Developmental Dysplasia of the Hips DDH formerly known as CDH A generic term describing abnormalities of the hip that may be congenital or occur during infancy Ranges from mild to severe Abnormal relationship between the femoral head and acetabulum ID: 1000176
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1. Cheryl Parker PA-CDepartment of Orthopedics and Sports MedicineDevelopmental Dysplasia of the Hips
2. DDH formerly known as CDH A generic term describing abnormalities of the hip that may be congenital, or occur during infancy. Ranges from mild to severe.Abnormal relationship between the femoral head and acetabulumDysplasia – shallow/underdeveloped acetabulumSubluxed – hip that is not reducedDevelopmental Dysplasia of the Hip
3. Incidence: 1.5/1000 live births – untreated leads to degenerative arthritis in adulthoodDysplasia: 1 per 100Frank Dislocation: 1.5 per 1,000Most common(+) FHxBreech presentationGirls 4:1Children with joint laxityL > R hip Developmental Dysplasia of the Hip
4. Breech presentation increases risk 5-10 foldFHx: increases risk 10 foldfor associated deformities: i.e. torticollis, calcaneovalgus foot, metatarsus adductus, knee deformitiesDiagnosis of DDH
5. Early Diagnosis is critical to successful treatmentSigns change with the age of the child, therefore repeat hip exams at each well-child visitCheck for asymmetry of legsfor pain – DDH is NOT painful – seek other causeDiagnosis of DDH
6. Infant: perform Galeazzi, Abduction, Barlow, and OrtolaniExam one hip at a timeDo not force – note any instabilityHip clicks & asymmetry of thigh folds are not pathognomonic – but asymmetry of motion can beNOT 100% reliable – obtain imaging studiesPhysical Exam of DDH
7. Note shortening of legNot apparent if DDH is bilateralIf walking may appear to be limping or toe walking on one sideClinical PresentationGaleazzi sign
8. With hip adducted push thigh posteriorly using piston like action. BACK out Barlow!(+) if hip goes out of socket - is confirm by performing Ortolani to reduce hip.Can be Barlow(+) initially but by 2-3weeks of age be Barlow (-) – however acetabular dysplasia may remain and require treatmentNot good in child > 6months of ageClinical PresentationBarlow test
9. The opposite hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. Out of here – Ortolani – lets get you back in!(+) sign: palpable and audible “clunk” as the femoral head moves over the posterior rim of the acetabulum and relocates in cavity. Shifts into position with initial abduction Not good in child > 6months of ageClick – benign high pitched sound occurring with abductionClinical Presentation Ortolani sign*
10. Older Infant & Child: perform Galeazzi, Abduction, ER, IRNote limitations and shortening of legParents may report unusual gait or crawlOlder child may report fatigue, hip/knee painMay have (+): Trendelenberg testLimpToe walk on affected sideIf bilateral may waddle and have decreased abductionToo much muscle development for Barlow and OrtolaniPhysical Exam of DDH
11. Imaging DDHHips at risk should be examined repeatedlyUltrasound (sensitive exam)– good up to 12 weeks of ageBest between 4 - 6 weeks of age and before ossification of femoral head
12. X-ray – gold standardmore reliable: single pelvis AP viewCT & MRI not useful in DxCT used following closed/open reductions to confirm hip reductionImaging DDH
13. Imaging Hips
14. Goal: obtain & maintain concentric reduction of hip without forceDx 0-6 months: Pavlik harness for 6-12 weeks90-95% success rate!Monitor with US/x-ray q2-4 weeksTreatment of Dysplasia/Dislocation
15. Treatment of DDHDx 6-30 months: SAB for 6-18 weeks if hip is reducible (surgery if not reducible)Wear for 23hours/day Move to nighttime only until x-ray is normal>30months: surgery: open reduction, femoral shortening & pelvic osteotomiesOlder child & Adolescents: usually left alone – may progress to OA
16. The End – Questions??