DEVELOPMENTAL DYSPLASIA OF THE HIP

Melih Güven, M.DAssoc. Prof.

Yeditepe University HospitalDepartment of Orthopaedics and Traumatology

Istanbul

Learning Objectives

1. Should be able to define the term developmental dysplasia of the hip (DDH), and also explain the etiology and epidemiology.

2. Should be able to list the risk factors of DDH.

3. Should be able to explain the soft tissue and bone pathologies at the hip joint due to DDH

4. Should be able to define the basic examination methods for DDH for different ages

5. Should be able to define the treatment algorithms at different ages, to define prevention methods and also define the basic healthcare services for this reason

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Description

Previously known as congenital dislocation of the hip implying a condition that existed at birth

Developmental encompasses embryonic, fetal and infantile periods

Includes congenital dislocation and developmental hip problems including subluxation, dislocation and dysplasia

Normal Growth and Development

Normal Growth and Development

Classification

Teratologic DDH

Typical DDHDysplasiaSubluxationDislocation

Incidence

Hip instability – 1%True hip dislocation –

0.1% – 0.15%

Barlow stated that 60% stabilize in 1st week and 88% stabilize in first 2 months without treatment remaining 12% true dislocations and persist without treatment

Etiology – Risk factors

Genetic and ethnic increased native Americans but very

low in southern Chinese and Africans positive family history 12-33% 10x risk if affected parent, 7X if

sibling intrauterine factors

breech position ( normal pop’n 2-4% , DDH 17-23% )

oligohydroamniosneuromuscular conditions like

myelomeningocele

high association with intrauterine molding abnormalities including metatarsus adductus and torticollis

first born female baby ( 80% cases) left hip more common

Pathologic Anatomy

Pathologic changes at soft tissues

Pathologic Anatomy

Pathologic changes at bone and joint

Diagnosis

Clinical risk factorsPhysical exam

Ortolani Testhip flexion and abduction , trochanter elevated

and femoral head glides into acetabulumBarlow Test

provocative test where hip flexed and adducted and head palpated to exit the acetabulum partially or completely over a rim

Diagnosis

Diagnosis

Secondary adaptive changes occur Limitation of abduction due to

adductor longus shorteningGalleazi sign

flex both hips and one side shows apparent femoral shortening

Asymmetry gluteal, thigh or labial folds

Limb-length inequailtyWaddling gait and hyperlordosis in

bilateral cases

Diagnosis

Hip ultrasonography (USG) Plain radiographs

Alfa

Beta

Natural History without Treatment

Barlow1 in 60 infants have instability ( positive Barlow)60% stabilize in 1st week88% stabilize in 2 months without treatment12 % become true dislocations and persist

Coleman23 hips < 3 months26% became dislocated13 % partial contact with acetabulum39% located but dysplastic feature22% normal

Because not possible to predict outcome all infants with instability should be treated

Goals of Treatment

StablePainlessCongruentDynamic and mobile

Hip joints

Treatment Modalities

Conservative vs Surgical

Depends on

Type of DDHTimingDegree of the pathologyPrevious treatments

Treatment Algorithm according to Age

0 to 6 monthsGoal is obtain reduction

and maintain reduction to provide optimal environment for femoral head and acetabular development

Treatment Algorithm according to Age

6 to 18 monthsSurgery startsClosed or open reduction

and spica cast immobilization

Treatment Algorithm according to Age

Above 18 monthsOpen reduction is usually

necessaryAdditionally pelvic and

femoral osteotomies

You should remember…

Risk factors of DDHDefinition of dysplasia, subluxation, dislocationSoft tissue and bone pathologies at the hip joint due

to DDHPhysical examination methods and imaging

modalities for DDHTreatment algorith of DDH

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Thank you …