About developmental dysplasia of the hip or DDHDevelopmental dysplasia of the hip (DDH) affects the hip joint in babies and young children. Show
It happens when the ball of a baby’s hip isn’t sitting in the right position in the hip socket. This can cause the hip to become loose and unstable. It can even cause dislocation, which is when the ball comes partially or completely out of the socket. Usually, only one hip is affected, most commonly the left hip. But sometimes both hips are affected. DDH can happen at birth or develop in the weeks or months after birth. DDH can vary from mild to severe. It isn’t painful. Signs and symptoms of DDHIf your baby or young child has developmental dysplasia of the hip (DDH), you might see the following signs, but they won’t always be obvious:
Does your child need to see a doctor about DDH?You should take your child to your GP if you notice any of the signs of developmental dysplasia of the hip (DDH) above. Tests for DDHDoctors and/or midwives do a very careful physical examination of both hips in all newborn babies in the first few days of life. Your GP or child and family health nurse will do these examinations again at six weeks. And your child and family health nurse will check your baby’s hips at every appointment in the first 12 months of your baby’s life. If your health professional suspects developmental dysplasia of the hip (DDH), your baby might get a hip ultrasound or X-ray. If you have a family history of DDH or your baby was breech, a hip ultrasound might be recommended at eight weeks of age. You might be referred to a paediatric orthopaedic surgeon for a specialist opinion. Treatment for DDHIf your baby is diagnosed with developmental dysplasia of the hip (DDH) when he’s a newborn or young baby, doctors might recommend a brace. Babies with braces usually have hip ultrasounds every 4-6 weeks to monitor their progress. For mild and moderate DDH, children generally wear braces for three months. For more severe DDH, babies wear braces for six months or longer. Babies with more severe DDH might need surgery too. The earlier DDH is diagnosed and bracing is started, the better. If babies are older than five months of age when diagnosed with DDH, they are more likely to get complications and need more complex treatment like surgery. DDH preventionDDH can sometimes be caused by wrapping your baby’s legs too tightly, so they’re straight and can’t move. If you wrap your baby, keep her legs loose so that her hips and knees can bend. Some babies really like to lie with their head turned to one side. This can affect the position of your baby’s hips. It’s important to alternate your baby’s head position for sleep from right to left. This can also help prevent your baby from getting an uneven or flattened head. To learn more about the right way to wrap your baby, check out our video on wrapping a newborn or our illustrated guide to wrapping babies. Risk factors for DDHRisk factors for DDH include:
Presentations of Hip DysplasiaNeonatal Hip DysplasiaIdeally, DDH is detected by routine history and physical exam in the neonatal period. Questions to the parents regarding risk factors can be important. Clinical screening is the gold standard for diagnosis with dynamic hip examinations carried out at birth and at subsequent pediatrician visits throughout childhood. The Ortolani test and Barlow maneuver should be done at each exam. The Ortolani Test: The examiner’s hands are placed over the child’s knees with his/her thumbs on the medial thigh and the fingers placing a gentle upward stress on the lateral thigh and greater trochanter area. With slow abduction, a dislocated and reducible hip will reduce with a described palpable “clunk.” The Barlow Maneuver is done by guiding the hips into mild adduction and applying a slight forward pressure with the thumb. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, again producing a palpable sensation of subluxation or dislocation. In Infants, the Degree of Instability Can Be Described As:
Hip Dysplasia Presentations in the Infant 2 Months or OlderAfter 2-3 months of age, the Ortolani test and Barlow maneuvers are less sensitive but several other physical exam findings become more apparent:
Hip Dysplasia Presentations in the Walking Child
Hip Dysplasia Presentations in Preadolescents and Adolescents
Other Possible Late Presentations
