CDH

CONGENITAL DISLOCATION
OF THE HIP

Nomenclature
CDH : Congenital Dislocation of the Hip

NORMAL PELVIS

Normal hip

Dislocated hip

Patterns of disease
Dislocated
Dislocatable
Sublaxated

Acetabular dysplasia

Radiology
After 6 months: reliable

Causes (multi factorial)

Hormonal
Relaxin, oxytocin

Familial
Lig.laxity diseases

Genetics
Female 4 X male --- twins 40%

Mechanical
Pre natal
Post natal

Mechanical causes
Pre natal
Breach , oligohydrominus , primigravida , twins
(torticollis , metatarsus adductus )

Post natal
Swaddling , strapping

Infants at risk
Positive family history: 10X

A baby girl:

4-6 X
Torticollis: CDH in 10-20% of cases
Foot deformities:
Calcaneo-valgus and metatarsus adductus

Knee deformities:
hyperextension and dislocation

Infants at risk
When risk factors are present
The infant should be reviewed
Clinically
radiologically

Clinical examination

The infant should be

quiet

comfortable

 Look:
External rotation

Lateralized contour
Shortening
Asymmetrical skin folds
Anterior posterior

 Move
Limited abduction

 Special test
Galiazzi
Ortolani , Barlow test

Trendelenburgh sign
Limping ( waddling gait if bilateral)

Special test

Galiazzi test

Special test
Ortolani test

Special test
Barlow test

Special test
Trendelenburgh sign

Screening programs
Clinical screening proven to be effective
Performed by trained personnel
Must be dynamic
Repeated with periodic examination

Investigations

0-3 months

> 3months X-ray pelvis AP + abduction

Radiology
Early infancy: not reliable

Radiology
After 2-3 months: more reliable

Radiology
After 2-3 months: more reliable

27o

39o

Radiology
After 2-3 months: more reliable
Von Rosen view
in

out

in

out
in

out

Radiology
After 2-3 months: more reliable

in

out

Radiology
After 6 months: reliable

Radiology
After 6 months: reliable

Treatment - Aims
Obtain concentric reduction
Maintain concentric reduction
In a non-traumatic fashion
Without disrupting the blood supply to

femoral head

Treatment
Method depends on age
The earlier started, the easier it is
The earlier started, the better the results are
Should be detected EARLY

Treatment
Birth 6m
Pavlik harness or hip spica

6-12 m:
Closed reduction under GA and hip spica

12 - 18 m:
Open reduction

18 24 m:
Open reduction and Acetabuloplasty

2-8 years:
Open reduction, Acetabuloplasty, and femoral shortening

Above 8 years:
Open reduction, Acetabuloplasty cutting all three pelvic bones, and

femoral shortening

Treatment: Neonatal hip instability

Most resolve spontaneously
Can initially wait
Avoid adduction swaddle
Apply double diapers to bring back!!
See at 2weeks of age

Treatment: Neonatal hip instability

Unstable at 2 weeks:
Double / Triple diapers: inadequate
Gives illusion that patient is in treatment while

wasting valuable time

Treatment: Neonatal hip instability

Unstable at 2 weeks:
Pavlik Harness
Dynamic, effective, safe

Treatment: 6-12 m
Initially non-operative closed reduction UGA and

immobilization in hip spica cast

Position:
Avoid sever abduction
Avoid frog position

Must obtain stable concentric reduction,

otherwise needs surgery

Treatment: 6-12 m
Possibly closed reduction
Stable and concentric reduction

Possibly open reduction

Unstable or un-concentric reduction

Arthrography-guided

Treatment: 6-12 m
Arthrography-guided Closed Reduction

Treatment: 6-12 m
Arthrography-guided Closed Reduction

Too lateralized

Acceptable

Treatment: 18-24 m
Open reduction surgery
Possibly: Acetabuloplasty

Treatment: Above 2 years

Open reduction, and
Acetabuloplasty, and
Femoral shortening

Acetabuloplasties
Many types

Treatment
Birth 6m
Pavlik harness or hip spica

6-12 m:
Closed reduction under GA and hip spica

12 - 18 m:
Open reduction

18 24 m:
Open reduction and Acetabuloplasty

2-8 years:
Open reduction, Acetabuloplasty, and femoral shortening

Above 8 years:
Open reduction, Acetabuloplasty cutting all three pelvic bones, and

femoral shortening

CDH - Summary
Complex multi-factorial, endemic disease

Health education and Drs. awareness

Screening programs are needed
Learning proper examination methods

Identify at risk groups

Efficient referral system
Proper management by specialized Drs

Examples