Developmental Dysplasia of the Hip (DDH) Presented By: Alaitia Enjady & Esther Kim

What is it? Previously known as Congenital Dislocation of the Hip Abnormal formation of hip joint where acetabulum is shallow, causing ball of the femur to be loose in the socket Ligaments that hold joint in place stretched renamed to show better how there are different degrees of abnormality (not just dislocated hips)

Develop during child’s first year Severity Onset Present at birth Develop during child’s first year Severity Can affect either hip, but most common in left hip Degree of hip instability varies: Dislocated- head of femur completely out of socket Dislocatable- head of femur w/in acetabulum but easily pushed out of socket Subluxatable- loose in socket, can be moved w/in socket but does not dislocate

In the U.S. about 1 to 2 babies per 1000 are born with DDH Prevalence In the U.S. about 1 to 2 babies per 1000 are born with DDH

Etiology Cause unknown, but condition related to several factors: Family Hx Gender (Female> Male) Race (Native Americans) Oligohydramnios- low volume of amniotic fluid Born in breech position First born Improper swaddling that forces hip adduction Frequency of hip dysplasia is 10 times higher in children whose parents had DDH

Clinical Presentation Left hip > Right hip Positive Special Tests Ortolani maneuver Barlow test Galeazzi Symptoms Different leg lengths Asymmetrical skin folds on thigh Decreased mobility/flexibility on one side Limping, toe walking, waddling gait The left hip is more commonly associated with DDH than the right hip, possibly because of the common intrauterine position of the left hip against the mother's sacrum, which forces it into an adducted position. Bilateral dislocation of the hip, especially at a later age, can be quite difficult to diagnose. This condition often manifests as a waddling gait with hyperlordosis. Galeazzi- when hip and knees flexed, knees on involved hip lower

Case Study Meet our patient Skyler Getchman. A baby diagnosed with hip instability in the form of developmental dysplasia of the hip (DDH). https://www.youtube.com/watch?v=k0HWHx1XLMc

Use of Orthotics Pavlik harness Denis Browne Bar

Treatment Spica Cast Hip abduction Brace Von Rosen Splint Pavlik Harness: Soft positioning device worn for 1-2 months to keep the bone in the socket Denis-Browne Bar: Thigh and hip bone contact to keep hip in a flexed and abducted position Hip Abduction Brace: More rigid cast to keep hip in position Closed Reduction: Doctor places hip in position and child is put in spica cast to keep hip in right position Open Reduction- open procedure where femur is shortened and child is casted to keep proper hip positioning for healing Von Rosen Splint- Hip must be flexed to 90 degrees & abducted to 60-70 degrees http://www.rch.org.au/kidsinfo/fact_sheets/dennis_browne_ba r_for_ddh/

Treatment cont... Closed Reduction Open Reduction Usually done with traction Followed by a spica cast Open Reduction More invasive

Take Home Message Needs to be addressed as early as possible At greater risk with family hx of DDH Early interventions include braces and casting More invasive treatments later on Proper treatments can prevent future OA & hip replacement

References Developmental Dislocation (Dysplasia) of the Hip (DDH). American Academy of Orthopedic Surgeons Website. http://orthoinfo.aaos.org/topic.cfm?topic=a00347. Updated October 2013. Accessed July 16, 2016. Developmental Dysplasia of the Hip: Background, Anatomy, Pathophysiology. Emedicinemedscapecom. 2016. Available at: http://emedicine.medscape.com/article/1248135- overview#showall. Accessed July 19, 2016. Developmental Dysplasia of the Hip. International Hip Dysplasia Institute. 2016. Available at: http://hipdysplasia.org/developmental-dysplasia-of-the-hip/. Accessed July 19, 2016. Melbourne T. Kids Health Info : Denis Browne Bar for DDH. Rchorgau. 2016. Available at: http://www.rch.org.au/kidsinfo/fact_sheets/dennis_browne_bar_for_ddh/. Accessed July 19, 2016. Hip Pain in a Teenaged Girl | Consultant for Pediatricians. Pediatricsconsultant360com. 2011. Available at: http://www.pediatricsconsultant360.com/content/hip-pain-teenaged-girl. Accessed July 19, 2016.

Questions?