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Developmental dysplasia of the hip

Developmental dysplasia of the hip

Description

The hip is a “ball-and-socket” joint. The “ball” is the round, head-shaped top of the femur. The “socket,” or acetabulum, is a rounded cup located on the pelvis bone. In a normal hip, the ball fits securely into the socket. Developmental dysplasia of the hip (DDH) includes a wide spectrum of conditions, from complete dislocation of the ball from the socket to having a very shallow hip socket. DDH can present at birth or as the child ages with one or both hips being involved.

Symptoms

Oftentimes there are no outward signs of DDH in a newborn. Possible signs could be:

  • Leg length discrepancy
  • Skin folds on the thigh that are uneven
  • Limited mobility or flexibility on one side
  • Toe walking, limping or a wobbling gait

Evaluation

Early diagnosis of hip dysplasia allows for prompt treatment and the best outcomes for the hip. A clinical examination is required to diagnose DDH. Often, patients will require a hip ultrasound or X-ray for diagnosis.

Treatment

0-6 months

A Pavlik harness is one type of brace used to treat DDH. It is worn for approximately one to three months while the soft tissues around the hip tighten and allow the hip joint to stabilize. Keeping the top of the femur, or “femoral head,” in the hipbone socket allows for normal development of the socket. This harness allows for unrestricted movement of the lower extremities and easy diaper care.

In some cases, resetting the bone under anesthesia without making an incision may be recommended. While the baby is safely asleep, the physician will gently move the thighbone into proper position to get the hip into the socket, and then apply a body cast to hold the hip in place.

Between 6 months and 2 years

Typically, children in this age group are too strong and too large for a Pavlik harness. Resetting the bone under anesthesia, or a “closed reduction” with a body cast is often the recommended treatment. If a closed reduction is not successful, surgery with an incision will be required. The surgeon will make an incision to remove the soft tissue that is preventing the femoral head from staying in the hip socket. Following the surgery, a body cast is required during recovery.

Older than 2 years

Open reduction is commonly required to get the femoral head into the socket properly. A body cast and brace are typically used for a few months to keep the hip in the socket. Depending on the age, osteotomies – a process where the bone is cut – may be required to help keep the hip in the proper position.

DDH in the adolescent

Unlike DDH in infants, the ability for the hip joint to change is limited in the adolescent. DDH in adolescents also often has more symptoms than in the infant. The pain can be in the hip, thigh or knee, that typically gets worse with activity. The patient might present with a limp.

X-rays as well as a physical exam are necessary for diagnosis, but frequently more advanced studies, including computed tomography (CT) or magnetic resonance imaging (MRI), are required.

DDH in adolescents can be treated with physical therapy and activity restrictions. If surgery is recommended, it involves hip preservation techniques to improve the shape and position of the hip joint. A Ganz periacetabular osteotomy (PAO) is frequently recommended to improve the socket coverage over the femoral head. The Ganz procedure involves cutting around the socket so it can be moved into a position that provides better coverage of the hip ball.

Goals of Ganz osteotomy

  • Preserve the hip
  • Avoid hip replacement
  • Improve coverage of the femoral head
  • Reduce/eliminate pain
  • Increase range of motion
  • Improve walking
  • Allow for future vaginal delivery in women
  • Allow surgeon to repair cartilage tears, if needed
  • Allow immediate limited weight-bearing