References: [4] Diagnostics Screening Physical examination must be performed at every well-baby visit for up to 6 months Screening with imaging is recommended up to 6 months of age only if one or more of the following risk factors are present Breech presentation [amboss.com]

As noted above, breech presentation may be the most important single risk factor, with DDH reported in 2 to 27% of males and females presenting in the breech position. [uwhealthkids.org]

In the present study, DDH was more common among girls (85.8%) with a male to female ratio of 1:6. [thejhs.org]

Of special value is the thorax and various conditions that exhibit that sign. presentation of variability of the condition with age. [books.google.com]

Case 1 This boy presented to the OI team at the age of 7 months. He was born by spontaneous vaginal delivery in a breech presentation following an uneventful pregnancy. [journals.lww.com]

• Pain

  The pain from this condition can be in the hip, thigh or knee area. [scottishritehospital.org]

  Some common symptoms of hip dysplasia include: -Pain in the groin or side of the hip -A sensation of “catching” or “popping” with activity -Worsening pain with sitting, walking or running -Limping -Increased difficulty with strenuous activities Diagnosis [ortho.wustl.edu]

  Complications Complications of DDH Residual acetabular dysplasia, subluxation, and/or redislocation despite treatment Early osteoarthritis in the hip joint Leg length discrepancy → back pain, functional scoliosis, and/or knee pain Genu valgum Complications [amboss.com]

  Over time, painful arthritis will develop in the untreated hip joint. [rch.org.au]

  Only one patient was followed up at one year with no pain, full range of motion and stable. [ncbi.nlm.nih.gov]

• Disability

  Please enable JS and disable any ad blocker [diagnosticimaging.com]

  Prognosis If diagnosed before 6 months of age, 80-95% have normal development of the hips Later diagnosis and treatment associated with development of avascular necrosis, osteoarthritis, and functional disability in adulthood. References Ballock, R. [pedclerk.bsd.uchicago.edu]

  DDH Screening The goal of screening programs is early detection and prevention of future disability from medical diseases. [uwhealthkids.org]

  Nearly all babies who are diagnosed with DDH go on to have a healthy, active life, with no disability. [nct.org.uk]

  Avascular necrosis (AVN) is considered to be the most significant complication following treatment for DDH because of the consequent early onset of progressive osteoarthritis, disability and the need for total hip arthroplasty at a young age [ 6 ]. [link.springer.com]

• Difficulty Walking

  This can lead to: A shortened leg Arthritis Difficulty walking Long-term pain Symptoms In an infant, developmental dysplasia of the hip can result in the following: One leg is shorter than the other. [drugs.com]

  If cases of congenital hip dysplasia go untreated, the child will have difficulty walking, which could result in life-long pain. [medical-dictionary.thefreedictionary.com]

  If left untreated, the child will have difficulty walking and may experience life-long pain. If diagnosed early, congenital hip dysplasia treatment is highly effective. [healthofchildren.com]

• Hip Dislocation

  […] of contractures around the hip Problems associated with leg length discrepancy (e.g., abnormal gait, scoliosis, lordosis) Accelerated osteoarthritis of the hip Teratologic hip dislocation Hip dislocation occurs early in-utero (especially around the 12 [amboss.com]

  Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It’s caused by abnormal formation of the hip joint during their early stages of fetal development. [healthline.com]

  Bilateral hip dislocations are much better tolerated than unilateral hip dislocations. Patients with bilateral dislocations often have no symptoms other than an altered gait. [clinicaladvisor.com]

  […] foramen, in dislocated hip this line is broken. 14. [slideshare.net]

  These names include: Hip Dysplasia Developmental Dislocation of the Hip (DDH) Hip Dislocation Developmental Dysplasia of the Hip (DDH) Acetabular Dysplasia Congenital Dislocation of the Hip (CDH) The term Congenital Dislocation of the Hip (CDH) tends [hipdysplasia.org]

• Joint Dislocation

  Synonym(s): developmental hip dysplasia. congenital hip dysplasia malformation of the hip joint, noted at birth; characterized by hip joint dislocation and/or reduced range of hip joint motion on the affected side [medical-dictionary.thefreedictionary.com]

  J Am Acad Orthop Surg 8: 232–242 Google Scholar Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasound compound treatment. [link.springer.com]

