Definition: Developmental dysplasia of the hip encompasses both subluxation and dislocation of the newborn hip, as well as anatomic abnormalities. DDH results from an abnormality of the acetabulum or femoral head that presents in infancy.
Diagnosis
H&P
Screening: The AAP and the pediatric orthopedic society recommend doing DDH on all babies. The USPSTF gives an “I” recommendation.
– Barlow & Ortolani test: PE may show a clunking sensation and feeling of movement when adducting the hip and applying posterior pressure.
-Risk Factors: It is more common in firstborns, females, breech presentations, oligohydramnios, and patients with a family history of developmental dysplasia.
– Referral for orthopedic consultation
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“Experts are divided as to whether hip subluxation can be merely observed during the newborn period, but if there is any question of a hip problem on examination by 2 weeks of age, the recommendation is to refer to a specialist for further testing and treatment. Studies show that these problems disappear by 1 week of age in 60% of cases, and by 2 months of age in 90% of cases. Triple diapering should not be used because it puts the hip joint in the wrong position and may aggravate the problem. Plain radiographs may be helpful after 4–6 months of age, but prior to that
Plain radiographs may be helpful after 4–6 months of age, but prior to that time, the ossification centers are too immature to be seen. Because the condition can be difficult to diagnose and can result in significant problems, the current recommendation is to treat all children with developmental dysplasia of the hip.
Closed reduction and immobilization in a Pavlik harness, with ultrasonography of the hip to ensure proper positioning, is the treatment of choice until 6 months of age. The American Academy of Pediatrics recommends ultrasound screening at 6 weeks for breech females, breech males (optional), and females with a positive family history of developmental dysplasia of the hip. Other countries have recommended universal screening, but a review of the literature has not shown that the benefits of early diagnosis through universal screening outweigh the risks and potential problems of over treating.” ABFM
**Barlow (dislocating an unstable hip) and Ortolani (reducing an unstable hip).
Reference
Am Fam Physician 2006;74(8):1310-1316