FREE ACCESS · 6 PAGES

Developmental Dysplasia of Hip (DDH)

Developmental Dysplasia of the Hip (DDH) is a spectrum of abnormalities in which the femoral head and acetabulum have an abnormal relationship, ranging from mild acetabular dysplasia to subluxation and complete dislocation. It is more common in girls and is associated with risk factors such as breech presentation, family history, and first-born status. Early diagnosis and treatment are essential to achieve a stable, concentrically reduced hip and prevent later degenerative changes.

Developmental Dysplasia of the Hip (DDH) describes a spectrum of disorders caused by abnormal development of the hip joint, including acetabular dysplasia, hip instability, subluxation, and complete dislocation. The condition may be present at birth or develop during infancy as the hip matures. Important risk factors include female sex, breech presentation, positive family history, first-born child, oligohydramnios, and associated packaging disorders such as torticollis or metatarsus adductus. The left hip is affected more commonly, although bilateral involvement can occur. Clinical examination varies with age. In newborns and young infants, hip instability is assessed using the Barlow and Ortolani manoeuvres. In older infants, findings may include limited hip abduction, asymmetrical skin folds, apparent limb shortening, and a positive Galeazzi sign. Children who present late may develop a limp, Trendelenburg gait, limb-length discrepancy, or lumbar hyperlordosis. Imaging depends on age. Ultrasound is the preferred investigation in young infants before significant ossification of the femoral head, while plain pelvic radiographs become more useful after approximately 4–6 months of age. Radiographic assessment includes the acetabular index, Hilgenreiner line, Perkin line, and position of the femoral head. Treatment is determined mainly by age at diagnosis and the reducibility of the hip. Young infants are commonly treated with a Pavlik harness to maintain the hip in flexion and controlled abduction. Failure of harness treatment or presentation at a later age may require closed reduction and hip-spica immobilisation, while older children or irreducible hips may need open reduction with femoral and/or pelvic osteotomy. The goals of treatment are to obtain and maintain a stable, concentric reduction, promote normal acetabular development, preserve femoral head vascularity, and reduce the risk of long-term complications such as avascular necrosis, residual dysplasia, early osteoarthritis, and functional impairment.

Free to read with your Orthonotes account. Save your place and annotate as you learn.