DDH Developmental Dislocation of Hip

Fahad H. Al Hulaibi

Orthopedic Resident

NGH

DEVELOPMENTAL

DYSPLASIA OF THE HIP

Abnormal relationship between acetabulum & femoral head

resulting :

Dysplasia, possible subluxation &dislocation of the hip.

DEFINITION

most common orthopedic disorder in newborns

most common in left hips in females

bilateral in 20%

EPIDEMIOLOGY

1st born

Female ×5

Breach presentation 3%

Large baby

+ve family history 10%

Oligohydraminous.

RISK FACTORS

Cambpell’s

Initial instability

(maternal and fetal laxity, genetic laxity, and intrauterine and

postnatal malpositioning )

leads to dysplasia

leads to gradual dislocation

PATHOPHYSIOLOGY

Typically:

Antero-lateral of acetabulum

In CP patient:

Posterio-superior of acetabulum

WHERE IS THE DEFICIENCY

Torticollis in 8%

ASSOCIATED CONDITIONS

Cambpell’s

Metatarsus adductus (10%)

ASSOCIATED CONDITIONS

Spine anomaly

ASSOCIATED CONDITIONS

- Vital signs

- Wight

- Height

- HC

- Head to toe examination.

- Look for associated conditions. ( neck, spine, foot)

GENERAL EXAMINATION

Pt < 3 month

- Barlow test.

- Ortolani test.

- Galeazzi test.

Pt > 3 month

- Limitation in Abduction.

- LLD.

Pt > 1 year

- Pelvic obliquity.

- Lumbar lardosis.

- Trendelberg gait.

- Toe walking.

LOCAL EXAMINATION

after the femoral head begins to ossify 4-5 Month

IMAGING

<25 >25

useful before femoral head ossification (<4 -6 mos)

ULTRASOUND

> 60

< 55

alpha angle

angle created by lines along the bony acetabulum and the ilium

normal is greater than 60°

beta angle

angle created by lines along the labrum and the ilium

normal is less than 55

ARTHROGRAM

Inverted labrum

Inverted limbus

Transverse acetabular ligament

Pulvinar

Thick ligamentous teres

Iliopsoas tendon contracture.

OBSTACLES THAT BLOCK REDUCTION

after reduction and hip spica

CT SCAN

Treatment

< 6 months & reducible hip

Success rate up to 95% ( C a m b p e l l )

PAVLIK HARNESS

Complication of pavlic harness: < 1%

1. AVN.

In extreme abduction

2. femoral nerve palsy

In hyper flexion

( C a m b p e l l )

When to say It’s failed Pavlic harness ?

3 to 4 weeks with no improvement

Pavlic harness failed

Patient 6-18 months

CLOSED REDUCTION, HIP ARTHROGRAM,

ADDUCTOR TENOTOMY + HIP SPICA

DDH > 2 yr with residual hip dysplasia

failure of closed reduction

Increased Acetabular index.

OPEN REDUCTION, PELVIC OSTEOTOMY

+_ FEMORAL SHORTENING

Femoral anteversion

Coxa valga

FEMORAL SHORTENING

PELVIC OSTEOTOMIES

Ost Age Coverage correction Hinge Contraindications

Salter 1-9 years Supero-

lateral

10-15 Symphysis • Posterior wall

deficiency

• Neurogenic hips

Pember-

Dega

18 mth All 10-40 Triradiate Coxa Magna

Double-

triple

8-15

years

Supero-

lateral

10-50 Symphysis

Open triradiate

Ganz Closed

triradiate

All 10-60

Most

Separate Open triradiate

Shelf Closed

triradiate

All - - Open triradiate

Chiari Closed

triradiate

All - - Open triradiate

COMPLICATIONS

Redislocation

Residual dysplasia

Lateralization

Stiffness

Impengement

Early OA

AVN

THANK YOU