Developmental dysplasia of the hip ddh what is ddh. Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. Acr appropriateness criteria on developmental dysplasia of the hipchild. Developmental dysplasia of the hip ddh is a condition where the ball and socket joint of the hip does not properly form in babies and young children. Developmental dysplasia of the hip ddh is one of the most common musculoskeletal problems in newborns. Tendons and muscles hold the femoral head in the socket. Although many studies have been conducted on ddh, some special pathology is still unrecognized. In developmental dysplasia of the hip, formerly called congenital dislocation of the hip, the newborns hip socket and the head of the thighbone femoral head, which normally form the hip joint, become separated, often because the hip has a socket that is not deep enough to hold the head of the femur. Developmental dysplasia of the hip ddh is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical factors. Developmental dysplasia of the hip radiology reference. This leads to delay in the appropriate therapy and results in complications.
Pdf developmental dysplasia of the hip ddh is a spectrum of abnormalities resulting in abnormal development of the femoral head and acetabulum. The change in name reflects the fact that ddh is a developmental process that occurs over time. If this is not successful or the developmental dysplasia of the hip is diagnosed. Sep 23, 2010 developmental dysplasia of the hip ddh is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. The natural history of ddh depends, in part, on the severity of the disease, bilaterality, and whether or not a false acetabulum is formed. The condition is found in babies or young children. Developmental dysplasia of the hip johns hopkins medicine.
Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and. What causes adult hip dysplasia and how is it treated. Developmental dysplasia should be treated soon after death. Other names can also be used to describe this condition, including congenital dysplasia of the hip, or congenital dislocation of the hip. The total hip registry from the authors institution. Developmental dysplasia of the hip brenner childrens hospital. The etiology is not yet fully understood but a breech presentation and family history of ddh are the most important risk factors. Developmental dysplasia of the hip ddh encompasses a broad spectrum of abnormal hip development during infancy and early development. The abnormalities include hip instability, shallow acetabulum preluxation, incomplete dislocation of the hip subluxation, and femoral head not in contact with the acetabulum dislocation. Developmental dysplasia of the hip for parents nemours. Skilled clinical examiners are capable of detecting the vast majority of developmental dysplasia of the hip ddh in neonates, and this remains the primary screening method in the united states. Since developmental dysplasia of the hip ddh represents one of the most. Developmental dysplasia of the hip often runs in families. Congenital hip dysplasia, retroversion, periacetabular osteotomyhip coverage.
Neonatal screening programmes, based on clinical screening examinations, have been established for more than 40 years. Developmental dislocation dysplasia of the hip ddh. Ddh is now the preferred term to reflect that ddh is an ongoing developmental process, which is variable in presentation and not always detectable at birth. The term congenital dislocation of the hip dates back to the time of hippocrates. Developmental dysplasia of the hip international hip dysplasia. Developmental dysplasia of the hip ddh encompasses a broad spectrum of anatomical hip abnormalities ranging from fixed irreducible dislocation to subtle dysplasia. Early finding and management provides the best possible result. Developmental dysplasia of the hip is a condition that distorts normal hip bony anatomy during the developmental stages of the hip when it is being formed in utero. Our understanding of the epidemiology, diagnosis, and management of developmental dysplasia of the hip ddh is. Developmental dysplasia of the hip ddh or hip dysplasia is a relatively common condition in the developing hip joint. Ddh alters hip biomechanics, overloading the articular cartilage and.
Developmental dysplasia of the hip ddh, previously known as congenital hip dysplasia is a common disorder affecting infants and young children. Risk of developmental dysplasia of the hip in breech presentation. Early recognition and treatment are important to prevent hiprelated complications later in life. Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns. Developmental dysplasia of the hip ddh, replaces the term congenital dislocation of the hip. Its diverse pathological changes require different treatments and result in different outcomes.
This paediatric orthopaedic fact sheet provides a quick and easy to understand guide written by expert clinicians on developmental dysplasia of the hip ddhin babies and young children. In children with ddh, the ball at the top of the thigh bone called the head of the femur bone is not stable within the socket called the acetabulum. Developmental dysplasia of the hip ddh is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Ddh is a condition in which the relationship between the hip socket and femoral head is abnormal. Developmental dysplasia of the hip, also referred to as ddh, is a condition in which the hip joint develops abnormally.
