CDH

Definition

Developmental dysplasia of the hip (DDH) is a problem with the shape of the hip joint. The condition is found in babies or young children.

Alternative Names

Causes

The hip is a ball and socket joint. The ball, called the femoral head, comes from the top part of the thigh bone (femur) and the socket (acetabulum) comes from the pelvis. Developmental hip dislocation depend on how badly deformed the hip is. The hip may be all the way out of the joint or the socket may be a little shallow.

The cause is unknown, but genetic factors may play a role. Problems resulting from very mild developmental dysplasia of the hip may not be seen until the person is in their 30's or 40's.

One or both hips may be involved. Risk factors include being the first child, being female, a breech delivery, and a family history of the disorder. It occurs in about 1 out of 1,000 births.

Symptoms

• Reduced movement in the affected side
• The leg may seem shorter on the affected side
• The leg positions may be different (asymmetric)
• The folds on the thigh fat may seem uneven
• After 3 months of age, the affected leg may turn outward or be shorter than the other leg

Exams and Tests

Pediatricians routinely screen all newborns and infants for hip dysplasia. There are several methods to detect a dislocated hip or a hip that is able to be dislocated.

A hip that is truly dislocated in an infant should be seen, but some cases are mild and some develop after birth, which is why multiple examinations are recommended. Some mild cases are silent and cannot be found during a physical exam.

Ultrasound of the hip is the most important method to show hip deformity. A hip x-ray (joint x-ray) may be helpful in older infants and children.

Treatment

In early infancy, positioning with a device to keep the legs apart and turned outward (frog-leg position) will usually hold the hip joint in place. If there is a problem in maintaining proper position, a cast may be place on the child's leg and changed as the child grows.

Surgery may be necessary if early measures to put the joint back in place are unsuccessful or if the defect is first detected in an older child.

Outlook (Prognosis)

If the dysplasia is picked up in the first few months of life, it can almost always be treated successfully with bracing. In a few cases, surgery is necessary to put the hip back in joint. An older age at diagnosis may be associated with a worse outcome and may necessitate more complex surgery to repair the problem.

Possible Complications

• Skin irritation from reduction devices
• Untreated, will lead to arthritis and deterioration of the hip which can be severely debilitating
• Limb length discrepancies may persist despite appropriate treatment

When to Contact a Medical Professional

Call your health care provider if you suspect that your child's hip is not properly positioned.

Prevention

Prevention is probably not possible, but early detection and treatment before complications occur is of paramount importance.

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