Pediatric Orthopedics

Congenital hip dislocation (developmental hip dysplasia) (DDH)

What is congenital hip dislocation?

Congenital hip dislocation is a hip disorder which may develop prenataly, at the time of birth or shortly after birth  characterized by dilocation, semi-dislocation or instability of the hip.

There are two major types of hip dysplasia :1-teratology, 2-Typical

How common is Congenital Dysplasia of the Hip? Are there any family involvement?

The incidence is 1% – 0.1% and seen more often in girls. More frequent on the left side as  60% in the left hip, 20% in right hip , 20% in both sides. A family history of DDH rate is higher. Incidence rise up to 34% for a baby, if the other monozygotic twin is involved, 6-7% in the involvement of brothers or sisters and 36% if one parents and sibling are involved.

What are the risk factors for Developmental Hip Dysplasia?

Additional risk factors for hip dislocation, family history, breech delivery (1st girl child in particular), oligohydramnios (less than amniotic fluid), torticollis deformity, foot deformities, include multiple pregnancy.

Which  complaints lead familes to seek medical attention in patients with Developmental Hip Dysplasia?

Inability to open the legs apart, limitation in abdıction, plia asymetria,, hip clicks, limping,

How is the diagnosis of Developmental Hip Dysplasia?

The diagnosis can be made by physical examination, radiography and ultrasonography. Physical examination is diagnostic particularly within the  first two months with Ortolani and Barlow tests. Ortolani and Barlow tests may reveal whether the hips are luxated,luxable or redıcable. In subsequent months, the skin folds asymmetry, hip abduction limitation, and  limb length discrepeancy. After walking age, a limping and walking with the foot turned outside can be seen.  Ultrasound is  helpful in the first 6 months. Radiographic evaluation is of particular importance for the assessment of bone structure. Pediatrich ortho doctor may  ask radiological exam.

What is the treatment of Developmental Hip Dysplasia?

Pavlik bandage is used successfully up to 6 months of age. Follow-up evaluations are done by physical examination and ultrasonography. Closed reduction and Spica Cast application is performed in children older than 6 months, and in failed treatment with a Pavlik harness. I prefer to do closed reduction and Spica Cast application  under anesthesia. Older children may need surgical treatment. Surgical treatments aim is to provide reduced and  stable hip joint. Surgical treatment may be a soft tissue or bony surgery depending on patients age and the severity of the disease. Usually bone surgeries are performed in patients over 1 and half years.

About the author

Prof.Dr. Seref Aktas