Developmental dysplasia of the hip complete orthopedics. Feb 06, 2020 the term congenital dislocation of the hip dates back to the time of hippocrates. It shows up in babies because the hip joint is made of soft cartilage when youre born. Congenital hip dislocation chd occurs when a child is born with an unstable hip.
Imaging update on developmental dysplasia of the hip with the. Developmental dysplasia of the hip refers to a spectrum of severity ranging from mild acetabular dysplasia with a stable hip, to more severe forms of dysplasia with hip instability, to established hip dysplasia with or without subluxation or dislocation. Treatment varies from pavlik bracing to surgical reduction and osteotomies depending on the age of the patient and degree of dysplasia. Developmental dysplasia of the hip ddh refers to hip instability, subluxation dislocation of the femoral head, andor acetabular dysplasia in a developing hip joint. It may be present at birth or occur in an infant or childs development. It occurs once or twice in every 1,000 live births. The hip is a ballandsocket type joint, formed by the round head of femur and a cupshaped socket acetabulum figure 1. This congenital disorder can lead to various developmental problems and physical deformities as a child grows up.
The child should be dysplasia of the hip flexed 90 as well as abducted and treat examined at regular intervals to ensure the ment is continued until the hip is stable, as reduction. Mild cases of ddh usually get better on their own as a baby grows. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Spectrum from hip laxity and instability to hip subluxation and dislocations. Sometimes the condition starts before the baby is born, and sometimes it happens after birth, as the child grows. Developmental dysplasia of the hip pediatrics in brevard. Developmental dysplasia of the hip, or ddh, means that the hip joint of a newborn baby is dislocated or prone to dislocation. Developmental dysplasia of the hip ddh is a problem with the way a babys hip joint forms before, during, or after birth causing an unstable hip.
Developmental dysplasia of the hip radiology assistant. Daniel joseph augustine mosc medical college, kolenchery 2. The term refers to a spectrum of pathology, ranging from mild acetabular dysplasia with a stable hip through more severe forms of dysplasia, often associated with neonatal hip instability, to established hip dysplasia with or without later subluxation or dislocation. The pathophysiology and natural history of the range of morphological and clinical disorders that constitute developmental dysplasia of the hip are poorly understood. Developmental dysplasia of the hip includes frank dislocation luxation, partial dislocation subluxation, instability wherein the femoral head comes in and out of the socket, and an array of. Developmental dysplasia of the hip what is developmental dysplasia of the hip ddh. Screening, assessment and management of developmental dysplasia of the hip ddh. This condition, also known as hip dysplasia or developmental dysplasia of the hip ddh, has been diagnosed and treated for several hundred years. There may be a range of severity from acetabular dysplasia, with slight flattening of the acetabulum, to severe dysplasia with abnormal shape of the acetabulum and femoral head. The normal hip joint is created as a ball and socket joint in which the ball is usually completely covered by the socket.
Developmental dysplasia of the hip is a general term referring to a spectrum of deformities, usually diagnosed in the neonatal period, in which the structural relationship of the proximal femur to the acetabulum is intermittently or continuously abnormal. Hip dysplasia into teens and later life may result in irregular gait, reduced the strength and generate many hip. Hip dysplasia developmental dysplasia of the hip is a condition in which a childs upper thighbone is dislocated from the hip socket. In a normal hip, the ball at the upper end of the thighbone femur fits firmly into the socket, which is part of the large pelvis bone. Developmental dysplasia of the hip guidelines bmj best. Hip dysplasia, also known as the developmental dysplasia of the hip ddh, is a hip joint deformation which is usually present at birth in patients. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and. Nov 24, 2009 developmental dysplasia of the hip affects % of newborns. The ligaments of the hip joint that hold it together may also be loose. Omim entry % 142700 developmental dysplasia of the. Developmental dysplasia of the hip in childhood etiology. The hip is a ball and socket joint, and dysplasia can refer to a hip that is subluxatable unstable if stressed, dislocatable can come out of socket under stress. In severe cases, the hip joint can dislocate or cause trouble walking. Most infants treated for ddh develop into active, healthy kids and have no hip problems.
