Congenital dysplasia of the hip

Congenital Dysplasia of the Hip (CDH), also known as Developmental Dysplasia of the Hip (DDH), is a condition where the hip joint does not develop properly in infants and young children. The term "dysplasia" refers to the abnormal development of the hip, where the femoral head (the top part of the thigh bone) and the acetabulum (the hip socket) do not fit together in their normal position. This condition can range from mild, where the hip is slightly loose, to severe, where the femoral head is completely dislocated from the acetabulum.

Causes and Risk Factors

The exact cause of CDH is not fully understood, but it is believed to be a combination of genetic and environmental factors. Risk factors include:

• Family history of the condition
• Female sex
• Firstborn status
• Breech presentation during pregnancy
• Oligohydramnios (low levels of amniotic fluid)

Symptoms

Symptoms of CDH can vary depending on the severity of the condition. In mild cases, there may be no noticeable symptoms. In more severe cases, symptoms may include:

• Asymmetry in leg length
• Limited range of motion in one leg
• A limp or waddling gait in toddlers
• Unequal skin folds on the thighs or buttocks

Diagnosis

Early diagnosis and treatment of CDH are crucial to prevent long-term complications. Screening methods include:

• Physical examination: A healthcare provider may perform specific tests, such as the Ortolani and Barlow maneuvers, to check for instability in the hip.
• Ultrasound: This imaging test is commonly used in infants younger than 6 months to visualize the hip joint.
• X-ray: In older infants and children, an X-ray may be used to assess the position of the hip bones.

Treatment

Treatment options for CDH depend on the age of the child and the severity of the condition. They may include:

• Pavlik harness: A soft brace that holds the baby's legs in a position that encourages the correct development of the hip joint.
• Closed reduction and spica cast: If the Pavlik harness is not effective, the hip may be manually repositioned under anesthesia, followed by the application of a spica cast to hold the hip in place.
• Surgery: In severe cases or in older children, surgical intervention may be necessary to correct the position of the hip joint.

Prognosis

With early diagnosis and appropriate treatment, most children with CDH can develop normally and participate in typical activities without limitations. However, some may experience complications later in life, such as osteoarthritis of the hip.

Prevention

There is no known way to prevent CDH, but early detection through routine newborn screening can help ensure timely treatment and reduce the risk of long-term complications.