developmental

dysplasia of the
hip (DDH)
Definisi
 The term developmental dysplasia of the hip
(DDH) represents a spectrum of conditions
affecting the proximal femur and acetabulum,
ranging from acetabular immaturity to hip
subluxation and frank hip dislocation.
Epidemiologi
 Insidensi:1 - 2 per 1000 bayi
 Perempuan> anak laki-laki
 Anak pertama
 Letak sungsang
 Lebih sering yg kiri
 Riwayat keluarga
 Kebiasaan membedong anak (geography)
Etiology multifaktorial
 Genetic:
 syndromic :
 Ehler’s Danlos
 Arthrogryposis
 Larsen’s syndrome

sex-linked
 Hormonal: oestrogen ; relaxin
 Mechanical: breech
liquor deficiency
Mechanical
 Left : Right – 4 : 1
 Breech : DDH ≥ x 10 (N.B. frank)
 Liquor ↓ : moulded baby
- plagiocephaly
- scoliosis
- foot deformity
- skew pelvis
Genetic / mechanical
Joint laxity
Acetabular and femoral version
Joint laxity
 Diagnosis
 Key physical findings :
 Asymmetry
 Limb length- Galeazzi
 Abduction ROM
 Skin folds
 Waddilng gait
Ortolani’s Maneuver
Barlow’s Maneuver
Galleazi sign
Trendelenburg sign
Tatalaksana
Dislokasi Sendi Panggul bawaan di koreksi berdasarkan umur.
 Terapi pada  bayi berusia kurang dari 6 bulan adalah dengan
memasang
 Pavlik Harness,  yaitu sebuah alat berbentuk M yang
dikenalkan oleh Arnold  Pavlik, ahli bedah ortopedi
berkebangsaan Ceznia, tahun 1950 .  Alat ini membantu
mendorong femur masuk ke dalam acetabulum. Alat ini
umumnya dipasang selama 3 sampai 9 bulan dan  tidak boleh
dibuka.  Orang tua akan mengalami kesulitan dalam
memandikan dan mengganti popok karena alat ini tidak boleh
dibuka. Tingkat keberhasilan alat ini mencapai 90%.   
Pelvik harness
Birth - Six months
 Pavlik harness
 Indications
 Fully reducible hip*
 Prevents hip adduction
 Child not attempting to stand
 Duration
 Childs age at hip stability + 3 months
Pavlik Harness
 Complications
 Avascular necrosis
 Forced hip abduction
 Safe zone (abd/adduction and flexion/extension)
 Femoral nerve palsy
 Hyperflexion

*Be aware of Pavlik Harness Disease

*Follow until skeletal maturity
0-3 bulan
 Observasi , double pampers
3-9 bulan
 Abduction splint
Birth - Six months
 Closed reduction + Spica
 Failure after 3 weeks of Pavlik trial
TX Summary
 Best if treated before 6 weeks of age
 0 - 6 months of age
 Pavlik
 6 - 18 months
 Closed vs open reduction and spica
 18 - 48 months
 Closed
 Open +/- osteotomies
DDH: what influences
arthritis risk?
Age at treatment
 Quality of reduction
 Stability
 AVN
Avascular Necrosis
 Most common
 Not part of the natural history of DDH
 Iatrogenic
 Etiology unknown
 Femoral head compression
 Injury to blood supply
 Excessive abduction
 Sullivan et al 1997
 Sig  blood flow w/ increasing abd angle