Developmental dysplasia of the hip joint

INFORMATION

Developmental hip dysplasia (DDH) is a condition in which the hip joint of a newborn or infant is either subluxated (the femoral head remains partially in contact with the pelvis) or dislocated (no contact between the femoral head and the pelvis). Hip dysplasia in infants most often occurs unilaterally (bilaterally in about 20% of cases), with an incidence of 1 in 1,000 live births, and is six times more common in girls. A breech presentation of the fetus is a risk factor for the development of DDH. Developmental hip dysplasia should not be confused with teratological hip dislocation, which is diagnosed in utero.

Abnormal intrauterine fetal positioning is thought to be the cause from which developmental hip dysplasia arises. It also often co-occurs with torticollis and clubfoot.

If left untreated, DDH can manifest as pain and limping, eventually leading to the development of hip dysplasia and osteoarthritis.

Developmental dysplasia is usually detected during an orthopedic examination at a preluxation clinic. An ultrasound examination is required to confirm the diagnosis.

Treatment consists of using wide diaphragm or wearing an abduction orthosis. In some cases, surgical treatment is necessary.

TREATMENT

When hip dysplasia is present, treatment varies depending on the patient’s age. If hip dysplasia is detected early enough in infants, treatment is simpler and can be performed noninvasively.If dysplasia is detected during the child’s first year of life, the recommended treatment is the use of a Pavlik harness. This is a non-invasive method that involves keeping the lower limbs in abduction. The harness is worn for about a month. The effectiveness of this method is nearly 90%. It is important to note that this treatment is not recommended for forms of dysplasia with neurological causes, such as spina bifida or cerebral palsy. Another treatment method involves applying a cast for a period of 6 weeks.

If conservative treatment is unsuccessful, surgery should be considered. When there is hip dysplasia in children, surgery is recommended when the child reaches the age of 2.

The hip dysplasia surgery provided by the pediatric orthopedics department at our center involves open reduction, which means repositioning the femoral head into the acetabulum. Depending on the severity of the anatomical abnormalities, a pelvic osteotomy is performed. Sometimes a femoral osteotomy is also required to achieve satisfactory coverage of the femoral head by the acetabulum. In severe cases involving significant dislocation, a minor shortening of the thigh is performed. This is only a temporary shortening that does not affect limb length discrepancy in later years— the deficit resolves spontaneously over time.

During surgery, the ligament that physiologically holds the head in the joint is shortened and reattached to the bone. With open repositioning, when an osteotomy is performed, there is a high probability of blood transfusion during or after surgery in the pediatric ward.

Next, while still in the operating room , a cast is applied to the lower extremities and abdomen, which keeps the legs in abduction. After 3–4 days of hospitalization, the patient is discharged home. After one week, if wound healing is progressing normally and the doctor and physical therapist see no contraindications, the cast is replaced with a removable brace.

After six weeks, an X-ray without the orthosis is taken to evaluate the result of the treatment. If there are no contraindications, rehabilitation begins.