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

stable at
Stable Irreducible
extremes

Spika 6 weeks, OR +/-

reassess then tenotomy/ pelvic
Treatment
spika for 6 more OR osteotomy/femora
weeks l shortening
 OR
Medial Anterolateral

<1 year any age

Avoid splitting
Splitting needed
apophysis

cannot address all

can address
problems

Risk MCFA Risk LFCN

 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