Developmental dysplasia of the hip | Symptoms & Causes | Diagnosis
 


What this section contains?
1. What is Developmental dysplasia of the hip?
2. Cause
3. Diagnosis & Tests
4. Prevention & Risk Factors
5. Treatments & Therapies
Developmental dysplasia of the hip

What is Developmental dysplasia of the hip?

Developmental dysplasia of the hip (DDH) is a condition where the "ball and socket" joint of the hip does not properly form in babies and young children.
It's sometimes called congenital hip dislocation or hip dysplasia.
The hip joint attaches the thigh bone (femur) to the pelvis. The top of the femur (femoral head) is rounded, like a ball, and sits inside the cup-shaped hip socket.
In DDH, the socket of the hip is too shallow and the femoral head is not held tightly in place, so the hip joint is loose. In severe cases, the femur can come out of the socket (dislocate).

Cause

Hip dysplasia is taken into account to be a complex condition. meaning that many factors are concerned in inflicting the condition to manifest.The reason for this condition is unknown; but, some factors of inborn hip dislocation are through heredity and racial background. it's additionally thought that the upper rates in some ethnic groups (such as some Native american groups) is because of the follow of swaddling of infants, that is thought to be a possible risk issue for developing abnormal condition.AcquiredAs an acquired condition it's usually been connected to traditions of swaddling infants, use of excessively restrictive baby seats, carriers and different strategies of transporting babies, or use of a cradle board that locks the articulatio coxae in an "adducted" position (pulling the knees along tends to tug the heads of the femur bone out of the sockets or acetabulae) for extended periods. modern swaddling techniques, like the 'hip healthy swaddle' are developed to relieve stress on hip joints caused by traditional swaddling strategies.Further risk factors embody breech birth, gender, genetic science (family history), and firstborns. In breech position the femoral head tends to get pushed out of the socket. A slim uterus additionally facilitates hip joint dislocation throughout fetal development and birth.

Diagnosis & Tests

Most countries have standard newborn exams that embrace a hip joint exam screening for early detection of hip dysplasia. typically throughout an exam a "click" or additional precisely "clunk" within the hip may be detected (although not all clicks indicate hip dysplasia). once a hip click (also referred to as "clicky hips" within the UK) is detected, the child's hips are tracked with further screenings to see if developmental dysplasia of the hip is caused.Two maneuvers ordinarily used for identification in neonatal exams ar the Ortolani maneuver and also the Barlow maneuver.In order to try and do the Ortolani maneuver it's counseled that the examiner place the babe in a position within which the contralateral hip is held still whereas the thigh of the hip being tested is abducted and gently force anteriorly. If a "clunk" is detected (the sound of the femoral head moving over the acetabulum), the joint is normal, however absence of the "clunk" sound indicates that the socket isn't totally developed. successive methodology which will be used is called the Barlow maneuver. it's done by adducting the hip whereas pushing the thigh posteriorly. If the hip goes out of the socket it means that it's separated, and therefore the newborn has a congenital hip dislocation. The baby is set on its back for examination by separation of its legs. If a clicking sound are often detected, it indicates that the baby might have a dislocated hip. it's extremely counseled that these maneuvers be done once the baby isn't fussing, as a result of the baby might inhibit hip movement.

Prevention & Risk Factors

The cause is unknown; however, some factors of congenital hip dislocation are through heredity and racial background.

Treatments & Therapies

Hip dysplasia presents a nearly perfect equilibrium between the arthritis, movement/mobility problems and pain associated with the developmental malformation, and the arthritis, movement/mobility problems and pain that are, as often as not in moderate to severe cases, inflicted by the treatment itself.

However, given the very real possibility of a limp, constant and/or debilitating pain, complicated treatment and impaired mobility later in life, careful developmental monitoring is indicated and early intervention is often the best result. The worst possible consequence of non treatment is developing early arthritis, sometimes even during teenage years. All treatment aims to delay the onset of arthritis, but no treatment is fully successful in avoiding it; and, all available treatments bear the risk of inflicting equivalent damage. Most unfortunately, studies have as yet been unable to find a method of predicting outcomes in either the surgical/orthopedic treatment of the condition in infants and young children, or the surgical treatment of these early treatments' negative outcomes later in life (such as arthritis, avascular necrosis, trochanteric bursitis, and bone spurs of up to 2.5 cm just medial of the gluteus maximus insertion point on the greater trochanter due to excessive friction).

Harnesses, casts, and traction
Early hip dysplasia can often be treated using a Pavlik harness or the Frejka pillow/splint in the first year of life with usually normal results. Complications can occur when using the Pavlik Harness. Cases of Femoral Nerve Palsy and Avascular Necrosis of the femoral head have been reported with the use of the Pavlik harness, but whether these cases were due to improper application of the device or a complication encountered in the course of the disorder remains unresolved. Complications arise mainly because the sheet of the iliopsoas muscle pushes circumflex artery against the neck of the femur and decreases blood flow to the femoral head, so the Frejka pillow is not indicated in all the forms of the developmental dysplasia of the hip.