Developmental dysplasia of the hip is usually suspected in the early neonatal period due to the widespread adoption of clinical examination including the ortolani test, barlow maneuvers, and galeazzi sign. Treatment methods include bracing, casting andor surgery to promote proper formation and position of the hip joint. Developmental dysplasia of the hip is an abnormal formation of the hip joint in which the ball at the top of the thighbone femoral head is not stable in the socket acetabulum. This disorder underlies up to 9% of all primary hip replacements and up to 29% of those in people aged 60 years and younger. Different diagnostics test for developmental dysplasia of hip were invented to treat with this condition. Screening programmes for developmental dysplasia of the hip in.
Developmental dysplasia of hip ddh is rare condition occurs in growing hip with structural abnormalities. Oct 15, 2006 developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. It is felt to be due to abnormal fetal positioning and even with improved detection and screening techniques early on in life, developmental hip dysplasia in many patients is often. Pdf developmental dysplasia of the hip ddh is a spectrum of anatomical abnormalities of the hip joint in. Diagnosis and treatment of developmental dysplasia of the.
Hip clunks are managed as developmental dysplasia of the hip see below hip clunk. Developmental dysplasia of the hip is an important cause of childhood disability. Sep 23, 2016 developmental dysplasia of the hip ddh was formerly referred to as congenital dislocation of the hip cdh. Indications for surgical treatment of developmental dysplasia of the hip ddh are met if the results of such treatment would be better than the results of the natural progression of the disease. Developmental dysplasia of the hip ddh developmental dysplasia of the hip ddh is a condition that affects the hip joint in babies and young children. The definition encompasses a wide range of severity, from mild acetabular dysplasia without hip dislocation to frank hip dislocation. Developmental dysplasia of the hip ddh, formerly known as congenital dislocation of the hip cdh, is a term used to describe a variety of abnormalities of the hip in development. Hip dysplasia is often referred to as developmental dysplasia of the hip or ddh and is generally the preferred term for babies and children with hip dysplasia since this condition can develop after birth.
Developmental dysplasia of the hip refers to a range of conditions that can affect the development of the hips in infants or young children. The diagnosis is then usually confirmed with ultrasound, although the role of ultrasound in screening is controversial 1,3. Developmental dysplasia of the hip ddh is the most common. Developmental dysplasia of the hip childrens wisconsin. Bursali a, tonbul m 2008 how are outcomes affected by combining the pemberton. Developmental dysplasia of the hip childrens health. Developmental dysplasia of the hip is a condition of the hip joint that occurs once in every 1,000 live births. Treatment includes special harnesses, or operations and casts, depending on the age of the child at diagnosis.
Jan 12, 2018 hip development in developmental dysplasia of the hip at birth, the affected hip will spontaneously slide into and out of the acetabulum. Seasonal variation in adult hip disease secondary to. Adults who have no history of the problem are affected too despite the fact that children are commonly affected with hip dysplasia. Jan 02, 2020 hip dysplasia is treated by placing the baby in a harness or brace for a period of a few months to keep the legs in the correct position to allow the hips to form normally. A patients guide to developmental dysplasia of the hip in children introduction. Hip dysplasia can run in families and it happens more often in girls than boys. The hip joint is made up of a ball femur and socket acetabulum joint. The hip joint is made up of the thigh bone the femur and the pelvic bone. If this is not successful or the developmental dysplasia of the hip is diagnosed later in life, surgery is necessary to reconstruct the hip joint. Developmental dysplasia of the hip ddh describes the spectrum of structural abnormalities that involve the growing hip. Its caused by abnormal formation of the hip joint during their early stages of fetal development. Girls are more likely to have developmental dysplasia of the hip than boys. Its sometimes called congenital hip dislocation or hip dysplasia.
Ddh is a term used to describe a spectrum of abnormalities affecting the relationship of the femoral head to the acetabulum. Ddh refers to a spectrum of severity ranging from mild acetabular dysplasia. Ultrasound us is no better than these examiners but may improve ddh diagnosis or exclusion for lessexperienced clinical examiners strong evidence. It is also known as congenital hip dysplasia, but actually this is a. Movements at the joint include flexion, extension, abduction, adduction, medial and lateral rotation, and circumduction. Evaluation and referral for developmental dysplasia of the. For this to occur, the posterosuperior rim of the acetabulum has to have lost its sharp margin and become flattened and thickened in the area over which the femoral head slides. Ddh affects one in every 600 girls, and one in every 3,000 boys.
