1. CDH CONGENITAL DISLOCATION OF THE HIP
Dr. ABDULMONEM ALSIDDIKY , MD , SSCO.
Assistant Professor & Consultant
pediatric Ortho.& Spinal Deformities
KSU,KKUH
Riyadh , Saudi Arabia

2. Nomenclature CDH : Congenital Dislocation of the Hip
DDH : Developmental Dysplasia of the Hip

3. NORMAL PELVIS

4. Normal hip
Dislocated hip

5. Patterns of disease Dislocated Dislocatable Sublaxated
Acetabular dysplasia

6. Radiology
After 6 months: reliable

8. Causes (multi factorial)
Unknown
Hormonal
Relaxin, oxytocin
Familial
Lig.laxity diseases
Genetics
Female 4 X male --- twins 40%
Mechanical
Pre natal
Post natal

9. Mechanical causes Pre natal Post natal
Breach , oligohydrominus , primigravida , twins
(torticollis , metatarsus adductus )
Post natal
Swaddling , strapping

11. Infants at risk Positive family history: 10X A baby girl: 4-6 X
Breach presentation: 5-10 X
Torticollis: CDH in 10-20% of cases
Foot deformities:
Calcaneo-valgus and metatarsus adductus
Knee deformities:
hyperextension and dislocation

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

13. Clinical examination
The infant should be
quiet
comfortable

14. Look: External rotation Lateralized contour Shortening
Asymmetrical skin folds
Anterior – posterior

16. Move
Limited abduction

17. Special test Galiazzi Ortolani , Barlow test Trendelenburgh sign
Limping ( waddling gait if bilateral)

18. Special test
Galiazzi test

19. Special test
Ortolani test

20. Special test
Barlow test

21. Special test
Trendelenburgh sign

22. Screening programs Clinical screening proven to be effective
Performed by trained personnel
Must be dynamic
Repeated with periodic examination
U/S screening is controversial

23. Investigations
0-3 months U/S
> 3months X-ray pelvis AP + abduction

24. U/S Screening
Incidence of hip stability declines rapidly to 50% within the first week of neonatal life.
Better to delay U/S screening

25. U/S - Problems Too sensitive: Operator-dependant
Detects a lot of hip abnormalities, most of which would develop normally if left alone
Operator-dependant

26. Radiology
Early infancy: not reliable

27. Radiology
After 2-3 months: more reliable

28. Radiology
After 2-3 months: more reliable
39o
27o

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

30. Radiology
After 2-3 months: more reliable
out in

31. Radiology
After 6 months: reliable

32. Radiology
After 6 months: reliable

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

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

35. Treatment Birth – 6m 6-12 m: 12 - 18 m: 18 – 24 m: 2-8 years:
Pavlik harness or hip spica
6-12 m:
Closed reduction under GA and hip spica 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

36. Treatment: Neonatal hip instability
Most resolve spontaneously
Can initially wait
Avoid adduction swaddle
Apply double diapers – to bring back!!
See at 2weeks of age

37. Treatment: Neonatal hip instability
Unstable at 2 weeks:
Double / Triple diapers: inadequate
Gives illusion that patient is “in treatment” while wasting valuable time

38. Treatment: Neonatal hip instability
Unstable at 2 weeks:
Pavlik Harness
Dynamic, effective, safe

39. 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

40. Treatment: 6-12 m Possibly closed reduction Possibly open reduction
Stable and concentric reduction
Possibly open reduction
Unstable or un-concentric reduction
Arthrography-guided

41. Treatment: 6-12 m Possibly closed reduction Possibly open reduction
Stable and concentric reduction
Possibly open reduction
Unstable or un-concentric reduction
Arthrography-guided

42. Treatment: 6-12 m
Arthrography-guided Closed Reduction

43. Arthrography-guided Closed Reduction
Treatment: 6-12 m
Arthrography-guided Closed Reduction
Too lateralized
Acceptable

44. Treatment: m
Open reduction – surgery
Possibly: Acetabuloplasty

45. Treatment: Above 2 years
Open reduction, and
Acetabuloplasty, and
Femoral shortening

46. Acetabuloplasties
Many types

48. Treatment Birth – 6m 6-12 m: 12 - 18 m: 18 – 24 m: 2-8 years:
Pavlik harness or hip spica
6-12 m:
Closed reduction under GA and hip spica 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

49. 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

52. Examples

57. THANKS