What is Developmental Dysplasia of the Hip? & How is Developmental Dysplasia of the Hip diagnosed in the neonate and why is it critical to detect this, if present, as soon as possible? How would it be treated?
It may be better to think of this condition in terms of its old name “congenital dislocation of the hip” (CDH): the baby is born with the hip out of the socket or unstable.
Being out of socket is not good, of course, yet not so much for present function –the baby is not walking on it–but because for the hip joint to grow properly, the (mostly cartilage) head has to be in the socket. If the head is not in the socket, it will be grow to be mal-formed (“dysplastic”). Prompt detection and expeditious treatment allows the hip to remodel and form properly.
DDH can be detected on exam – there are a variety of physical exam maneuvers that can be used for diagnosis, including the Ortolani reduction maneuver (abduction and elevation to feel for reduction) and the Barlow provocation test (adduction/posterior pressure to feel for dislocation)—but in high risk patients (Breech position, female gender, first born children, and a positive family history are risk factors) ultrasound is used.
The goal of early treatment is to maintain reduction of the hip to provide the proper environment for the development of the femoral head and acetabulum, which requires that the cartilaginous surface of the femoral head be in contact with the cartilaginous floor of the acetabulum
Abduction splinting in a Pavlik harness (or even with double diapers for low tech areas) before 6 months of age can usually achieve and maintain hip reduction.
If found late, the hip needs to be reduced, perhaps surgically. Note: even though this put the hip in a “normal” position, it is not “normal” for this baby, and therefore the REDUCTION can damage the blood supply and cause AVN. Untreated DDH should not have AVN
The greater the delay in treatment, the harder it is to treat.
