Developmental Dysplasia of the Hip (DDH)

Overview:

The developmental dysplasia of the hip (DDH) or hip dysplasia is a condition of loosened joints of the hip. This condition occurs mainly in babies before or after birth. The joint of the hip suffers from instability. Other than instability, the hip functions normally.

Developmental-Dysplasia-of-the-HipCauses:

The hip dysplasia is assumed to be developmental. It can affect a child before or after birth or during early childhood. The assumed causes are:

  • Family history
  • Position of baby inside the womb
  • Large weight during birth
  • Soft hip joints of infant
  • Positioning of baby during first year of life

Symptoms:

Pain is usually not experienced in hip dysplasia. The common symptoms include:

  • Asymmetry in legs
  • Hip click
  • Uneven skin folds on buttocks or thighs
  • Reduce or limited movement
  • Swayback

Treatments:

A combination of imaging tests and physical examination is done to diagnose hip dysplasia. Imaging tests include ultrasound, x-rays, etc. Bilateral hip dysplasia are difficult to detect. The treatment basically includes both non-surgical treatment and surgical treatment.

  • Non-surgical Treatment:

For more stable hip joints, non-surgical treatment procedure is a good option. They are mainly used for baby under 6 months of age. The treatment methods included are:

  • Pavlik Harness

A well-designed pavlik harness is specially designed to reposition the hip of the baby. The hip is positioned to a secure and well aligned place. This provides normal development of the hip joint.

  • Hip Abduction Braces

The hips of infants are properly supported through braces. As a result, the hip develops normally in a proper position. They have the advantage of being less flexible than pavlik harness. They are also known as fixed-abduction braces.

  • Traction

The traction is useful in stretching the ligaments of hip. Thus, a normal working hip is achieved.

  • Surgical Treatment:

Surgery is mainly chosen as the last resort for treating hip dysplasia. The child is placed under the effect of general anesthesia. The surgical methods include:

  • Closed reduction

Children between the age of 6months to 2 years are treated with closed reduction method. It is a less-invasive technique and hence more popular. In this procedure, the ball of the hip is correctly manipulated. It is then properly aligned back into the socket.

  • Open reduction

In some children, the tissue in the hip prevents the ball of hip from going into the socket. So a the hip joint is cleared out or repaired completely. Sometimes, it is also required to repair the ligaments of hips.

  • Pelvic Osteotomy

This surgery aims to repair the hip socket. There exists different types of pelvic osteotomy. The shape of socket determines the exact method of surgery.

  • Femoral Osteotomy

This type of surgery is required when the upper end of thigh bone has to be tipped. This is done to point the ball deep into the socket. Sometimes it is also known as Varus De-rotational Osteotomy (VDO or VDRO).

Post-treatment:

During the healing process, a spica cast is used in the hip. It holds the hip in proper alignment. It is important to clean the wound regularly. Physical therapies may be used to enhance fast recovery. It may take 6-8 months for complete recovery.

Risks:

The possible risks included are:

  • Irritation in skin due to braces or casts
  • Uneven length of legs
  • Chances of arthritis
  • Bleeding
  • Infection

 

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