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Developmental Dysplasia of the Hip

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Overview

Previously known as congenital dislocation of the hip, developmental dysplasia of the hip (DDH) describes abnormal development of the hip acetabulum with or without hip dislocation. It can lead to hip pain and dislocation and early osteoarthritis.

Risk Factors

  • DDH is significantly more common in girls (around 80% of cases)
    • This may be due to the maternal hormone relaxin leading to ligaments relaxing
  • Firstborn children are more likely to be affected
  • Breech babies – the risk is around 17 times higher
  • Oligohydramnios
  • Multiple pregnancy

Screening

Clinical examination: Barlow and Ortolani tests

Screening for DDH is part of the physical examination of the newborn and 6-8-week-old babies. This involves:

  • The Barlow test – attempts to dislocate a femoral head:
    • The examiner applies gentle backward pressure to the head of each femur in turn
    • A ‘clunk’ is heard if the hip can be dislocated
  • The Ortolani test – attempts to put a dislocated femoral head back in position:
    • The examiner applies gentle forward pressure to each femoral head to move a dislocated femoral head back into the acetabulum of the hip
    • If a ‘clunk’ is felt, this suggests that the femoral head has moved over the acetabulum
    • If the clunk is not felt,  this may suggest that the acetabulum has not fully developed

Overview

The following infants should be offered a routine ultrasound examination:

  • 1st-degree family history of hip problems in early life
  • Breech presentation at ≥36 weeks, regardless of presentation at birth or means of delivery
  • Breech presentation at delivery if delivery is occurring at <36 weeks
  • Multiple pregnancy

Investigations

  • Ultrasound scan:
    • Generally the initial investigation of choice if DDH is suspected
  • X-ray of the hip:
    • Used first-line if the infant is >4.5 months old

Management

Overview

In general:

  • Most unstable hips stabilise by 2-6 weeks of age and any unstable/dislocatable hip after this time is treated using bracing, harnesses, or surgery
  • For children younger than 4.5-6 months, a Pavlik harness may be used
  • Older children may require surgery

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