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]

[…] displacement of the joint with some contact remaining between the articular surfaces dislocation complete displacement of the joint with no contact between the original articular surfaces teratologic hip dislocated in utero and irreducible on neonatal exam presents [orthobullets.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]

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]

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

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

Conservative treatment with the Pavlik harness remains the most widely used treatment for DDH in infants. [clinicaladvisor.com]

treatment timing, based on the practitioner’s discretion. [thischangedmypractice.com]

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

Treatment of Hip Dysplasia with a Pavlik Harness. Image courtesy My Hipster Bub. Surgical Treatment If the above treatments are unsuccessful or if DDH is diagnosed late, open surgery or an open reduction is required. [revivephysio.com.au]

[…] 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]

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]

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]

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]

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 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]

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]

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

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]

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]

Cover the cast during feedings to prevent spills from entering the cast. Prevent small toys or objects from being put inside the cast. Elevate the cast above the level of the heart to decrease swelling. [texaschildrens.org]