Developmental Dysplasia of The Hip
Developmental dysplasia of the hip (DDH) is the most common disorder affecting the hip joints of children under age 3. DDH occurs when structures in the hip joint articulate abnormally. The condition may be unilateral or bilateral. It occurs in three forms of varying severity:
About 60% to 70% of affected infants are female. Dislocation is 10 times more common after breech delivery than after normal cephalic delivery. It also may be more common among large neonates and twins. With prompt treatment, the prognosis is good.
Experts are uncertain about the cause of DDH. Some theorize that the hormones that relax maternal ligaments in preparation for labor may also relax the ligaments around the infant's hip joint.
Signs and Symptoms
X-rays reveal the location of the femur head and a shallow acetabulum and allow monitoring of the progress of the disorder or treatment. X-rays are difficult to interpret because the femoral head isn't evident until ossification begins at age 3 to 4 months.
Ultrasonography can define the relationship between the head of the femur and the acetabulum without the use of ionizing radiation.
The earlier an infant receives treatment, the better the chances of normal development. Treatment for an older child depends on the patient's age.
Infants younger than age 3 months receive gentle manipulation to reduce the dislocation, followed by placement of a splintlike brace or harness (such as the Frejka pillow or the Pavlik harness) to maintain the hips in a flexed and abducted position. The infant must wear the appliance continuously for 2 to 3 months and then wear a night splint for another month so the joint capsule can tighten and stabilize in correct alignment.
If treatment doesn't begin until after age 3 months, it may include bilateral skin traction (Bryant's traction). Skeletal traction may be necessary if the child has started walking. Both treatments are used to reduce the dislocarion by gradually abducting the hips.
If traction fails, gentle closed reduction under general anesthesia can further abduct the hips; the infant then wears a spica cast for 4 to 6 months. If closed reduction fails, the doctor may perform open reduction and apply a spica cast for about 6 months, or he may perform an osteotomy.
Treatment for children ages 2 to 5 is difficult; it includes skeletal traction and subcutaneous adductor tenotomy. Treatment started after age 5 usually fails to restore satisfactory hip function.
Prevention is probably not possible, but early detection and treatment before complications occur is of paramount importance.
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