3 learning resources available for this topic
Developmental dysplasia of the hip (DDH) is a spectrum of hip abnormalities ranging from mild acetabular dysplasia to complete hip dislocation, occurring in approximately 1-3 per 1000 births. It is more common in females, firstborns, and infants with breech presentation or family history. Early detection and treatment are crucial to prevent long-term complications such as avascular necrosis and early arthritis.
DDH results from abnormal development of the hip joint during fetal development or early infancy, leading to inadequate formation of the acetabulum and instability of the femoral head. Contributing factors include genetic predisposition, hormonal influences (particularly maternal relaxin), mechanical factors such as breech positioning, and postnatal positioning practices. The condition exists on a spectrum from subtle acetabular underdevelopment to complete dislocation where the femoral head sits entirely outside the acetabulum.
Diagnosis relies on physical examination findings including positive Ortolani and Barlow tests in newborns, asymmetric skin folds, limited hip abduction, and leg length discrepancy in older infants. Ultrasound is the imaging modality of choice in infants under 6 months, while radiographs become more useful after ossification begins. Treatment varies by age and severity, ranging from observation and monitoring to Pavlik harness application in infants, and surgical intervention including closed or open reduction with possible osteotomy in older children.