Developmental Dysplasia of Hip (DDH)
Developmental Dysplasia of Hip (DDH) occurs when a child is born with an unstable hip. It’s caused by abnormal formation of the hip joint during their early stages of fetal development. It is also known as Congenital dislocation of hip (CDH).
The hip is a ball and socket joint. The femur (thigh bone) ends with a rounded projection, or ball, which fits into the hollowed out socket (acetabulum) of the pelvic girdle. The ball is anchored firmly into the socket with tough connective tissue called ligaments. In a baby with DDH, the socket is abnormally shallow, which prevents a stable fit. Slack ligaments may also allow the femur to slip out of joint.
The ball-and-socket joint in the child’s hip may sometimes dislocate. This means that the ball will slip out of the socket with movement. The joint may sometimes completely dislocate.
The left hip is affected three times more often than the right hip. Dislocation of both hips is not uncommon. DDH is also more common in babies born with particular disorders, including cerebral palsy and spina bifida.
Developmental dysplasia of the hip(DDH) doesn’t cause pain in babies, so can be hard to diagnose. Doctors check the hips of all newborns and babies during well-child exams to look for signs of DDH.
Parents could notice the following signs –
• The baby’s hips make a popping or clicking that is heard or felt.
• The baby’s legs are not the same length.
• One hip or leg doesn’t move the same as the other side.
• The skin folds under the buttocks or on the thighs don’t line up.
• The child has a limp when starting to walk.
Developmental dysplasia of hip (DDH) present in either hip and in any individual. It usually affects the left hip. Girl babies are more prone to have DDH than boy babies.
There are many causes of DDH, both genetic and environmental, including –
• family history – around one third of babies with DDH have a blood relative who also had the condition
• congenital disorders – DDH is more common in babies with disorders such as cerebral palsy and spina bifida
• breech delivery – being born feet first can put considerable stress on the baby’s hip joints
• multiple babies – crowding inside the womb may dislocate the hip
• first-time mother – the inexperienced uterus and vagina may cause a difficult or prolonged delivery
• Firstborn children
• Oligohydramnios (low levels of amniotic fluid)
• Children treated with spica casting may have a delay in walking. However, when the cast is removed, walking development proceeds normally.
• The Pavlik harness and other positioning devices may cause skin irritation around the straps, and a difference in leg length may remain.
• Growth disturbances of the upper thighbone are rare, but may occur due to a disturbance in the blood supply to the growth area in the thighbone.
• Even after proper treatment, a shallow hip socket may still persist, and surgery may be necessary in early childhood to restore the normal anatomy of the hip joint.
If a baby has signs of Developmental dysplasia of hip (DDH) or has a higher risk for it, the doctor will order tests.
Two tests help doctors check for DDH:
• An ultrasound uses sound waves to make pictures of the baby’s hip joint. This works best with babies under 6 months of age. That’s because most of a baby’s hip joint is still soft cartilage, which won’t show up on an X-ray.
• AnX-ray works best in babies older than 4–6 months. At that age, their bones have formed enough to see them on an X-ray.
▪︎ Non surgical Treatment
If your baby is younger than 6 months of age and diagnosed with CHD, it’s likely they’ll be fitted for a Pavlik harness.
This harness presses their hip joints into the sockets. The harness abducts the hip by securing their legs in a froglike position. Your baby may wear the harness for 6 to 12 weeks, depending on their age and the severity of the condition. Your baby may need to wear the harness full time or part time.
▪︎ Surgical Treatment
• Your child may need surgery if treatment with a Pavlik harness is unsuccessful, or your baby is too big for the harness. Surgery occurs with general anesthesia and may include maneuvering their hip into the socket, which is called a closed reduction. Or the surgeon will lengthen your baby’s tendons and remove other obstacles before positioning the hip. This is called an open reduction. After your baby’s hip is placed into position, their hips and legs will be in casts for at least 12 weeks.
• If your child is 18 months or older or hasn’t responded well to treatment, they may need femoral or pelvic osteotomies to reconstruct their hip. This means a surgeon will divide or reshape the head of their femur (the ball of the hip joint), or the acetabulum of their pelvis (the hip socket).
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