Developmental Dysplasia of the Hip

1. DEVELOPMENTAL DYSPLASIA OF THE HIP
(DDH)

2. DDH
 Dislocation
 Subluxation
 Unstable
 dislocatable
 subluxatable
 Other Dysplasia
 acetabulum
 femur

3. Incidence of DDH
0.7 to 35 per 1000 live births

4. DDH: Predisposing Factors
• Female
• Breech delivery
• Family history
• Other congenital abnormalities

5. “ Risk Factors ”
• breech presentation
• metatarsus adductus

6. Neonatal Hip Examination
• Baby must be relaxed
• Examiner must not use
excessive force

8. Protocol for Neonatal
Hip Screening
• all newborns examined clinically
• “persistent” hip clicks referred to clinic at 6
weeks
• unstable hips splinted and reviewed in clinic

9. Protocol for Neonatal
Hip Screening
• US for “persistent” hip clicks at 6 weeks
• X-rays at 3 months for all hip clicks
• Dysplastic hips followed up until resolution

10. X-ray
• Hilgenreiner's line
• Perkin's line
• Shenton's line
• Acetabular index (AI)

11. Hip Ultrasonography
• Graf (1980)
• Harcke and Grissom (1990)
• dynamic US

13. Hip Ultrasonography

14. Age-Based Guidelines for Treatment of Developmental
Dysplasia of the Hip
Neonate Place in Pavlik harness for 6 weeks.
1 to 6 months Place in Pavlik harness for 6 weeks after hip reduces.
6 to 18 months Traction; closed reduction. If closed reduction is successful, place in
cast for 3 months. If closed reduction is unsuccessful, perform open
reduction.
Open reduction is performed by a medial approach in children
younger than 12 months of age and by an anterolateral approach
in children older than 12 months of age.
18 to 24 months Trial of closed reduction, or primary open reduction (anterolateral
approach). A Salter osteotomy may or may not be part of the
procedure.
24 months to 6 years Perform primary open reduction (anterolateral approach) and
femoral shortening, with or without a Salter osteotomy.

18. Pavlik Harness
• Used in babies from 3 to 9
months of age
• Difficult for some parents
• Compliance

19. Pavlik Harness for
Dislocated Hips
 Proper understanding and use
 May require adductor tenotomy
 X-ray after 2-3 weeks (45º flexion / 45ºabduction)
 Stop if not successful

22. Complications of Pavlik
Harness
 Pavlik Harness disease
 Inferior dislocation
 Femoral nerve palsy
 Avascular necrosis

23. DDH
6 months to 1 year
 Traction
 Adductor tenotomy
 Closed reduction and spica
 Open reduction

26. Arthrogram
• Useful in assessing
blocks to reduction
• Not routinely used

28. Avascular Necrosis
• Related to treatment
• “Safe” zone
• Gentle closed reduction

30. Open Reduction
• Medial approach
• Anterior approach
- soft tissue release
- clear blocks to reduction

34. DDH – Early Management
9 months to 2 years
• Closed reduction  adductor
tenotomy + spica
• Open reduction + adductor
tenotomy + spica

38. Blocks to reduction
-- Transverse ligament
-- Pulvinar

39. Salter
osteotomy

42. Post-op
Management
• 6 weeks in hip spica
• Remove pins and spica in OR
• Self-mobilisation

44. Operative treatment of DDH
 Perform soft tissue releases (adductors and
ilio-psoas)
 Find true acetabulum
 Clear blocks to reduction
 Achieve reduction
 Bony procedures after 18 months

45. THANK
YOU