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Developmental Dysplasia of the Hip (DDH)


Developmental dysplasia (dislocation) of the hip (DDH) is an abnormal formation of the hip joint in which the ball on top of the thighbone (femur) is not held firmly in the socket. In some instances, the ligaments of the hip joint may be loose and stretched. The condition is found in babies or young children.

The degree of hip looseness, or instability, varies in DDH. In some children, the thighbone is simply loose in the socket at birth. In other children, the bone is completely out of the socket. In still other children, the looseness worsens as the child grows and becomes more active.

dysplasia of the hip
 

Pediatricians screen for DDH at a newborn's first examination and at every well-baby checkup thereafter. When the condition is detected at birth, it can usually be corrected. But if the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated and uncertain.

Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or a "duck-like" gait and decreased agility. If treated successfully (and the earlier the better), children regain normal hip joint function. However, even with appropriate treatment, especially in children 2 years or older, hip deformity and osteoarthritis may develop later in life.

Causes, incidence, and risk factors

The hip is a ball and socket joint. The ball, called the femoral head, forms the top part of the thigh bone (femur) and the socket (acetabulum) forms in the pelvic bone. In some newborns, the socket is too shallow and the ball (thigh bone) may slip out of the socket, either part of the way or completely. One or both hips may be involved. The cause is unknown. Low levels of amniotic fluid in the womb during pregnancy can increase a baby's risk of DDH. Other risk factors include:

  • Being the first child
  • Being female
  • Breech position during pregnancy, in which the baby's bottom is down
  • Family history of the disorder
  • DDH occurs in about 1 out of 1,000 births.

Symptoms of Hip Dysplasia

There may be no signs of hip dysplasia. Symptoms that may occur can include:

  • Leg with hip problem may appear to turn out more
  • Reduced movement on the side of the body with the dislocation
  • Shorter leg on the side with the hip dislocation
  • Uneven skin folds of thigh or buttocks
  • After 3 months of age, the affected leg may turn outward or be shorter than the other leg.

Treatment of Hip Dysplasia in Infants and Children

Nonsurgical Treatment: Treatment methods depend on the child's age.

  • Hip Dysplasia in Newborns: Newborns are placed in a Pavlik harness for 1 to 2 months to treat DDH. Newborns are placed in a Pavlik harness for 1 to 2 months to treat DDH. The baby is placed in a soft positioning device, a Pavlik harness, for 1 to 2 months to keep the thighbone in the socket. This will help tighten the ligaments around the hip joint and promote normal hip socket formation.
  • 1 to 6 months (Infant hip dysplasia): The baby's thighbone is repositioned in the socket using a harness or similar device. The method is usually successful. But if it is not, the doctor may have to anesthetize the baby and move the thighbone into proper position, and then put the baby into a body cast (spica).

Surgical Treatment

  • 6 months to 2 years: The child is placed under anesthesia, and the thigh bone is manipulated into the proper position in the socket. Open surgery is sometimes necessary. Afterwards, the child is placed into a body cast (spica) to maintain the hip position.
  • Older than 2 years (child hip dysplasia): Deformities may worsen, making open surgery necessary to realign the hip. Afterwards, the child is placed into a body cast (spica) to maintain the hip in the socket. In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. X-rays and other regular follow-up monitoring are needed after DDH treatment until the child's growth is complete.

Expectations (prognosis)

If hip dysplasia is found in the first few months of life, it can almost always be treated successfully with a positioning device (bracing). In a few cases, surgery is needed to put the hip back in joint. Hip dysplasia that is found after early infancy may lead to a worse outcome and may need more complex surgery to fix the problem.

Complications

Bracing devices may cause skin irritation. Differences in the lengths of the legs may persist despite appropriate treatment. Untreated, hip dysplasia will lead to arthritis and deterioration of the hip, which can be severely debilitating.

Authored By: Dr. S. V. Santpure

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