Developmental dysplasia of the hip (DDH) represents a spectrum of conditions affecting the proximal femur and acetabulum, ranging from acetabular immaturity to hip subluxation and frank hip dislocation.
The Barlow and Ortolani screening tests are recommended up to 6 months of age, although they begin to lose their sensitivity and usefulness around 3-6 months of age due to increased musculature. Thereafter, limited and/or asymmetric hip abduction suggests the diagnosis.
Ultrasound may be used to confirm an abnormal hip exam, but should be used with caution as a preliminary screening test due to the high number of false positive results.
There is a high rate of spontaneous resolution of hips identified as mildly abnormal by both clinical exam and ultrasound in the neonatal period. Frank dislocations and persistently abnormal exams should be referred to a pediatric orthopedist.
Most cases can be treated nonsurgically using an abduction harness (Pavlik harness). If a harness fails, a rigid abduction brace may be used.
Surgery is required for children with severe DDH or those who have failed treatment with an abduction harness or brace, and in older children.
The term DDH represents a spectrum of conditions affecting the proximal femur and acetabulum, ranging from acetabular immaturity to hip subluxation and frank hip dislocation. In true DDH, the femoral head has a persistently abnormal anatomic relationship with the pelvic acetabulum, which leads to abnormal bony development that can ultimately result in premature arthritis and significant disability. This is distinct from transient dysplasia, which represents acetabular immaturity in which the anatomic relationship stabilizes and normalizes over a period of weeks to months.
History and exam
Key diagnostic factors
- positive Ortolani test
- positive Barlow test
- limited hip abduction
Other diagnostic factors
- abnormal positioning of the leg or delayed crawling/walking
- toe-walking (especially unilateral)
- female sex
- positive family history
- breech presentation
- postural deformity
- restricted intrauterine space
- incorrect lower-extremity swaddling
1st investigations to order
- ultrasound of hips
- hip x-ray
<6 months of age
6-18 months of age
>18 months to 6 years of age
>6 years of age
- Acetabular immaturity
- Proximal femoral focal deficiency
- Residual effects of septic arthritis
- Evidence-based clinical practice guideline: detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age
- Management of developmental dysplasia of the hip in infants up to six months of age - intended for use by orthopaedic specialists
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