Developmental Dysplasia of the Hip (DDH)

Developmental Dysplasia of the Hip (DDH)

Definition

• A spectrum of hip instability due to underdevelopment of the femoral head and/or acetabulum

• Can range from mild subluxation to complete dislocation

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Pathophysiology

• Shallow acetabulum fails to provide secure coverage of the femoral head

• Tight swaddling with the hips forced in extension and adduction can exacerbate dysplasia

• Genetic predisposition and in-utero positioning also contribute

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Presentation

• Female, firstborn, family history, and breech presentation are common risk factors

• Limb shortening and asymmetric gluteal or thigh creases

• Clicking hip on examination (Barlow and Ortolani tests may reveal instability)

• A “click” may resolve after 2 months but still warrants investigation if previously noted

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Diagnosis

• Ultrasound is preferred up to 4 months of age, typically initiated after 4 weeks of life

• X-ray is more accurate after 6 months once the proximal femoral epiphysis begins to ossify

• Further imaging is indicated even if early clinical signs appear to resolve

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Management

• Avoid tight swaddling, encourage free movement of the hips

• Refer to paediatric orthopaedics for possible Pavlik harness in infants

• Early harness use can reposition the femoral head and facilitate proper acetabular development

• Surgery may be required for severe or late-detected cases

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Notes

• Early recognition is crucial to prevent long-term complications such as gait disturbances and premature osteoarthritis

• Ongoing follow-up is essential to ensure stable hip development and detect any recurrence or residual dysplasia