How Is Hip Dysplasia Evaluated?Children under 6 months of age: Beyond clinical screening exams, US (ultrasound) is the preferred technique. Though US screening of all infants is not advised, infants with identified risk factors or questionable exams should be routinely screened. With a normal exam, screening US should be delayed until at least 4-6 weeks, when hip maturation improves exam specificity. US is also used to document reduction and follow the improvement or maturity of a dysplastic hip following treatment. Children 6 months of age or older: Plain radiographic evaluation is used. On an AP radiograph, lines which localize the femoral head in relationship to the acetabulum-- Hilgenreiner’s, Perkin’s, and the acetabular index--can be drawn and measured. The proximal femoral metaphysis should lie medial to Perkin’s line, within the inner and lower quadrant of the resulting grid. In the dysplastic hip, the normal acetabular index (around 25 to 27 degrees) is increased. Other findings include disruption of Shenton’s line, delay in epiphyseal ossification and/or a widened or delayed “teardrop” appearance. Plain radiographs and measurements are also used to follow hip development and maturation. How Is Hip Dysplasia Treated?Once DDH is identified, prompt referral to a pediatric orthopedist is suggested. Birth to 6 months: Immature, stable hips (Barlow negative) that become normal do not need treatment. Hips that are Barlow positive at birth may also become stable in the first 3 weeks of life; therefore, treatment may be delayed. In both cases, close follow-up and routine physical exams are required, plus a later US to document normal hip stability and development. With an unstable, Ortolani positive hip, early treatment is required. Reduced hips are positioned in flexion and mild abduction to stimulate normal joint development, most commonly performed via the Pavlik harness, a dynamic brace which positions the thighs to allow and maintain hip reduction. Infants are followed bi-weekly for strap adjustment. Progress is monitored and reduction verified with subsequent US evaluations. Pavlik treatment continues until US parameters have normalized and the hip stabilized on exam, on average 2-3 months later. Follow-up through skeletal maturity is then emphasized. 6 months to 1-2 years: Children who present at this time or fail to stabilize with the Pavlik harness require genera anesthesia, followed by closed or open hip reduction and spica casting. Over 2 years of age: Older children may require extensive open surgical reductions with possible femoral and pelvic osteotomies (cutting and realigning the bones), followed by a spica cast. Outcomes of TreatmentTreatment success depends on the child’s age and the success of repositioning. Many cases treated in the first 6 months of life with a Pavlik harness recover and develop normally with no long-term problems. The older the child or less successful the reduction, the greater the possible need for repeated surgeries or eventual hip arthritis and subsequent replacements later in life. You Might Also Be Interested In
Pavlik HarnessDoes your child wear a pavlik harness? This Helping Hand can aid you in day to day activities with your child in a pavlik harness.
Blog Hip Dysplasia in Children: Causes, Symptoms and TreatmentFor parents, a diagnosis of Developmental Dysplasia of the Hip (DDH) brings a wide range of emotions and responses. Parents want to understand not only the condition, but what the future holds for their child after diagnosis. How is hip dysplasia in babies treated?Infants are usually treated with a soft brace, such as a Pavlik harness, that holds the ball portion of the joint firmly in its socket for several months. This helps the socket mold to the shape of the ball. The brace doesn't work as well for babies older than 6 months.
How is dysplasia of the hip treated?Hip dysplasia is often corrected by surgery. If hip dysplasia goes untreated, arthritis is likely to develop. Symptomatic hip dysplasia is likely to continue to cause symptoms until the deformity is surgically corrected. Many patients benefit from a procedure called periacetabular osteotomy or PAO.
Can be used to treat developmental dysplasia of the hip?Babies diagnosed with DDH early in life are usually treated with a fabric splint called a Pavlik harness. This secures both of your baby's hips in a stable position and allows them to develop normally.
When should hip dysplasia be treated in babies?If a brace or splint doesn't help, your doctor may recommend surgery once your child is at least 6 months old or is 6 months or older at the time of diagnosis. The most common operation is called a “closed reduction.” First, your baby will get medicine that makes them sleepy.
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Which treatment would the nurse expect for a newborn with developmental dysplasia of the hip
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