Developmental dysplasia of hips
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Explain normal hip formation.
By 10 week gestation the hip joint capsule is well developed and will continue to enlarge throughout the gestation. There needs to be contact between the femoral head and the acetabulum.
What is DDH commonly known as?
Congenital hip dysplasia and/or dislocation. The name change indicates that DDH is a developmental process that occurs in utero or during the first year of life.
Incidence of DDH?
- The incidence is 8.6 to 11.5 per 1000 live births
- about 85% affected are females
- DDH can be unilateral or bilateral
- 25% oof cases involve both hips
- when unilateral the left hip is affected more often then the right.
3 forms of severity with DDH?
- 1- unstable hip dysplasia (hip is positioned normally but can be dislocated by manipulation
- 2- subluxation or incomplete disloaction (the femoral head remains in contact with the acetabulum but the head of the femur is partially displaced or uncovered
- 3- complete dislocation (the femoral head is totally outside the acetabulum)
Risk factors for DDH?
Breech delivery, large neonate, twin or multiples, idiopathic scoliosis, arthrogryposis, CP, spina bifida, family history, first pregnancies, low amniotic fluid, correlated with torticollis, metatarsus adductus, calcaneus valgus, ethnic groups
Causes of DDH?
- cultural customes, swaddle in hip extension and adducion
- hormonally drive (maternal hormone relaxin)
- hereditary ligament laxity
Early treatment and DDH?
Early treatment IS necessary. If not diagnosed or treated early secondary changes occur (stretching of the jt capsule, hip contractures, changes in blood supply, flattening of the femoral head, acetabular dysplasia, development of a false acetabulum.)
Clinical manifestations of DDH in a newborn to 12 month old - nonambulating?
- any ROM asymmetries (especially in hip abduction)
- asymmetry in buttock or gluteal folds (higher on the affected side), extra thigh skin folds, log length descrepancy,
Clinical manifestations of DDH in an ambulating child?
- bilateral = waddling gait patten (compensated trendellenbug)
- unilateral = trendellenburg
- posterior hip displacement = hip flexion contracture with lumbar lordosis
Medical diagnosis of DDH?
- Positive ortolani and barlow clock (only in the first month of life)
- positive galeazzi sign
- ultrasound - accurate in the first 6 months of life
- x-rays - unreliable secondary to the lack of ossification
PT intervention of DDH?
Goal is to ensure stability of the femoral head in the acetabulum. Parent education on positioning (100 degrees of flexion, 90 degrees of abduction, use of the pavlik harness (worn for 3-9 months). Standing program, strengthening of LE and trunk. Facilitation of gross motor skills.
- Do not flex hip above 120 (vascular interference)
- avoid prolonged hip adduction
- do NOT repeat ortolani and varlow (result in persistent laxity)
Prognosis and outcomes of DDH?
- directly related to the child's age at initiation of treatment
- if treated early, it is completely reversble, rates of success as high as 95%
- if surgical reduction is necessary, 86% success rate (main complications are avascular necrosis -7% and premature physeal arrest -18%)
If DDH is untreated patient can develop what?
- degenerative joint disease early
- chronic hip pain
- antalgic gait
- back pain and/or premature hip replacement
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