What are the long-term consequences of Developmental Dysplasia of the Hip (DDH)?

From the Guidelines

Long-term management of Developmental Dysplasia of the Hip (DDH) is crucial to prevent complications such as avascular necrosis, residual dysplasia, and early-onset osteoarthritis, and should include regular follow-up with an orthopedic specialist throughout childhood and into adolescence. The goals of long-term management are to maintain proper hip development and function, and to monitor for potential complications. According to the American Academy of Pediatrics (AAP) recommendations, as outlined in the study by 1, selective screening of children with risk factors or based on physical examination findings is recommended.

Key Components of Long-term Management

• Regular follow-up with an orthopedic specialist throughout childhood and into adolescence
• Periodic imaging studies (ultrasound for infants under 6 months, X-rays for older children) to monitor hip development
• Clinical examinations every 6-12 months, then annually during adolescence, with particular attention during growth spurts
• Monitoring for long-term complications such as avascular necrosis of the femoral head, residual dysplasia, and early-onset osteoarthritis
• Physical therapy focusing on strengthening hip muscles and maintaining range of motion throughout development

Importance of Early Detection and Treatment

Early detection and treatment of DDH are critical to prevent long-term complications, as highlighted in the study by 1. The study notes that late presentation is a major negative prognostic factor, with these patients more likely to require complex treatment and surgical intervention, and to experience long-term complications. Therefore, it is essential to prioritize early detection and treatment of DDH to improve long-term outcomes.

Parent Education and Monitoring

Parents should be educated about potential signs of complications, such as limping, pain with activity, or leg length discrepancy, and should be encouraged to monitor their child's hip development and function throughout childhood and adolescence. This comprehensive approach is necessary because the developing hip joint requires ongoing monitoring to ensure proper formation and to address any issues before they cause permanent functional limitations, as emphasized in the study by 1.

From the Research

Long-term Outcomes of DDH

• The long-term outcomes of total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) have been studied, with a minimum 21-year follow-up 2.
• The study found that the Kaplan-Meier survivorship was 98.3% at 10 years and 81.8% at final follow-up, with an overall revision rate of 18% (22 cases) 2.
• The most common complications observed were dislocations (9 cases, 7%) and severe heterotopic ossification (1 case, 1%) 2.

Challenges in THA for DDH Patients

• THA in patients with DDH can be challenging due to the complexity of acetabular and femoral morphologic abnormalities 3.
• The surgeon must be prepared for bone deficiency when reconstructing the acetabulum and should place the component low and medial (at the anatomic hip center), and avoid oversizing the acetabular component 3.
• Femoral dysplasia is also complex and variable, and the surgeon must be prepared for different stem choices that allow for decoupling of the metaphyseal stem fit from the implanted stem version 3.

Management of DDH

• The management of DDH is still a topic of discussion, with various treatment options available, including pelvic osteotomy and open hip reduction 4, 5.
• Neonatal screening, along with physical examination and ultrasound, is critical for the early diagnosis of DDH to prevent the occurrence of early coxarthrosis 5, 6.
• The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index, and pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected 6.

Complications of DDH Treatment

• Avascular necrosis is the most serious complication of DDH treatment, related to excessive abduction of the hip, force closed reduction, maintained dislocated hip, or surgical open reduction 6.
• The risk of avascular necrosis can be minimized by careful planning and surgical technique, and by avoiding forceful abduction or closed reduction when obstacles for reduction are present 6.