  Early diagnosis and treatment of congenital dislocation of the hip joint in the newborn. J Bone Joint Surg [Br]. 1962;44-B:292–301. 17. von Rosen S. Diagnosis and treatment of congenital dislocation of the hip in the newborn. [aafp.org]

  A decrease in the incidence of late hip dislocation has also been shown. [ijri.org]

  J Bone Joint Surg [Br] 1962 ; 44 : 284 –91. ↵ Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg [Br] 1962 ; 44 : 292 –301. ↵ Boere-Boonekamp MM, Verkerk PH. [fn.bmj.com]

• Fracture

  When the harness was put on, fractures of both femurs, the proximal left tibia, and the proximal right fibula were noted. [journals.lww.com]

  Conventional femoral prosthesis (cemented and uncemented) often can fracture the narrow proximal bone. [omicsonline.org]

  Femoral fractures in conjunction with total hip replacement. J Bone Joint Surg Am (1975) 57(4):494–501. PubMed Abstract | Google Scholar 16. Morag G, Zalzal P, Liberman B, Safir O, Flint M, Gross AE. [frontiersin.org]

  Horizontal or close to horizontal screw placement increases screw fracture and graft resorption or migration. [josr-online.biomedcentral.com]

  Occult hip and pelvic fractures and accompanying muscle injuries around the hip. Arch Orthop Trauma Surg 132: 105-112, 2012. [hama-med.ac.jp]

• Joint Subluxation

  2017/5/2/87/205076 Introduction Developmental dysplasia of the hip (DDH) is a spectrum of disorders that range from subluxation to complete dislocation of the hip joint. [thejhs.org]

• Fear

  […] boys (80%) and only 1 girl (20%), which is in contrast with the female predominance for hip dysplasia (81% female predominance) in the general population. 20 Hip dysplasia was diagnosed late in 4 children because of the rarity of this association and fear [journals.lww.com]

• Confusion

  A true + Ortolani or Barlow is a “clunk”; do not confuse this with a mild, high pitched “clink”, which is benign (surface tension or tendon snapping) Ortolani and Barlow are most useful only in the first 3 months of life For children aged 3-12 months, [pedclerk.bsd.uchicago.edu]

  This should not be confused with high pitched hip clicks often elicited with hip flexion and extension. [uwhealthkids.org]

  In children with arthrogryposis or skeletal dysplasias, confusion can occur due to difficulty in determining the normal landmarks of the proximal femur. [ijri.org]

• Abnormal Gait

  gait, scoliosis, lordosis) Accelerated osteoarthritis of the hip Teratologic hip dislocation Hip dislocation occurs early in-utero (especially around the 12 th week of gestation) → abnormal hip development in-utero A pseudoacetabulum is present at birth [amboss.com]

KEYWORDS: Hip; Salter; dysplasia developmental; osteotomy; treatment [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

The short treatment duration seems ascribable to the early treatment initiation, and delayed treatment would be expected to require a longer treatment duration. [em-consulte.com]

No single treatment method will work for all patients, and no single treatment consistently prevents the development of femoral head deformity. [scottishritehospital.org]

[…] detection of treatment failure. [ijoonline.com]

The satisfactory prognosis associated with early treatment of severe congenital dislocation of the hip joint underlines the advisability of scheduling routine hip screening programs to ensure early diagnosis and effective treatment of the disorder. [ncbi.nlm.nih.gov]

In individuals for whom the diagnosis is made later, the prognosis is not as positive. These children may require more extensive surgery. After surgery, however, the prognosis for normal development of the hip and leg is excellent. [healthofchildren.com]

[…] age 3 months, the deformity is expected to persist without treatment; - type III: dislocation - acetabulum is shallow; - cartilaginous roof is displaced with eversion of labrum; - type IV: high dislocation - acetabular cup is flat and has the worse prognosis [wheelessonline.com]

Prognosis If diagnosed before 6 months of age, 80-95% have normal development of the hips Later diagnosis and treatment associated with development of avascular necrosis, osteoarthritis, and functional disability in adulthood. References Ballock, R. [pedclerk.bsd.uchicago.edu]

Etiology The exact etiology remains unknown but a number of risk factors have been associated with DDH Family history Breech presentation Inadequate intrauterine space for the fetus ; (e.g., oligohydramnios, first born child, twins, large birth weight [amboss.com]

