Developmental
Dysplasia of
the Hip
BARAJAS CONTRERAS PALOMA M.
GALAVIZ RODRIGUEZ ALEJANDRA
HERNANDEZ JIMENEZ JOSUÉ
HERRERA MORENO FRANCISCO JAVIER
RODRIGUEZ SUAREZ JOSÉ ALBERTO
Developmental Dysplasia of the Hip
Hip Dysplasia is often referred to as Developmental Dysplasia of the
Hip or DDH and is generally the preferred term for babies and children with hip
dysplasia since this condition can develop after birth. DDH is a medical term for
general instability, or looseness, of the hip joint.
Hip Joint Anatomy
The hip is a “ball-and-socket” joint that is held
together by ligaments.
The ball is called the “femoral head” which is
the top of the femur or thigh bone.
The socket is called the “acetabulum” and is a
part of the pelvis.
The femoral head fits into the acetabulum
creating the hip joint.
EMBRYOLO
GY
7th week The hip begins its development
precartilaginous cells
head of the femur
acetabulum
these structures are completely cartilage
4th – 7th month ossification begins
CLASSIFICATION
Teratological Typical
Simple acetabular dysplasia (femoral head
contained in an anomalous acetabulum)
Subluxated (femoral head slightly separated
from the acetabulum)
Dislocated (complete loss of contact between
femoral head and acetabulum)
12-33% heritage
80% female sex
birth in ventral
position
RISK FACTORS
oligohydramnios
High weight
excessive clothing
of children
Signs and Symptoms
The newborn physical
examination and the check at six
to eight weeks aim to diagnose
DDH early. However, sometimes
hip problems can develop after
these checks. It is also hard to detect because
hip dysplasia is known as a
“silent” condition. It does not
cause pain in babies and doesn’t
normally prevent them from
learning how to walk at a normal
age.
SIGNS
Legs of different lengths
Uneven skin folds on the thigh
Less mobility or flexibility on one side of the hip
Limping, toe walking, or a waddling gait
Types of dislocations
Dislocated. In the most severe cases of DDH, the head of the
femur is completely out of the socket
Dislocatable. In these cases, the head of the femur lies within the
acetabulum, but can easily be pushed out of the socket during a
physical examination
Subluxatable. In mild cases of DDH, the head of the femur is
simply loose in the socket. During a physical examination, the
bone can be moved within the socket, but it will not dislocate
Basic measurements in
dysplasia of the
development of the hip
Radiographic approach is necessary
in developmental dysplasia of the
hip.
Basic and important concept about
Anteroposterior and Abducción
with medial rotation pelvis
radiographic projections are
exposed.
Hilgenreiner line, Acetabular
index, Perkins and Shenton’s lines,
will give us information to obtain
an objective evaluation and plan
treatment.
Ultrasound
It is the ideal study from birth It will indicate that we are
that we should request instead discarding or diagnosing CDD at
of radiographs when disposing ideal ages and therefore doing
of it. preventive medicine, the only
real solution in CDD.
Insist on its use and generalize
it in any health sector.
Ultrasound
Anteroposterio
r bone scan of
pelvis in frog
position.
Projection taken with hips in
abduction of 45 °, flexion of 90
to 110 °, without rotations;
simulates the human position,
that is, the position that the hip
would take with a harness
Pavlik or Calot in human
position.
Anteroposterior
pelvic radiography
with abduction and
internal rotation.
It is taken with abduction of 45 °
and internal rotation of 25 °, it
allows to eliminate the effect of
physiological anteversion and
valgus of the femoral neck and
head, which are greater during
the growth compared with the
known values of the adolescent
and adult.
References:
1.-Inan M, Korkusuz F. Developemental Dysplasia of the Hip. Clin Orthop Relat Res
2008; 466: 761-2.
2.- Williams H, Johnson KJ. Developemental Dysplasia of the hip 1: Child. En
Davies AM, Johnson K, Whitehouse RW: Imaging of the hip & bony pelvis:
Techniques and applications. Springer-Verlag, Berlin Heidelberg, 2006: pp 107-124.
3.-Tallroth K. Developemental Dysplasia of the hip 2: Adult. En Davies AM, Johnson
K, Whitehouse RW: Imaging of the hip & bony pelvis: Techniques and applications.
Springer-Verlag, Berlin Heidelberg, 2006: pp 126-140.
HIP DISLOCATION
TREATMENT
Treatment will be determinated by:
Your baby's age, overall health, and medical history.
The extent of the condition.
Your baby's tolerance for specific medications, procedures,
or therapies.
Expectations for the course of the condition.
Your opinion or preference.
The goal of treatment is:
to put the femoral head back into the socket of the hip so
that the hip can develop normally.
Treatment options
Nonsurgical positioning device or placement of a Pavlik
harness.
The Pavlik harness is used on babies under to 6 months of
age to hold the hip in place, while allowing the legs to move a
little.
Is usually worn one to two months.
At the end of this treatment, X-rays (or an ultrasound) are
used to check hip placement.
Most of the cases the hip may be successfully treated with
the Pavlik harness
Surgery
If the other methods are not successful, or if the problem is diagnosed at
age 6 months to 2 years, surgery may be required to put the hip back into
place manually, also known as a "closed reduction.
Surgery occurs with general anesthesia and may include maneuvering their
hip into the socket.
Thank you for your attention
