Developmental dysplasia of the hip (DDH): diagnosis and treatment

Abstract

This paper describes the definition, investigation, imaging and treatment of developmental dysplasia of the hip (DDH).There is controversy in what constitutes physiological or pathological DDH. The results of hip screening programmes are disappointing. DDH may be diagnosed by clinical, sonographic or radiological means. The clinical diagnosis is confirmed by sonographic imaging (in the first months of life). Late presenting pathological DDH (>6 months of age) is usually diagnosed by an X-ray(s) of the pelvis. The majority of pathological DDH cases are female and unilateral, with the left hip joint being involved more commonly. Dysplasia, subluxation and dislocation of the hip joint may be associated with the development of premature osteoarthrosis in adults.The majority of neonatal hip joint instabilities and sonographic hip dysplasia spontaneously resolve without treatment. Persistent hip joint instability is initially treated with bracing/splintage, the majority resolving without further additional treatment. Some early presenting probable irreducible hip dislocations can be treated by manipulation under anaesthetic, hip arthrography plus the application of a hip spica. If this procedure fails, if it is not technically possible or if the dislocation presents ‘late’, more invasive surgery with open reduction of the hip joint and reconstructive surgery to the pelvis or femur may be necessary.