‫ُأ‬

‫(َيْر َفِع ُهَّللا اَّل ِذيَن َآ َمُنوا ِم ْنُك ْم َو اَّل ِذيَن و وا‬
‫ُت‬
‫اْل ِع ْل َم َد َرَج اٍت َو ُهَّللا ِبَما َتْع َمُل وَن َخ ِبيٌر )‬

‫صدق هللا العظيم‬

‫سورة المجادلة (أية‪)11‬‬
DEVELOPMENTAL DYSPLASIA OF HIP (DDH)

DR. RAGAEE SAEED MAHMOUD

 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

It is a condition where the "ball and socket" joint of the hip does not

properly form in babies and young children. It's sometimes called

“congenital hip dislocation or hip dysplasia”. The hip joint attaches

the thigh bone (femur) to the pelvis (acetabulum).

In all cases of DDH, the socket (acetabulum) is shallow, meaning that the

ball of the thighbone (femur) cannot firmly fit into the socket.

Sometimes, the ligaments that help to hold the joint in place are

stretched. The degree of hip looseness, or instability, varies among

children with DDH and it can be classified as:

 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

1) Subluxatable: In mild cases, the head of the femur is simply

loose in the socket. During a physical examination, the bone

can be moved within the socket, but it will not dislocate.

2) Dislocatable (low dislocated): In moderate cases, the head

of the femur lies within the acetabulum, but can easily be

pushed out of the socket during a physical examination.

3) Dislocated (high dislocated): In the most severe cases of

DDH, the head of the femur is completely out of the socket.

WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

 Incidence: It increases on infants with other congenital

deformities such as torticollis or metatarsus adductus.

 Causes:
It can be present in either hip and in any individual. It usually
affects the left hip and is predominant in:
- Girls
- Firstborn children.
- Babies born in the breech position.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

- Oligohydramnios (low levels of amniotic fluid).

- Abnormal or absent muscle pull in utero-postnataly.
- Abnormal forces resulting from positioning and decreasing
space in utero.
 General symptoms:
- Legs of different lengths.
- Uneven skin folds on the thigh (asymmetry of thigh or gluteal
folds).
- Less mobility or flexibility on one side.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?
 Signs :
- In infants (below 2 months), Ortolani test and Barlow’s
maneuver are more reliable when infant is calm and not crying
to facilitate soft tissue relaxation, a clunk is a positive sign and
both hip should be tested separately. It can be applied in
bilateral cases.
- In older infant (3 to 8 months), limitation or asymmetry of hip
abduction ROM and apparent unequal femoral lengths
(appeared as unequal level height of both knees) refereed as
Galeazzi (Allis) sign. It applied in unilateral cases only.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

- In older children (about one year), who are ambulatory, DDH is

usually diagnosed by abnormal gait pattern. Children with
unilateral DDH had a positive trendelenburg gait while with
bilateral had a positive waddling gait.

 N.B
- Ultrasound is used when radiograph is not surely diagnosed.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?
 Barlow’s maneuver: Infant in supine, hip and knee
flexed 90 degree, index/middle fingers of therapist placed along
lateral aspect of thigh while thumb on the medial aspect of the
thigh (child’s knee joint on therapist’s palm) then bringing thigh
in the midline (direction of adduction) and mild pressure
downward (direction of force posteriorly) (Dislocatable cases).

https://www.youtube.com/watch?v=imhI6PLtGLc
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?
 Ortolani sign: Infant in supine, hip and knee flexed 90
degree, index/middle fingers of therapist placed along lateral
aspect of thigh while thumb on the medial aspect of the thigh
(child’s knee joint on therapist’s palm) then gently abduction
while lifting hip upward (direction of force anteriorly)
(Dislocated cases).
WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?
 Galeazzi (Allis) sign: Infant in supine, hip flexed 90
and both knees are full flexed (both ankles touched both
buttocks), both feet full contact on the surface and the level of
both knee joints are noted with a horizontal line to determine
the height of both knees. The test is applied in children with
unilateral cases between 3 to 8 months.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

 Treatment:
A) Goals:
- Return or maintain femoral head to its normal relationship
within the acetabulum.
- Maintain this relationship until the abnormal changes reverse.
-The earlier the treatment is initiated, the fewer abnormal changes
are present in the structures of hip joint to return their normal
relationship.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

B) Conservative treatment:
 Newborn to 6 months: Pavlik harness is used to maintain hip
joint in flexion and abduction position. If it is not properly
monitored, the complication may be presented such as a skin
irritation, vascular necrosis of the femoral head, femoral nerve
palsy and inferior dislocation of hip. It is worn 23 hours daily
(one hour for hygiene) for 6 to 8 weeks and then partial time
about 12 hour daily for another 6 to 8 weeks to enhance
stability of hip joint.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

 From 6 to 12 months:
- Traction for a period of time may be attempted to relocate hip
joint.
- Abduction orthosis may be more practicable than Pavlik harness
for ambulatory children.
- Closed reduction under anesthesia may be required with the
application of hip spica cast to maintain hip in its normal
located position.
 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

Abduction orthosis Pavlik harness

 WHAT IS DEVELOPMENTAL DYSPLASIA OF HIP?

c) Surgical treatment:
 From 12 to 24 months:
- It is applied if conservative treatment is not successful.
- Rarely the child’s hip will relocate without surgery.
- Release of tight soft tissue structures or osteotomy of proximal
femur to allow normal movement of femoral head on
acetabulum.
 N.B:
- A spica cast is usually applied during surgery to maintain hip on