Developmental Dysplasia of the Hip

Developmental Dysplasia of the Hip (DDH)/Congenital Dislocation of the Hip (CDH)

Developmental dysplasia is preferred term – spectrum of problems that varies from a displacement of femoral head from acetabulum to a radiographic abnormality of acetabulum formation. Dislocation occurs in 1.5 per 1000 births. 1 in 60 at risk. F>M. L>R. 20% bilateral. Usually picked up at birth due to screening. A few may be detected later as a gait problem.

Aetiology unknown (higher risk for breech presentation; flattened acetabulum; females; ligamentous laxity; family history (in up to 30%); higher levels of relaxin during labour; first born; Down syndrome).

Classification:
• The dislocated hip
• The dislocatable hip
• The subluxatable hip
• The dysplastic hip

Clinical tests (high number of false positive and false negatives):
Barlow’s test (used to indicate a dislocation of a reduced hip): – Test for ligamentous laxity; place infant on back with hips and knees fully flexed; apply thumb pressure in an anterior-posterior direction over the lessor trochanter to dislocate femoral head posteriorly; release thumbs  allows head to slip back into socket; if dislocation/relocation occurs  unstable hips.
Ortolani Manoeuvre (used to indicate a reduction in dislocation): – Knees flexed, hips flexed to 90 degrees and abducted; during abduction of the hips, a previously dislocated femoral head “clunks” in over the posterior rim of the acetabulum.
Limitation of abduction: – Limitation of 50 degrees or less is a reliable sign
Less significant clinical tests: – Asymmetry of skin fold in thigh and buttocks; telescoping – pushing the leg beyond the usual hip joint articulation; Galeazzi’s sign – apparent shortening of the affected limb when the dislocation is unilateral; Trendelenburg test – when reach weightbearing age; femoral head palpation; bulging of flesh near the femoral head; delayed locomotion.
Radiographic: – definitive. Can also be detected by ultrasound. X-rays will also detect the maldevelopmental problems of the acetabulum (acetabular dysplasia).

Differential diagnosis: neonatal hip instability; acetabular dysplasia

Treatment:
Less than one year of age – splinting hip in flexed and abducted position (Pavlik harness)
After one year – traction to force femoral head back into acetabulum
Up to five years – rotational osteotomy of femur usually needed
After seven years – arthroplasty of hip and later a hip prothesis may be needed.

Congenital dislocation of the hip in Adults:
If undiagnosed early  may present later with osteoarthritis in a ‘false’ hip joint between subluxed/dislocated femoral head and ilium. Changes may have occurred in spine due to scoliosis.

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=101988

We have not yet got to this page to finish it yet. We will eventually. Please contact us if you have something to contribute to it or sign up for our newsletter or like us on Facebook and Instagram or follow us on Twitter.

Page last updated: @ 2:31 am