Has your doctor ever told you that your child has DDH? That may probably be the first time you have heard of it.
DDH in full is Developmental Dysplasia of the hip. This means that there is an abnormal development in the hip joint.
There are very many more names to describe DDH but the most common is congenital dislocation of the hip.
In this article, we shall discuss the common symptoms of DDH, who is at risk of getting DDH, and it’s treatment.
DDH as a condition is a spectrum spanning from just the abnormal appearance of the hip socket (acetabulum) to complete dislocation of the hip joint.
What are the symptoms of DDH?
- It’s painless. There is no pain in a hip that is born dislocated.
- One leg is longer than the other.
- There may be reduced abduction of the affected hip. Abduction of the hip is the movement where the leg moves away from the center of the body.
Do you need to see a paediatric orthopaedic surgeon?
Risk factors for developmental dysplasia of the hip
- Breech presentation. Breech means that the child’s legs are what appear first when a child is born instead of the head. Sometimes it can be interpreted as the child sitting in the uterus instead of the head being first.
- A positive family history of DDH
- First-born child
- Female gender
- Swaddling of babies
Investigations for DDH
The investigations of choice depend on the child’s age.
- Ultrasound scan of the hip joints.
This is recommended for children under 4 months of age. This is because the upper part of the femur is mostly cartilage which doesn’t display on x-ray.
- X-ray of the pelvis.
The x-ray is recommended for children over 4 months of age. The cartilage in the upper part of the femur has started to turn into bone and so will appear on the x-ray film.
- MRI scan of the hip joint
This is an advanced investigation that is used to visualize the head of the femur and other aspects of the hip joint.
It is also used after surgery to assess if the head is well reduced in the socket.
MRI scan is also used to check for adequate blood flow to the head of the femur especially following surgical treatment for DDH.
How is DDH treated?
Treatment of DDH depends on the severity.
Treatment is divided into operative and nonoperative care.
Non-operative care includes
- Observation
In this case, the child will get serial reviews from the doctor until the affected hip joints are deemed to be fine.
- Bracing; there is an array of braces on the market for the treatment of DDH. the most commonly used is the Pavlik Harness.
Operative treatment
This is further divided into soft tissue surgery and bony surgery
Soft tissue surgery; Release of tight adductor tendons, open reduction of the hips
Bone surgery; pelvic osteotomy, femoral osteotomy.
What happens if DDH is not treated?
There is a risk of early onset of hip arthritis leading to hip pain and so predisposes to the early need for total hip replacement surgery.
Also an untreated dislocated hip joint can lead to the child to walk with a limping gait.
Are children with DDH able to walk?
Yes, children with DDH are able to walk whether they have treatment or not. It’s just that the gait may be abnormal.
Conclusion;
DDH is a condition where there is an abnormal formation of the hip joint. The presentation of this condition is a spectrum. Treatment is available and varies from nonsurgical to surgical care.
