Developmental Dysplasia of the Hip (DDH): Causes, Diagnosis, and Treatment

Study Notes

Developmental Dysplasia of the Hip (DDH): Causes, Diagnosis, and Treatment Options

Developmental Dysplasia of the Hip (DDH) is a complex disorder that affects the structure and function of the hip joint, often leading to various abnormalities in the femoral head and acetabulum. DDH can manifest as different hip problems, including neonatal instability, acetabular or femoral dysplasia, hip subluxation, and hip dislocation. This disorder has replaced the previous term 'congenital dislocation of the hip (CDH)' since several manifestations of DDH may not be congenital and include acetabular dysplasia. Early detection and treatment are crucial for improving the pediatric quality of life and preventing the development of coxarthrosis.

Causes

DDH is primarily caused by abnormal development of the hip joint, which can result from various factors. These factors include:

In utero positioning: The left hip of the fetus is adducted against the mother's lumbosacral spine, which can prevent proper development of the hip joint.
Gender: Females are more susceptible to DDH due to hormonal factors.
Genetics: There is a genetic predisposition to DDH, and it can be associated with certain syndromes and genetic loci.
Mode of delivery: Breech infants have a higher risk of spontaneous stabilization of DDH instability.
Altered biomechanical stimulation: The presence of hip dysplasia risk factors can alter the biomechanical stimulation of the developing hip joint.

Diagnosis

The diagnosis of DDH is typically made through a combination of physical examination and imaging studies. Clinical examination is crucial, especially in babies with risk factors, and can be done using the Barlow and Ortolani maneuvers. Radiography and ultrasonography are used to confirm the diagnosis, and other imaging modalities, such as magnetic resonance imaging, are also used to evaluate the severity of the dysplasia.

Treatment Options

Treatment for DDH depends on the age of the patient and the reducibility of the hip joint. For infants up to 6 months, the main treatment is an abduction brace, such as the Pavlik harness. If this fails, closed reduction and spica casting are usually performed. After the age of 18 months, treatment typically consists of open reduction and hip reconstruction surgery. Various treatment protocols have been proposed, emphasizing updates in screening and treatment during the last two decades.

In cases of persistent acetabular dysplasia (AD), pelvic osteotomy is required to manage residual dysplasia of the hip (RD). This procedure could also be undertaken simultaneously with an open hip reduction. Recent research has opened the door to discussion on this issue and suggested treatment options for AD, but more research is needed to assist in managing AD effectively.

Description

Explore the causes, diagnosis methods, and treatment options for Developmental Dysplasia of the Hip (DDH), a complex disorder affecting the hip joint. Learn about risk factors, diagnostic techniques like radiography and ultrasonography, and treatment modalities including abduction brace, closed reduction, and hip reconstruction surgery.