About Developmental Dysplasia of the Hip (DDH)

Overview

Developmental dysplasia of the hip (DDH) is a condition present at birth where the hip joint doesn’t develop properly or is misaligned. DDH is a complex disorder that can show up in various ways, from newborn hip instability to problems with the hip socket or thigh bone, partial hip dislocation, or complete hip dislocation. DDH is influenced by genetics and cultural practices. It is one of the most common limb abnormalities in children and can lead to secondary osteoarthritis. The treatment approach for DDH depends on the patient's age and how severe the condition is. Early treatment of DDH can sometimes correct the problem.

Causes and Risk Factors

The disease mechanism and causes of developmental dysplasia of the hip (DDH) are not fully understood, but the condition is believed to have many factors for happening, influenced by both genetic and environmental factors.

The non-modifiable risk factors, which are disease factors that cannot be changed, for DDH include:

• Family history: Having a close relative with DDH increases the risk
• Gender: Females are more likely to develop DDH than males
• Position within the womb: Limited space for fetal movement in the womb due to factors like multiple pregnancies, or low amniotic fluid volume (oligohydramnios), may play a role. Being in a breech position during pregnancy can also increase the risk.

On the other hand, there are some modifiable risk factors, which are factors that can be changed or controlled, that may contribute to DDH:

• Swaddling: Incorrect swaddling techniques that restrict hip movement can increase the risk
• Use of carrying devices: Prolonged positioning of the infant in devices that put pressure on the hips, such as car seats or baby carriers, may contribute to DDH.
• Birthing method: Mode of delivery can also influence the development of DDH.

It's important to note that while these risk factors have been identified, not all individuals with these factors will develop DDH. Early detection and appropriate management are crucial for optimal outcomes.

Symptoms

The most common early symptoms of developmental dysplasia of the hip (DDH) include:

• Limited hip abduction (movement of the leg away from the midline of the body)
• Difference in leg length
• A "click" or "clunk" felt with hip movement

As DDH progresses or becomes more severe, other symptoms may occur, such as:

• Limping
• Pain or discomfort
• Walking pattern abnormalities
• Hip instability

It's important to note that symptoms can vary depending on the severity and progression of DDH. Early diagnosis and treatment are key to achieving optimal outcomes. If you suspect your child may have DDH or notice any concerning symptoms, it's important to consult with a healthcare professional for a proper evaluation and management plan.

Diagnosis

To diagnose developmental dysplasia of the hip (DDH), the following examinations, tests, and procedures are commonly performed:

• Physical examination: This involves assessing hip mobility, checking for limited hip abduction (moving the leg outward), and observing for skin creases on the hip and groin that are not symmetrical
• Ultrasound: Ultrasonography is a popular imaging examination used for screening and confirming the diagnosis of DDH in infants under 6 months old
• Radiography: Anteroposterior (AP) pelvic radiographs are used to screen and image DDH in older infants. However, this screening may be less effective or misleading in certain cases

Additional examinations, tests, and procedures to determine the stage or severity of DDH include:

• Ossification assessment: Using X-rays to look at the bone development of the top of the thigh bone (femoral head) helps determine how severe the hip displacement is in DDH
• Thigh/groin asymmetry assessment: Uneven skin folds in the thigh and groin area can provide additional information for diagnosis
• Barlow and Ortolani tests: These physical examination techniques help detect instability or dislocation of the hip joint

It is important to consult with a healthcare professional for accurate diagnosis and appropriate management.

Treatment Options

The goals of treatment for developmental dysplasia of the hip (DDH) are as follows:

• Achieve and maintain a stable, well-aligned hip joint to allow for normal development of the hip
• Prevent further slipping or dislocation of the femoral head
• Promote proper development of the femoral head and hip socket (acetabulum)
• Prevent complications, such as the loss of blood flow of the femoral head (avascular necrosis) and the need for additional surgeries to correct the hip condition

To achieve these treatment goals, the following approaches may be recommended:

• Medications: There are no specific medications used to treat DDH directly. However, pain relievers or anti-inflammatory medications may be prescribed to manage any discomfort or inflammation associated with the condition.
• Therapies and devices:
• Physical therapy and exercises may be recommended to strengthen the muscles around the hip joint, improve range of motion, and promote stability.
• Abduction brace: This is a standard treatment for infants younger than 6 months. It helps keep the hip joint in the correct position and allows for natural alignment.
• Procedures:
• Closed reduction: In some cases, if non-surgical treatment fails or if DDH is diagnosed late, this procedure under general anesthesia may be performed. This involves manipulating the hip joint to move it back into the proper alignment without making an incision
• Open reduction: If closed reduction is not successful or if DDH is diagnosed late, open reduction may be necessary. It involves surgically opening the hip joint, and manually placing the thigh bone (femoral head) back into the hip socket (acetabulum)
• Osteotomy: This surgical procedure is applied for persistent cases of DDH, when non-surgical treatment and other surgical procedures have failed to treat DDH. It is sometimes performed alongside open reduction surgery. During this procedure, the surgeon cuts and reshapes the bones around the hip joint (usually the pelvis or femur) to improve the alignment of the hip
• Self-care and health behavior changes:
• Avoiding positions that place stress on the hip joint, such as sitting with crossed legs or excessive stretching
• Regularly attending follow-up appointments to monitor progress and make any necessary adjustments to treatment

It's important to note that each treatment approach should be tailored to an individual's specific situation, so it's best to consult with a healthcare professional for personalized advice and recommendations.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation.Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.