Developmental Dysplasia of the Hip: Diagnosis, Treatment, and Symptoms

Developmental Dysplasia of the Hip: Diagnosis, Treatment, and Symptoms

Diagnosis

Developmental dysplasia of the hip (DDH) is a spectrum of disorders related to the development of the hip joint, including neonatal instability, acetabular or femoral dysplasia, hip subluxation, and hip dislocation. The condition can lead to structural modifications, which may lead to early coxarthrosis. Early detection and treatment are crucial for improving quality of life and preventing complications.

Newborn Examination

The diagnosis of DDH in newborns is primarily based on clinical examination. The hip joint should be evaluated for stability, range of motion, and any signs of dislocation or subluxation. Milbrandt, M.D., an orthopedic surgeon and the chair of Pediatric Orthopedics at Mayo Clinic in Rochester, Minnesota, emphasizes the importance of assessing the baby's history of DDH and the presence of breech position during pregnancy to prevent missed hip dislocations. Infants with an unstable hip should be seen by a pediatric orthopedic specialist within 1-2 weeks for prompt treatment or further imaging.

Ultrasound Imaging

Ultrasound imaging is also essential for detecting DDH, particularly in infants with risk factors such as a first-degree relative with hip dysplasia or history of breech intrauterine positioning. Ultrasound should be performed at 4-6 weeks of age, following the initial hip examination.

Treatment Options

Treatment for DDH depends on the age of the patient and the severity of the condition. Early treatment is crucial for achieving optimal outcomes.

Brace Treatment

The first step in early treatment is the use of a Pavlik harness or rigid abduction brace, which helps maintain the hip in the correct position. In some cases, children may require closed or open reduction (OR) and Spica casting if they do not respond to brace treatment or present late.

Pelvic Osteotomy

In cases of persistent acetabular dysplasia (AD) after a successful hip reduction, pelvic osteotomy may be necessary. This procedure could also be performed simultaneously with an open hip reduction.

Symptoms

Developmental dysplasia of the hip patients may experience the following symptoms:

• Limited hip abduction on one or both sides
• Hip instability or subluxation
• Hip pain, particularly in children who have not received early treatment
• Gait abnormalities or difficulty walking

Untreated dysplasia may lead to severe discomfort, pain, and osteoarthritis, potentially requiring total hip arthroplasty.

Conclusion

Developmental dysplasia of the hip is a complex disorder that requires careful diagnosis and treatment. Early detection and intervention are crucial for promoting optimal outcomes and preventing long-term complications. Pediatricians, orthopedic surgeons, and other healthcare professionals play a vital role in identifying and managing DDH to ensure the best possible outcomes for patients.