[…] presentation and mechanical, familial, and hormonal factors all contributing; female predominance is 6:1. con·gen·i·tal hip dys·pla·si·a ( kŏn-jen'i-tăl hip dis-plā'zē-ă ) A developmental abnormality in which a neonate's hips easily become dislocated; etiology [medical-dictionary.thefreedictionary.com]

Genetic and environmental factors in the etiology of congenital dislocation of the hip. Clin Orthop Relat Res. 1964 Mar-Apr. 33:119-28. [Medline]. Salter RB. Etiology, pathogenesis and possible prevention of congenital dislocation of the hip. [emedicine.medscape.com]

Etiology Generalized relaxation of the hip joint. -Family history. -Generalized ligamentous Laxity; due to maternal estrogen and other hormones “which prevents the maturation of collagen”. -Primigravida. -Breech presentation. -Oligohydramnios. [slideshare.net]

Etiology Multifactorial + family history in 20% incidence of breech 30-50%, thought to be secondary to stretching of the hip capsule. 15% associated with congenital muscular torticollis, 1-10% associated with metatarsus adductus Majority of infants have [pedclerk.bsd.uchicago.edu]

Sami populations Low incidence in Chinese and black populations References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011;2011:238607. 12. Moosa NK, Kumar PT, Mahmoodi SM. Incidence of developmental dysplasia of the hip in Dubai. Saudi Med J 2009;30:952-5. 13. Mirdad T. [thejhs.org]

An epidemiological assessment of neonatal screening for dislocation of the hip. J R Coll Physicians Lond. 1986;20:56–62. 25. Jones DA. Principles of screening and congenital dislocation of the hip. Ann R Coll Surg Engl. 1994;76:245–50. 26. [aafp.org]

Developmental dysplasia of the hip: epidemiology and pathogenesis. UpToDate 03 Jul Rosenfeld. 2018b. Developmental dysplasia of the hip: treatment and outcome. UpToDate 03 Jul Shorter D, Hong T, Osborn DA. 2013. [babycentre.co.uk]

The epidemiology of developmental dysplasia of the hip in males. Acta Ortop Bras. 2020; 28(1): 26-30. https://doi.org/10.1590/1413-785220202801215936 Olivo Rodríguez AG, Redón Tavera A. [revistamedicasinergia.com]

The harness should be worn for 23 hours in a day for at least 6 weeks The goal of treatment is to create a physiologic concentric reduction to promote normal bone modeling in the acetabulum and normal ossification of the femoral head (see “Pathophysiology [amboss.com]

[…] femoral anteversion Hip may be subluxatable or dislocated (reducible or irreducible) a dysplastic hip does not necessarily need to be subluxated a subluxated hip is dysplastic by definition Subluxation invariably leads to degenerative joint disease Pathophysiology [orthopaedicsone.com]

[…] the fetal uterus breech more commonly seen in female children, firstborn children, and pregnancies complicated by oligohydramnios higher risk of DDH with frank/single breech position compared to footling breech position family history oligohydramnios Pathophysiology [orthobullets.com]

In the clinical context of caring for infants, would a clinic practice model that takes into account the contributions of patient’s values, understanding pathophysiology of disease, and a physician’s clinical experience such as the one used in the 2000 [uwhealthkids.org]

It is important to understand the pathophysiology of DDH. [ijri.org]

The primary goals of treatment for Perthes disease are to alleviate pain and to prevent lasting deformity of the femoral head. [scottishritehospital.org]

The goal, though, is to prevent these signs from manifesting by correcting DDH in early childhood. [pedclerk.bsd.uchicago.edu]

Prevention Prevention includes proper prenatal care to determine the position of the baby in the womb. This may be helpful in preparing for possible breech births associated with hip problems. [healthofchildren.com]

Avoiding excessive and prolonged infant hip adduction may help prevent strain on the hip joints. Early diagnosis remains an important part of prevention of congenital hip dysplasia. [medical-dictionary.thefreedictionary.com]

The USPSTF Report on DDH Screening The USPSTF is composed of a panel of national experts in evidenced based medicine and prevention that provide evidence-based recommendations about clinical preventive services such as screening. [uwhealthkids.org]