Developmental dysplasia of the hip is a congenital (present at birth) condition of the hip joint. It occurs once in every 1,000 live births. The hip joint is created as a ball and socket joint. In DDH, the hip socket may be shallow, letting the "ball" of the long leg bone, also known as the femoral head, slip in and out of the socket. The "ball" may move partially or completely out of the hip socket.
The greatest incidence of DDH occurs in first-born females with a history of a close relative with the condition.
Hip dysplasia is considered a "multifactorial trait." Multifactorial inheritance means that many factors are involved in causing a birth defect. The factors are usually both genetic and environmental.
Often, one gender (either male or female) is affected more frequently than the other in multifactorial traits. There appears to be a different "threshold of expression," which means that one gender is more likely to show the problem than the other gender. For example, hip dysplasia is more common in females than males.
One of the environmental influences thought to contribute to hip dysplasia is the baby's response to the mother's hormones during pregnancy. A tight uterus that prevents fetal movement or a breech delivery may also cause hip dysplasia. The left hip is involved more frequently than the right due to intrauterine positioning.
First-born babies are at higher risk since the uterus is small and there is limited room for the baby to move; therefore affecting the development of the hip. Other risk factors may include the following:
The following are the most common symptoms of DDH. However, each baby may experience symptoms differently. Symptoms may include:
A baby with developmental dysplasia of the hip may have a hip that is partially or completely dislocated, meaning the ball of the femur slips partially or completely out of the hip socket. The symptoms of DDH may resemble other medical conditions of the hip. Always consult your baby's doctor for a diagnosis.
Developmental dysplasia of the hip is sometimes noted at birth. The pediatrician or newborn specialist screens newborn babies in the hospital for this hip problem before they go home. However, DDH may not be discovered until later evaluations. Your baby's doctor makes the diagnosis of developmental dysplasia of the hip with a clinical examination. During the examination, the doctor obtains a complete prenatal and birth history of the baby and asks if other family members are known to have DDH.
Diagnostic procedures may include:
Specific treatment for DDH will be determined by your baby's doctor based on:
The goal of treatment is to put the femoral head back into the socket of the hip so that the hip can develop normally.
Treatment options vary for babies and may include:
The cast remains on the hip until the hip returns to normal placement. Following casting, a special brace and/or physical therapy exercises may be necessary to make the muscles around the hip and in the legs stronger.
A short leg hip spica cast is applied from the chest to the thighs or knees. This type of cast is used to hold the hip in place after surgery to allow healing.
Contact your baby's doctor or other health care provider if your baby develops one or more of the following symptoms:
While newborn screening for DDH allows for early detection of this hip condition, starting treatment immediately after birth may be successful. Many babies respond to the Pavlik harness, and/or casting. Additional surgeries may be necessary since the hip dislocation can reoccur as the child grows and develops. If left untreated, differences in leg length or a duck-like gait, and a decrease in agility may occur. In children 2 years or older with DDH, deformity of the hip and osteoarthritis may develop later in life. DDH can also lead to pain and osteoarthritis by early adulthood.
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