Developmental Dysplasia of the

Hip
(DDH) : Treatment
GROUP I :
I H / RR / DW / NR / PF
Introduction
The Term DDH is more likely than CDH (congenital
Dysplasia of the Hip)
Girls are affected 5 times more than boys.
The left hip is affected in 45%, right one 20% and
35% of the cases are bilateral.
Two facts about DDH:
1) not all hip dislocation are present at birth. But
they all occur before the age of 3 months
2) newborns have hypotonic muscles in the 1
st
6 wks
till 3 months so not all cases of DDH can be
diagnosed at that time.
Etiology
Generalized relaxation of the hip joint.

- Genetics
- Hormonal Factors
- Intrauterine Malformation
- Postnatal factors

X-ray
Acetabular index:
angle between horizontal line of hilgenreiner and
the line between the two edges of the acetabulum.
normal hip 2030
dislocated or dysplastic hip 30
Shentons line:
semicircle between femoral neck and upper arm of
obturator foramen, in dislocated hip this line is
broken.

TREATMENT
The earlier the better.
Best time for treatment is in newborn period.
It depends on the device and age of the patient.
Goal is to:
1.Flex and abduct hips.
2.Reduce femoral head and maintaining it.

TREATMENT
From (1-6 months) use Pavlik Harness.
From 6 months 18 months use hip spika.
From 18 months - 4 years :
traction , adductor tenotomy , surgical closed
reduction, salter innominate osteotomy.


Treatment Options
Age of patient at presentation
Family factors
Reducibility of hip
Stability after reduction
Amount of acetabular dysplasia

Birth to Six Months
Triple-diaper technique
Prevents hip adduction
Success no different in some
untreated hips
Pavilk harness (1944)
Experienced staff*
Very successful
Allows free movement within
confines of restraints
*posterior straps for preventing add. NOT producing abd.
Birth to Six Months
Pavlik harness

Indications
Fully reducible hip*
Child not attempting to stand
Family
Close regular follow-up (every 1-2 weeks)
For imaging and adjustments
Duration
Childs age at hip stability + 3 months

Pavlik Harness
Complications

Avascular necrosis
Forced hip abduction
Safe zone (abd/adduction and flexion/extension)
Femoral nerve palsy
Hyperflexion

*Be aware of Pavlik Harness Disease
*Follow until skeletal maturity
Birth - Six months
Closed reduction + Spica
Failure after 3 weeks of Pavlik trial
Birth - Six months
Closed reduction
General anesthesia
Arthrogram
Safe zone - avoid AVN
+/- adductor tenotomy
Open reduction if concentric reduction not possible
Usually teratogenic hips in this age group
6 months 18 months
Present a more difficult problem
Prolonged dislocation
Contracted soft tissues
6 - 18 months
Closed reduction +/- adductor tenotomy
Spica in human position of 100 degrees of flexion and
about 55 degrees abduction (3 months)
Abduction Orthosis 4 wks full time/4 wks nighttime
Open reduction (if closed fails)
Capsulorraphy
CT scan
Spica for 6 wks followed by PT


18 months - 4 years

Closed reduction
medial dye pool check arthrogram and - Reducibile
Irreducible - Open reduction

Open reduction
Tight - femoral shortening
Stable - +/- pelvic osteotomy
Femoral Shortening
Schoenecker + Strecker 1984
Traction vs. Femoral shortening
56% AVN in traction group
0% AVN in femoral shortening
Pelvic Osteotomy
1) Persistent instability + dysplasia after open
reduction + femoral shortening
2) Requires concentric reduction of a reasonably
spherical femoral head
3) Usually based on surgeon preference
Salter and Pemberton
Pelvic Osteotomy
Volume changing

Pemberton
Hinges on triradiate
Requires remodeling of new incongruity
Provides more anterolateral coverage

Pemberton
Pelvic Osteotomy
Redirecting
Salter
Osteotomy thru sciatic notch
Hinge thru pubic symphysis
Triple innominate
Ganz
Dial
Salter Osteotomy
Salter Osteotomy