Anatomy of hip joint it is a multiaxial ball and socket joint designed for stability and weight bearing. Although it may be associated with various neuromuscular disorders, such as myelodysplasia, or occur in utero, it most commonly occurs in neurologically normal infants and is multifactorial in origin. If untreated, developmental dysplasia of the hip can lead to pain or problems with walking. The upper end of the femur is shaped into a ball femoral head that fits into a socket the acetabulum. In ddh, this joint may be unstable with the ball slipping in. It should be in the cupshaped socket of the pelvis called the acetabulum.
Developmental dysplasia of the hip knowledge for medical. Hip dysplasia into teens and later life may result in irregular gait, reduced the strength and generate many hip and knee disease. Identical twins are more prone to development of hip dysplasia than fraternal twins. Developmental dysplasia of the hip stapleton and pearl. Developmental dysplasia of the hip ddh is a condition that affects the neonatal and infant hip joint. Evidence synthesis number 42 screening for developmental dysplasia of the hip prepared for. A condition of the hip where the socket acetabulum and hip ball femoral head is misaligned in adults is known as adult hip dysplasia. Hip dysplasia may occur at birth or develop in early life. The ball is loose in the socket and may dislocate easily.
Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. Developmental dysplasia of the hip pubmed central pmc. Hip developmental dysplasia childrens hospital colorado. Developmental dysplasia of the hip ddh acetabulum or femoral head dysgenesis resulting in hip incongruity in infants. The term describes a spectrum of hip problems that ranges from mild movement of the femur upper leg bone in the acetabulum cartilaginous lining of the hip to complete dislocation of the femur from the acetabulum. Dec 18, 2016 to determine if there was a seasonal variation in adults undergoing total hip arthroplasty for end stage hip disease due to osteoarthritis oa or sequelae of developmental dysplasia of the hip ddh. Distinct, palpableaudible shift of the femoral head as it is relocated or dislocated barlow hip clunk suggests developmental dysplasia of the hip, with dislocation or subluxation. Developmental dysplasia of the hip aka congenital hip dysplasia is generally identified in the newborn period. Developmental dysplasia of the hip juniper publishers. In this article we will discuss the ultrasound examination technique according to graf.
Hip arthroscopy can be helpful in treating hip dysplasia in adults. The ihdi is here to help you find answers to your questions when dealing with hip dysplasia. Doctors use a number of different terms for hip dysplasia. Developmental dysplasia of the hip ddh encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation.
A hip may be dislocated at rest, dislocatable but in a normal position at rest, subluxed incomplete contact between the femoral head and acetabulum. Developmental dysplasia of the hip ddh is one of the most common congenital disorders in childhood. Developmental dysplasia of the hip ddh is an abnormal development of the hip joint. Ddh occurs when a babys hip joint does not grow normally. Uncorrected developmental dysplasia of the hip ddh is associated with long term morbidity such as gait abnormalities. Congenital hip dysplasia also known as developmental hip dysplasia is related to abnormal hip development that may arise during the fetal life. Developmental dysplasia of the hip dunwoody pediatrics. Developmental dysplasia of hip linkedin slideshare. The hip joint attaches the thigh bone femur to the pelvis. Hip dysplasia or ddh is normally diagnosed in babies however it can develop later on. In its severest form, developmental dysplasia of the hip is one of the most common congenital malformations.
Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods. Hip dysplasia is treated by placing the baby in a harness or brace for a period of a few months to keep the legs in the correct position to allow the hips to form normally. The full text of this article is available in pdf format. Developmental dysplasia of the hip ddh is a problem with the way a babys hip joint forms. Developmental dysplasia of the hip american academy of. The ball at the top of the thighbone called the femoral head is not in the right place. In ddh, this joint may be unstable with the ball slipping in and out of the socket. Regardless, it does not typically produce symptoms in babies less than a year old. Management of developmental ly applied, they allow motion while the hips are orthosis with ap xray. The treatment options are diverse depending on etiology, degree of dislocation, and age of the child when diagnosis is made. Eight individuals in 4 generations had acetabular dysplasia manifested as pain in the hip joint during adolescence and progressing to severely crippling hip osteoarthritis before age 60 years. Developmental dysplasia of the hip ddh encompasses the spectrum of hip abnormalities involving the relationship between the femoral head and the acetabulum during early growth and development. It can be present at birth or develop during a childs first year of life.