Developmental Dysplasia of the Hip
American Academy of Paediatric defines developmental dysplasia of the hip as a condition in which the femoral head has an abnormal relationship to the acetabulum.
It is spectrum varying from mild dysplasia to frank dislocation of joint.
Clearly multifactorial and is influenced by hormonal and genetic elements.
Multifactorial factors include ligamentous laxity, prenatal positioning, postnatal positioning, and racial predilection.
High-risk factors include breech presentation, female baby, firstborn, positive family history, oligohydramnios, Metatarsal adductus, and Torticollis.
Varies with the age of the child –
Newborn – Detected only either by clinical examination or sonographic finding.
Infants – Detected by clinical examination, gluteal fold at the higher level, asymmetrical thigh folds, and limitation of hip abduction
Walking child – All the clinical features described for children below the age of 1 year and also shortening, palpation of the femoral head in the gluteal region, waddling gait, exaggerated lumbar lordosis.
Varies with age of the child –
Newborn to 3months of age – Ultrasonography of hip joint
3months and later – Radiograph of the pelvis with both hip joints
Special circumstance – Arthrography, MR arthrography and MRI of the hip joint is needed
Treatment also depends on the age –
Newborn – Dynamic flexion abduction orthosis (Pavlik Harness)
1month to 6 months – Dynamic flexion abduction orthosis (Pavlik Harness)
6 months to 18 months – Closed reduction / Open reduction and Hip Spica
18 months – Open reduction+/- Femoral shortening/Derotation Osteotomy +/- Acetabular procedure and Hip Spica application
Long term consequences of neglected, inadequate and insufficiently treated cases include early arthritis of the hip, degeneration of the lumbar spine, valgus deformity of knee and Limb length discrepancy