DDH

Developmental Dysplasia of the Hip (DDH), formerly known as congenital dislocation of the hip, is a condition where the ball-and-socket joint of the hip does not properly form in babies and young children. It's a condition that can range from mild dysplasia, where the hip is slightly out of place, to severe dysplasia, involving a complete dislocation of the hip joint. Early diagnosis and treatment are crucial in preventing long-term issues such as hip dysplasia in adults, which can lead to pain and osteoarthritis.

Causes and Risk Factors

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

• Family history of DDH
• Female sex
• Firstborn status
• Breech presentation
• Low levels of amniotic fluid (oligohydramnios)
• Swaddling methods that extend and adduct the legs

Symptoms

Symptoms of DDH in infants may include:

• Legs of different lengths
• Uneven skin folds on the thigh or buttocks
• Less mobility or flexibility on one side
• In older children, limping, walking on toes, or a waddling gait may be observed.

Diagnosis

Diagnosis of DDH is often made through a combination of physical examination and imaging tests. During the physical exam, healthcare providers may perform the Ortolani and Barlow maneuvers to check for instability in the hip. Ultrasound imaging is commonly used in infants younger than six months, as their cartilaginous structures are not yet visible on X-ray. In older children, X-rays are used to assess the position of the hip joints.

Treatment

The goal of treatment for DDH is to get the head of the femur to properly fit into the acetabulum, promoting normal hip joint development. Treatment options vary depending on the child's age and the severity of the condition:

• Pavlik Harness: For infants less than six months old, a Pavlik harness may be used to hold the hip in place while allowing leg movement. This harness is typically worn for several weeks to months.
• Closed Reduction and Spica Casting: If the Pavlik harness is not effective or if the child is older, a procedure called closed reduction may be performed under anesthesia. This is followed by the application of a spica cast to hold the hip in place.
• Open Reduction: In some cases, surgery may be necessary to correctly position the hip joint. This is followed by spica casting.
• Osteotomies: For older children with more established dysplasia, surgical cutting and realignment of the bone may be necessary.

Prognosis

With early treatment, most children with DDH can develop normally and participate in typical activities without limitations. Delayed treatment or severe dysplasia may lead to complications such as hip osteoarthritis or the need for hip replacement later in life.

Prevention

There is no sure way to prevent DDH, but avoiding tight swaddling that extends and adducts the legs may reduce the risk. Early screening, especially in babies with risk factors, is crucial for early detection and treatment.