DDH

Spectrum of conditions ranging from mild dysplasia to frank irreducible dislocation of hip

Theories

• Mechanical: packaging disorder (Torticolis, plageocephaly and foot deformity)
• Genetic: identical twins 36%
• Hormone: High progesterone and relaxin
• External: swaddling of babies

M/C

• Left
• Breech
• First
• Female

Risk Factors

• 1st degree relative
• Breech

Screening

• Undertaking the examination
• Before the examination practitioners should establish:
• mother’s recent obstetric history
• baby’s family history
• national hip risk factors
• The examination should take place in a warm environment and on a firm flat surface with the baby undressed and settled.
• Observation
• Observation covers:
• symmetry of leg length
• level of knees when hips and knees are both flexed
• symmetry of skin folds in the groin when baby is in ventral suspension6
• if legs can be fully abducted
• Manipulation
• Undertake both the Ortolani and Barlow manoeuvres on each hip separately to assess hip stability.
• Ortolani manoeuvre is used to screen for a dislocated hip.
• Barlow manoeuvre is used to screen for dislocatable hip.

Problems

• Hypertrophied Tr acetabular lig
• Bulky lig teres
• Inverted limbus( Labrum, capsule and rim of acetabular cartilage)
• Psoas tendon
• Hour glass constriction of capsule
• Pulvinar

Principle of treatment

• Obtain concentric stable reduction of the hip as early as possible while limiting the risk of complication as remodelling potential decreases with age

Treatment

• 1st 6 weeks: double napkin
• 6 week USG : resolves in 90%
• 6wk to 6mo:
  • Reducible: pavlik harness (dynamic flexion abduction brace)
  • Irreducible: 1-2 week in harness and discontinue as this can cause AVN

Failed Harness

• EUA, arthrogram
• CR +/-tenotomy

Closed reduction scenarios

OR

Timing

• early OR: better remodelling, more AVN
• OR >13 months: less AVN less remodelling
• Any treatment other than Pavlik after 13 mo: Very low AVN

Pelvic osteotomy

• Redirectional
• volume reduction
• salvage

Redirectional

Deficient anteriorly

• Salter : 18m to 6 y (pubic symphysis is hinge)
• Tripple innominate: 6-12
• Periacetabular: >12. Triradiate cartilage is fused

Volume reducing

• Posterior hinge osteotomy
• Used in CP
• Pemberten and dega

Salvage

• shelf