Developmental Dysplasiaof the Hip (DDH)Pediatric Physical TherapyBy; Mshari S. AlghadierBSc Physical TherapyRHPT 364

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Developmental Dysplasia of the Hip (DDH)

Is a term used to cover a broad spectrum of hip anomalies in infants and young children that resultfrom abnormal growth and development of the joint.

Etiology;

Malposition and mechanical factors in utero.

Hormone-induced Ligamentous laxity.

Genetics.

Cultural or environmental factors.

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Classification

Classification Criteria

Normal No instability of hip joint.

Subluxatable Femoral head within the acetabulum but can be partially displaced out from under the acetabulum.

Dislocatable Femoral head within the acetabulum but can be fully dislocated using the Barlow maneuver.

Subluxed Femoral head rests partially out of the acetabulum but can be reduced.

Dislocated Femoral head is completely out of the acetabulum.

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Assessment

Newborn screening DDH includes; Ortolani test.

Barlow test.

They more reliable when infant is calm and not crying and before age of two months.

Crying infant prevent the examiner from observing any joint laxity or instability.

These test are much less reliable for infants older than 2 or 3 months.

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Ortolani test and Barlow maneuvers!

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Ortolani test and Barlow maneuvers!

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Assessment

Other sign which are; Asymmetry of thigh or gluteal folds. Limitation of hip abduction ROM or asymmetric hip

abduction ROM. Apparent of unequal femoral length “Galeazzi‟s sign”.

These sign are strong sign in older child.

In older children; DDH is diagnosed by abnormal gait pattern. Unilateral DDH exhibit positive Trendelenburg sign. Bilateral DDH walk with Waddling gait.

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Management

The aim is to return the femoral head to its normal place which is the acetabulum.

The earlier treatment, the less abnormal changes, and less time is needed.

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Newborn to 6 months

Return the femoral head to its normal place which is the acetabulum.

An orthosis, typically the Pavlik harness is used to maintain the hips in flexed and abducted position.

Pavlik harness contains of; Shoulder harness with two anterior and two posterior straps.

Stirrups for the legs.

Booties to secure the feet.

Pavlik harness the infants are flexed 90 to 100 degree, which locates the femoral head in the acetabulum.

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Newborn to 6 months

The abducted position stretched the hip adductors muscles and allow the femoral head to fit into the acetabulum.

The anterior and posterior straps permit active hip flexion and abduction but limit hip extension and adduction.

Pavlik harness has dynamic components and its worn 24 hours.

Child„s progress must be closely monitored to detect complications or alternative treatment.

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Newborn to 6 months

Complication of Pavlik is:

Avascular necrosis of femoral head.

Femoral nerve palsy.

Inferior dislocation.

These complication can be avoided;

Regular monitoring.

Parents and caregiver education.

Proper fit to of the harness.

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Pavlik harness

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6 to 12 months

After 6 months it may be difficult to relocate the femoral head to its normal place in acetabulum.

Traction for a period of time may be attempted to relocate the hip and then apply the Pavlikharness.

If the child ambulatory, an abduction orthosis more practical than Pavlik harness.

Closed reduction under anesthesia may be required with application of a hip spica cast to maintain hip in location.

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Hip spica cast

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After 12 months

Rarely it can be relocated without surgical intervention.

Home traction followed by closed reduction is recommended before the a surgical procedure.

Surgical intervention include; Release of tight soft tissue structures.

Osteotomy of the proximal femur to allow the femoral head to move in the acetabulum.

Older children may require removal of the femoral shaft to reduce the force on femoral head.

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Thank you

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Reference,

Pediatric physical therapy, JAN S. TECKLIN, fourth edition. Chapter 12, page (432 to 435)

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