DEVELOPMENT DYSPLASIA OF HIP

What is Developmental Dysplasia of Hip (DDH)?

The hips joint is a ball and socket joint. i.e. the femoral head (ball) articulates with the acetabulum (socket). In DDH, the acetabulum is shallow and so the femoral head is either inadequately covered (dysplasia/ subluxation) or completely dislocated

What are the risk factors for DDH?

Though the exact cause of DDH is not known, the following risk factors are known to be associated with increased incidence of DDH:

  • Female Child
  • Firstborn child
  • Breech presentation
  • Intrauterine overcrowding (oligohydramnios, twin pregnancy)
  • Positive family history

What are the signs I should look for to identify DDH?

  • Uneven skin creases near your child’s bottom
  • Your child does not move their leg normally
  • Your child leans to one side when they stand or walk (uneven leg length)
  • Your child is not sitting by 10 months of age or walking by 18 months of age
  • Your child’s foot is turned out
  • Your child has a ‘waddling’ gait when they walk
  • You have difficulty parting the legs for nappy changes

How is the diagnosis of DDH confirmed?

  • On clinical examination by the doctor, hip instability identified (special tests called Ortolani-Barlow tests and telescopy test are positive), also short limb and tight adductor muscle
  • In children, less than 6 months age, Ultrasonography is the investigation modality of choice to detect DDH
  • After the age of 6 months, plain X-rays are sufficient to detect DDH

USG Hip In DDH

X-ray in DDH

What treatment will be needed?

The treatment plan for your child will be guided by their age and the abnormality to the hip. Newborns with DDH respond well to treatment in a soft brace (called a Pavlik harness) for six to ten weeks. The brace helps the hip develop and grow normally. The Pavlik harness will not cause long-term delay to your baby’s development. Your baby will catch up once the brace is off.

Pavlik Harness

What if treatment does not improve my baby’s hip?

Some baby’s hips do not improve with early treatment, and DDH can be found in older children. X-rays are used to look at your child’s hips after six months of age. If the socket of the pelvis is too shallow and the femoral head is too small, the femoral head may easily move in and out of the socket. A femoral head that stays outside the socket is dislocated. If not found before walking age, a dislocated hip can cause a painless ‘waddling’ walk. As the child grows older, their hip will become stiff and painful (called arthritis).

Will surgery be needed?

Surgery may be needed for children older than six months, or children whose hips do not improve after wearing the Pavlik harness. The type of surgery needed will depend on the age of your child and the abnormality to the hip. Your doctor will discuss the type of surgery needed. If surgery is needed, a plaster lower body cast (called a hip Spica) will hold your child’s hip in place. This may be for a few months. The hospital staff will show you how to care for your child. A few children may not improve after treatment. They may require surgery between two to four years of age. All surgery has risks and benefits. Your child’s surgeon will tell you about the risks and benefits before the surgery.