Developmental dysplasia of the hip

Developmental Dysplasia of the Hip (DDH), also known as hip dysplasia, is a condition where the hip joint does not develop properly in infants and young children. The term "dysplasia" refers to a disorder of abnormal growth or development of a tissue or organ. In the case of DDH, the hip joint, comprising the ball (femoral head) and socket (acetabulum), does not fit together in its normal position. This condition can range from a slight abnormality to a complete dislocation where the femoral head is completely out of the socket.

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 during pregnancy
• Low levels of amniotic fluid (oligohydramnios)
• Swaddling methods that restrict the movement of the legs

Symptoms

Symptoms of DDH may vary depending on the age of the child and the severity of the condition. In infants, signs may include:

• Legs of different lengths
• Uneven skin folds on the thigh
• Restricted movement on the side of the hip dislocation
• In older children, limping, walking on toes, or a waddling gait may be observed.

Diagnosis

Early diagnosis of DDH is crucial for effective treatment. Screening methods include:

• Physical examination: The Ortolani and Barlow tests are commonly used to check for DDH in newborns.
• Ultrasound: Recommended for infants less than 6 months old, as it can provide a clear image of the soft cartilage.
• X-rays: Used for older infants and children to view the bone structure of the hip.

Treatment

The goal of treatment is to place the femoral head back into the socket so the hip can develop normally. Treatment options depend on the child's age and the severity of the condition:

• Pavlik Harness: Used for infants up to 6 months old, this harness helps to keep the hip in position while allowing leg movement.
• Closed Reduction and Spica Cast: If the Pavlik Harness is not effective, or if the child is older, this method may be used. It involves manually adjusting the hip into place and then applying a cast.
• Surgery: In severe cases or if other treatments fail, surgical options such as open reduction, pelvic osteotomy, or femoral shortening may be necessary.

Prognosis

With early diagnosis and treatment, most children are able to develop normally and participate in typical activities without limitations. However, some may experience complications such as differences in leg length, decreased hip mobility, or the need for additional surgeries.

Prevention

There is no guaranteed way to prevent DDH, but avoiding tight swaddling that restricts the movement of the legs may reduce the risk. Early screening and regular check-ups during infancy can ensure prompt treatment if DDH is detected.