Hip developmental dysplasia: Description, Causes and Risk Factors:Abbreviation: Developmental dysplasia of the hip (DDH).Hip developmental dysplasia is an abnormal development of the hip joint. The ball at the top of the thighbone (called the femoral head) is not stable within the socket (called the acetabulum). The ligaments of the hip joint which hold it all together may also be stretched and loose. Sometimes hips dislocate after birth and may not be noticed until the child starts to walk.Developmental dysplasia of the hip is more common in girls, firstborn children, babies born in the breech position (bottom-first) and in families where a parent has had a dislocated hip joint. Hip developmental dysplasia can be in one or both hip joints.Pregnant mothers secrete hormones in their bloodstream which allows their ligaments to relax. This helps the delivery of the baby through the pelvis. Some of these hormones enter the baby's blood, which can make the baby's ligaments also relaxed. This can loosen the hip joint in the socket. The way the baby lays in the womb can also cause the hip joint to become loose or dislocate.Hip developmental dysplasia occurs in 11.5/1,000 infants, with frank dislocations occurring in 1-2/1,000 infants. The left hip is involved in 60% of cases, the right in 20%, and both hips in 20%. The left hip is affected more than the right because the left hip is forced into adduction (with limited abduction) against the mother's sacrum in the typical intrauterine position.The incidence of Hip developmental dysplasia varies with factors such as age, race, sex, the experience and training of the examiner, and the diagnostic criteria that is used. Hip developmental dysplasia is believed to be multifactorial, with physiologic, genetic, and mechanical factors implicated in the etiology. Risk factors for a positive newborn screening include female sex (19/1,000 risk), positive family history (boys 9.4/1,000; girls 44/1,000) and breech presentation (boys 26/1,000; girls 120/1,000). The incidence of DDH has been observed to be as high as 34% in family history and sibling and twin studies, supporting the role of a strong genetic influence. DDH is much more common among female patients (80%) and children born breech. Although breech presentation occurs in fewer than 5% of all newborn births. In the breech position, knee extension of the fetus will result in sustained hamstring forces about the hip with subsequent hip instability. There are twice as many female infants as male infants who present in the breech position, and 60% of all breech presentations are noted in firstborn children. Girls are also much more susceptible to the maternal hormone relaxin (hormone secreted by the corpus luteum during the last days of pregnancy; relaxes the pelvic ligaments and prepares the uterus for labor), which may also contribute to ligamentous laxity and subsequent hip dysplasia.Symptoms:A stiff hip joint.
The legs are different lengths.
Your child may lean to the affected side when standing.
Their leg may turn outward on the affected side.
The skin folds may be uneven on their bottom.
Diagnosis:Early detection and diagnosis of Hip developmental dysplasia allows for simplerand much more effective treatment. Therefore, screeningfor DDH by physical examination is of the utmostimportance for all pediatric healthcare providers. To screen effectively for Developmental dysplasia of the hip , both hips shouldbe evaluated as a routine part of every neonatal and infantphysical examination. Providers should realize thateven an ideal screening program could produce both falsenegatives and positives. To diagnose andmanage DDH correctly, healthcare providers must alsohave a thorough understanding of the normal growth anddevelopment that occurs in the hip joint.Treatment:Researchhas shown that it is the initial treatment provider whohas the greatest chance of successfully achieving a normalhip in patients with DDH. Themanagement of DDH is aimed toward early detection,treatment, and prevention or early recognition of complications.Treatment Options Include:Splints: Babies with Hip developmental dysplasia can be successfully treated with a special splint. The splint holds the hip joint in the correct position so that the ligaments tighten. Your child may need to wear the splint for several months - until the hip is stable or x-rays are normal. One splint often used is called a `Pavlik Harness'.
Hip spicas: A hip spica is a plaster cast that covers their body from the knees to the waist. Hip spicas may need to be worn for a number of months. Children may then need to wear different splints or braces to make sure the hip joint remains stable and in the right position.
Closed reduction procedure: If splinting does not work, your child may need a procedure called a 'closed reduction'. The hip joint is moved into the correct position while your child is asleep under anesthetic. Children then need to wear a 'hip spica' plaster cast to keep the hip in the right position.
Open reduction' surgery: Sometimes, when the above treatments do not work or DDH is diagnosed late, your child may need what is called an 'open reduction'. The hip joint is moved into the correct position while your child is asleep under anesthetic. The hip joint is made more stable by surgery to the surrounding tendons. This is done through a small cut in the groin. Children then need to wear a 'hip spica' to keep the hip in the right position.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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