Developmental Dislocation of the Hip

The incidence is approximately 1:1000 live births. Girls have a 6:1 ratio of presentation compared to boys. A breech presentation also is a risk factor for DDH. DDH should not be confused with teratologic hip dislocation, which is diagnosed in-utero. If left untreated, or undiagnosed, DDH can lead to the development of both hip dysplasia and osteoarthritis later in life, as well as painful disability and a limp. DDH is diagnosed early in life by formal physical examination, ultrasound scanning and/or radiographs (xrays) of the hips, at which point pediatric orthopedic consultation and referral is sought. Treatment of DDH is age-dependent. Bracing using Pavlik harness is described in the first year of life; this harness works by keeping the leg(s) in flexion and abduction (a leg-separated position). Pavlik harness splinting has a success rate of ~90%, and not indicated for neurological causes of DDH, such as spina bifida and/or cerebral palsy. Other non-operative options include spica casting for up to 6 weeks. If presented late, or in case of non-operative methods fail to reduce the hip into a normal position, surgery is then indicated. The surgery is either just an open procedure in which the hip is reduced into the socket, or in addition, a pelvic, and sometimes, femoral osteotomy is required to ensure good coverage; If indicated, a small shortening of the femur is sometimes required; however this has a minute effect on overall limb length discrepancy later in life.