![]() The left side is involved in 60% of the children, the right side in 20% and 20% have bilateral involvement. Risk factors include female sex (80% of the affected children) probably due to increased ligamentous laxity as a result of the circulating maternal hormone relaxin. In “safe swaddling” the infant hips should be positioned in slight flexion additional free movement in the direction of hip flexion and abduction may have some benefit. It has been shown that keeping the legs in a naturally flexed and abducted position without restricting hip motion lessens the risk of DDH. ![]() Similar experience was documented in Japan and Turkey. Studies in Native Americans showed, following a change from traditional swaddling to “safe swaddling”, a decrease in the prevalence of dysplasia from 6 times the United States average to the same prevalence as the rest of United States population. The incidence is higher in cultures that still practice swaddling with the lower extremities fully extended and wrapped together. The incidence of a dislocated hip at birth is 1:1000-5:1000, the incidence of subluxation and dysplasia is 10:1000 when implementing universal ultrasonographic screening, the reported incidence is 25:1000-50:1000. At a later age, treatment involves more extensive surgery with more complications with a worse functional outcome. Treatment of DDH changes with the age at presentation. Despite efforts to recognize and treat all cases of DDH soon after birth, the diagnosis is delayed in some children. Different screening programs have been devised to recognize DDH as soon as possible. The hip joint will not develop properly if it stays unstable and anatomically abnormal by walking age.Įarly diagnosis and treatment is critical to provide the best possible functional outcome. The normal development of the child’s hip relies on congruent stability of the femoral head within the acetabulum. Dislocation that is associated with neuromuscular disorders is called teratologic and it occurs prenatally. Acetabular dysplasia describes the abnormality in the development of the acetabulum, including an alteration in size, shape and organization.ĭislocations are divided into two subtypes: Dislocation that occurs in an otherwise healthy infant is called typical and it may occur pre- or post-natally. Similarly, the hip is called subluxable, if just gliding of the femoral head is noticed. The hip is called dislocatable, when application of posteriorly directed force on the hip positioned in adduction, leads to complete displacement of the femoral head from the margins of the acetabulum. In a subluxated hip, the femoral head is partially displaced from its normal position, but some degree of contact with the acetabulum still remains. A dislocated hip may be irreducible or reducible. In a dislocated hip there is no articular contact between the femoral head and the acetabulum. This term replaced the previously accepted “congenital dysplasia of the hip”, which did not describe the developmental aspect of the disorder. The term developmental dysplasia of the hip (DDH) describes the whole range of deformities involving the growing hip including frank dislocation, subluxation and instability, and dysplasia of the femoral head and acetabulum. We summarize the current practice for detection and treatment of DDH, emphasizing updates in screening and treatment during the last two decades. Various treatment protocols have been proposed. After the age of 18 mo, treatment usually consists of open reduction and hip reconstruction surgery. If this fails, closed reduction and spica casting is usually done. At an early age and up to 6 mo, the main treatment is an abduction brace like the Pavlik harness. Treatment depends on the age of the patient and the reducibility of the hip joint. ![]() The role of other imaging modalities, such as magnetic resonance imaging, is still undetermined however, extensive research is underway on this subject. Radiography and ultrasonography are used to confirm the diagnosis. The suspicion is raised based on a physical examination soon after birth. Different screening programs for DDH were implicated. Despite efforts to recognize and treat all cases of DDH soon after birth, diagnosis is delayed in some children, and outcomes deteriorate with increasing delay of presentation. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease. Early diagnosis and treatment is critical to provide the best possible functional outcome. Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. ![]()
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