Developmental dysplasia of hip (DDH) / Congenital dislocation of hip (CDH)
DEFINITION-:
– Developmental dysplasia of hip is defined as partial or complete displacement of femoral head from the acetabular cavity.
– It is spontaneous dislocation of hip before , during or shortly after birth.
• Risk factors
– Female
– Familial
– First born
– Faulty intrauterine position
• Etiology
– Genetic : dysplastic trait found in family.
– Hormonal : hormone induced joint laxity.
– Mechanical : faulty intrauterine position
– Primary : Acetabular dysplasia.
• Pathology
(1) Bone
– Shallow acetabulum due to Acetabular dysplasia.
– Ossification is delayed in dislocated head of femur
– Shortening of neck of femur.
(2) Capsule
– Hour glass constriction.
(3) Muscles
– Pelvifemoral group of muscles are shortened.
– Pelvitrochanteric group are elongated.
• Stages of DDH
– Dysplastic stage
– Subluxation stage
– Dislocated stage
• Clinical features
(1) In infants
✓ Look for other anamolies
✓ If hip is dislocated all signs of dislocation are present.
✓ Perineum is widened
(2) Childhood and adolescents
– Gait : waddling/sailors
– lordosis
– bilateral shortening of legs
– Buttocks broad and flat.
(3) Adults
– All signs seen in adolescents
– Pain in hip
– All features of OA hip
• Tests
– Galeazzi sign is positive.
The level of knee are compared in child lying with the hip flexed to 70 degree and knee flexed.
Lowering of knee on the affected side.
– Ortolanis sign of entry is positive.
– Barlows provocative test is positive.
TWO PART
1)The surgeon face the child ‘s perenium.
-He graps the upper pat of each thigh with his finger behind on th greater trochanter and thumb in front in front.
-Hip and knee in 90 degree flexed and gradually adducted ,then gently pressure is applied where the thumb “push out” the hip ,where the head of femur rolls out the acetabulum , it may dislocate.
2) HERE, the hip is 90 degree flexed and fully adducted , thigh is gently abuduted then finger in greater trochanter exerts pressure in forward direction; as if one is trying to put back the dislocated hip.
IF DISLOCATION OCCURS ‘CLUNK’ SOUND IS HEARD AND FELT ,INDICATING RELOCATION OF DISLOCATED HIP.
AND IF NOTHING HAPPENS THEN HIP IS NORMAL
– Delayed walking.
• Radiological features
– Perkin’s sign
-Hilgenreiner’s line
– Shenton’s line
– Acetabular index
– Angle of wiberg
• Treatment
– The aim of treatment in DDH is to achieve and maintain an early reduction to prevent future degenerative joint disease.
(1) Infants ( less than 6 months ).
– Application of splints like pavlik harness in position of hip flexion and abduction fascilitates spontaneous reduction
.
(2) 6 months – 2 years
– The Dislocation is reduced by manipulation under general anaesthesia and maintained in a plaster of hip spica.
– The spica is removed after 3 months to check the stability of the joint.
– If the method fails open reduction is done.
– Followed by pelvic / femoral osteotomy
(3) 3 – 8 years
– Open reduction followed by femoral shortening or pelvic osteotomies.
(4) 8 – 18 years
– Open reduction followed by femoral shortening or pelvic osteotomies.
– Total hip replacement if OA develops
– Arthrodesis is rarely done.
• Innominate osteotomy in DDH
(1) Salter’s osteotomy
(2) Pemberton’s osteotomy
(3) Steel’s osteotomy
(4) Self operation
(5) Chiari’s osteotomy
• Physiotherapy management
(1) During immobilization
– Exercise : Isometrics to glutei and quadriceps.
– Movements : Active ROM exercise to hip and knee.
(2) During mobilization
– Active ROM for hip , knee and ankle passive relaxed adduction is emphasized.
– Strengthening exercises to glutei and quadriceps , muscle Isometrics , isotonic and PRE.
– Ambulation : Gradual weight bearing and walking is encouraged with help of assistive devices.
