligaments & other soft tissues around the hip joint are not tight, allowing the femur to move around too much in the hip socket.

more severe: the joint is too loose & lets the head of femur to partially come out of the hip socket (subluxation).

dislocation: most severe form of DDH. The head of femur fully slips out of the hip socket (luxation / dislocation).

With subluxation & luxation, the hip socket is often too shallow, more like a saucer than the deep cup that it should be.

Question 3

etiology

Answer 3

unknown

Question 4

risk factors

Answer 4

family history and fetal position in the womb and at birth

Question 5

clinical presentation

Answer 5

• DDH is Painless.
• The hip joint feels loose / slips out of place, when examined.
• One leg seems shorter than the other.
• Extra folds of skin on the inside of the thigh(s).
• A hip joint that moves differently than the other.

A child who is walking may:
• Walk on the toes of one foot with the heel up off the floor.
• Walk with a limp / waddling gait if both hips are affected

Question 6

diagnosis

Answer 6

Usually by physical examination.
If the baby is older, may be diagnosed during a routine checkup.
Harder to diagnose in a baby > 1 - 3 months, because the only outward sign may be less mobility / flexibility in the movement of the affected hip joint(s).
If the physical exam is inconclusive - USG / X-ray.

Question 7

treatment

Answer 7

By moving the upper femur into the hip socket & keeping it in place while the hip joint grows.
A splint, called a Pavlik harness, is most often used in babies < 6 months old.
A hard cast (spica cast), is used for older babies.
Surgery / brace, also may be needed.
It’s important to treat DDH early.
Most children born with looseness (laxity) of the hips will not have problems But children with untreated DDH may develop lasting hip problems.

Question 8

physical examination tests

Answer 8

Barlow maneuver: adduct hip by bringing thigh towards midline, then apply a gentle posterior pressure to the knee

ortolani maneuver: flex infants knee to 90 degree position and then abduct the legs by folding the thigh outwards