Developmental Dysplasia of the Hip (DDH) refers to a spectrum of hip abnormalities that can occur during foetal development or infancy, resulting in abnormal formation or misalignment of the hip joint. It encompasses a range of conditions from mild instability to complete dislocation of the hip joint.
The exact cause of DDH is not always clear, but several factors may contribute to its development:
1. Genetics: There is evidence to suggest a genetic predisposition to DDH, with a higher incidence in families with a history of the condition.
2. Foetal Positioning: Breech presentation during pregnancy, where the baby's buttocks or feet are positioned to enter the birth canal first, increases the risk of DDH.
3. Antenatal factors: Polypregnancy (twins, triplets, etc), Oligohydramnios, bifurcate uterus – factors which may reduce the potential space the foetus has to grow are recognised low risk factors.
4. Environmental Factors: Factors such as swaddling infants tightly with their legs extended or using baby carriers that force the legs into an unnatural position may increase the risk of DDH.
In infants, DDH may not cause any noticeable symptoms, especially in mild cases. However, parents or caregivers may observe the following signs:
1. Limited Range of Motion: The affected hip may have limited movement, especially during diaper changes or when dressing the infant.
2. Asymmetrical Gluteal Folds: One thigh may appear shorter or have less skin creasing compared to the other. Creases around the mid-thigh may be normal however different creases around the buttocks should be investigated.
3. Clicking or Popping Sensation: A clicking or popping sound may be heard when the hip joint is moved, although this is not always present. It is important to note that there a number of reasons a hip may “click” and the majority of time it is soft tissues around the joint and not the hip itself.
Diagnosing DDH typically involves a combination of physical examination and imaging studies:
1. Physical Examination: The Orthopaedic surgeon or Paediatrician will performa physical exam to assess hip mobility, stability, and leg length equality.
2. Imaging Studies: X-rays and ultrasound,may be used to confirm the diagnosis and evaluate the severity of thecondition. Typically until 4-6 months of age. USS is the imaging modality ofchoice. After this time X-Rays are typically used.
The treatment approach for DDH depends on the age of the patient and the severity of the condition:
1. Pavlik Harness: In infants younger than six months with mild to moderate DDH, a Pavlik harness may be used to maintain the hips in a stable position and encourage proper joint development. If DDH persists as the child gets larger more rigid braces such as a rhino brace may be used.
2. Closed Reduction: For infants older than six months or those with more severe hip instability, a closed reduction procedure may be performed under anaesthesia to manually reposition the hip joint.
3. Surgery: In cases where other treatments are ineffective or if DDH is diagnosed later in childhood or adulthood, surgical interventions such as open reduction, osteotomy, or hip replacement may be necessary to correct the hip joint abnormalities and improve function.
With early diagnosis and appropriate treatment, the prognosis for DDH is generally favourable. However, untreated or late-diagnosed cases can lead to long-term complications such as chronic hip pain, osteoarthritis, and functional limitations.
While not all cases of DDH can be prevented, early detection and intervention can significantly improve outcomes. Newborns should undergo routine hip screenings as part of their regular paediatric care, and parents should be educated about proper swaddling techniques and encouraged to avoid positions that may increase the risk of hip dysplasia. In Western Australia we have a world class DDH Screening program where if your newborn meets the criteria an Ultrasound screening scan will be performed and Orthopaedic review organised.
Developmental Dysplasia of the Hip (DDH) is a congenital condition that affects the formation and alignment of the hip joint. Early detection and appropriate management are essential for achieving optimal outcomes and minimizing long-term complications. Parents should be vigilant for signs of hip dysplasia in infants and seek prompt medical attention if any concerns arise. With timely intervention, most cases of DDH can be successfully treated, allowing affected individuals to lead active and fulfilling lives.
