From the Guidelines
Hip dysplasia, also known as Developmental Dysplasia of the Hip (DDH), is a condition where the hip joint doesn't develop properly, causing the ball and socket to fit together incorrectly, and can lead to instability, pain, and eventually arthritis if left untreated. This developmental abnormality occurs when the hip socket (acetabulum) is too shallow or the ball (femoral head) is not properly seated in the socket 1. Hip dysplasia can be present at birth (congenital) or develop during periods of growth, and it ranges from mild to severe. The condition creates instability in the joint, leading to abnormal wear on the cartilage, which can cause pain, limping, and eventually arthritis. In infants, it may be detected during routine screenings, while in older children and adults, symptoms often include pain in the hip or groin, a sensation of instability, and limited range of motion.
Risk Factors and Screening
The most important risk factors for DDH are female gender, breech positioning in utero, and a positive family history, carrying relative risks of 2.5,3.8, and 1.4, respectively, in a large meta-analysis 1. Other risk factors include infant swaddling, and the left hip is three times more frequent to have DDH with a relative risk of 1.5 1. The American Academy of Pediatrics (AAP) recommends selective screening of children with risk factors or based on physical examination findings 1.
Diagnosis and Treatment
Diagnosis of DDH can be made through physical examination, including the Barlow and Ortolani tests, and imaging studies such as ultrasound and X-rays 1. Treatment depends on age and severity, ranging from simple harnesses or braces for infants (like the Pavlik harness), to physical therapy for mild cases in adults, to surgical interventions such as osteotomy (cutting and repositioning bones) or total hip replacement for severe cases 1. Early detection and treatment are crucial to prevent long-term complications and joint damage, as late presentation is a major negative prognostic factor, with these patients more likely to require complex treatment and surgical intervention 1.
From the Research
Definition and Overview of Hip Dysplasia
- Hip dysplasia, also known as Developmental Dysplasia of the Hip (DDH), is a treatable developmental disorder that presents early in life but can lead to chronic disability if neglected 2.
- It is a spectrum of disorders that results in anatomic abnormalities leading to increased contact stress in the joint and, eventually, secondary osteoarthritis 3.
- DDH is a condition in which the 'ball and socket' hip joint fails to form properly during infancy, leading to increased mechanical stress on the hip joint and contributing to the development of osteoarthritis during adulthood 4.
Causes and Risk Factors
- The main causes of hip dysplasia in the young adult are residual childhood developmental dysplasia of the hip (DDH) and adolescent-onset acetabular dysplasia 2.
- Routine screening for DDH and counseling regarding risks for acetabular dysplasia in families with a history of early hip osteoarthritis may allow early identification and intervention in these hips with anatomical risk factors for joint degeneration 2.
- Being born breech may also be a risk factor for late presenting DDH, even with a normal hip ultrasound at 6 weeks of age 4.
Consequences and Treatment
- Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip 5.
- Early diagnosis and appropriate treatment for DDH are of the utmost importance to prevent the occurrence of premature wear of the joint, curvature of the spine, significant shortening of the limb, deformities in the knee and the contralateral hip, as well as pain and loss of joint mobility 6.
- Treatment options include joint-preserving procedures such as pelvic osteotomy, capsular arthroplasty, arthroscopy, and femoral head-neck junction osteochondroplasty, as well as total hip replacement for more arthritic joints 5, 3.