You are here

Developmental Dysplasia of the Hip

DDH xray

DDH xray landmarks

DDH ultrasound picture

synonyms: DDH, congenital hip dislocation

DDH ICD-9

  • 754
  • 754.30 unilateral dislocation
  • 754.31 bilateral dislocation
  • 754.32 unilateral subluxation
  • 754.33 bilateral subluxation
  • 754.35 dislocation of one hip, subluxation of the other

DDH Etiology / Epidemiology / Natural History

  • 1/1000 live births, left hip most common
  • More common in children of central European, Native Americans, Laplanders, and native Alaskan descents.
  • Etiology: multifactorial, genetic, intruterine mechanical environment,
  • Risk of DDH without family history = 0.2%
  • Risk of  DDH with a parent with DDH = 12%. First-born children are affected twice as often as subsequent siblings. Female infants have histest risk of DDH (@800% of affected infants are female).

DDH Risk factors (five f's)

  1. first born
  2. female
  3. family history
  4. feet( breech position)
  5. fluid(oligohydramnios)

DDH Anatomy

DDH Clinical Evaluation

  • Ortolani=out-reduces
  • Barlow=in-dislocates
  • Asymmetric gluteal folds
  • Galeazzi sign: apparent femoral length idscrepancy when the legs are held together with the hips and knees flexed.
  • Decreased hip abduction
  • Amubulatory Patient: flexion contracture, gluteus medius lurch, toe walking, increased lordosis if bilateral

DDH Xray / Diagnositc Tests

  • U/S=gold standard <4months, want Graf(alpha) angle >55 degrees, 50% or more head coverage. (Harcke HT, JBJS 1991;73A:622).
  • Patients will likely have severe arthritis if at maturity the lateral center edge angle is <16 degrees and the femoral head is uncovered >1/3.

DDH Classification / Treatment

  • Initial treatment for infants =Pavlic harness with weekly U/S f/u until hip is reduced.  Pavlic holds hip in flexion(100°) and abduction(limit adduction to neutral).If unreduced in 3-4wks>CR,arthrogram,spica+/-traction,+/-adductor tenotomy.  Post-op CT.  Cast changes Q6wks follow by night splinting vs Rhino brace
  • OR=fails CR, or >18months at presentation.  Generally ant approach.  Femoral shortening necessary if >24months.
  • acetabular index should be 22 degrees at 22 months
  • medial approach=can not do capsulorhaphy, higher risk of AVN(25%), <1y/o.  Invterval between pectineus and iliopsoas or between adductor brevis and magnus.  Risks=medial femoral circumflex vessels
  • anteriorleateral approach(Smith-Peterson)=allows capsuloraphy, bikini incision
  • Irreducible hip dislocation, moderate dysplasia, moderate subluxation withou complete obliteration of the joint space, preop center-edge angle >10°: Chiari pelvic osteotomy (Ito H, JBJS 2004;86A:1439).
  • See also Adult Hip Dysplasia.

DDH Associated Anomalies

  • Metatarsus adductus
  • Hyperextended knees / congential knee dislocation
  • Torticollus

DDH Complications

  • Pavlik harness complications=femoral nerve palsy, AVN, post acetab wear, medial knee instability, brachial plexus palsy
  • Osteonecrosis
  • Persistent Acetabular dysplasia

DDH Follow-up Care

  • Frequent follow-up with repeat ultrasound/CT indicated to ensure maintenance of reduction.

DDH Review References

  • Guille JT, JAAOS 2000;8:232
  • Vitale MG, JAAOS 2001;9:401
  • Weinstein SL, JBJS 1979;61A:119
  • Hayes RJ, ICL 2001;50:535
  • Nemeth BA, Narotam V. Developmental dysplasia of the hip. Pediatr Rev. 2012 Dec;33(12):553-61. doi: 10.1542/pir.33-12-553. Review.
  • Lee CB, Mata-Fink A, Millis MB, Kim YJ. Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip. J Pediatr Orthop. 2013 Mar;33(2):107-11
  • °

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer