Developmental Hip Dysplasia (DHD)

Byfikirperestajans@gmail.com

Developmental Hip Dysplasia (DHD) is a significant condition that must be carefully monitored during a baby’s growth and development. Previously referred to as congenital hip dislocation, the widespread use of hip ultrasound in newborns has led to the recognition of various hip abnormalities beyond complete dislocation. These include acetabular dysplasia (insufficient development of the hip socket) and subluxation (partial displacement of the hip joint). As a result, the term Developmental Hip Dysplasia (DHD) has been adopted to encompass all these conditions.

What is Developmental Hip Dysplasia (DHD)?

DHD occurs when the bones and cartilage of the hip joint do not develop properly. This can happen due to:

  • The femoral head (thigh bone head) not fitting correctly into the hip socket (acetabulum).
  • The hip socket being too shallow, preventing proper joint stability.

Risk Factors for DHD

Genetic and Pregnancy-Related Factors

  • Family history of hip dislocation or DHD increases the risk.
  • DHD is more common in girls.
  • Firstborn babies are at a higher risk since the uterus is less flexible, leading to space constraints affecting the hip.
  • Low amniotic fluid levels (oligohydramnios) reduce the space in the womb, increasing the risk.
  • Breech presentation (feet-first position at birth) is another major risk factor.

External Factors

  • Swaddling Practices: Tight wrapping that keeps a baby’s legs straight and together may prevent normal hip development and cause dislocation.
  • Clothing Choices: Tight, non-flexible clothing (such as tights or baby jeans) that restricts natural hip movement can negatively affect hip development.
  • Improper Carrying Techniques: Traditional practices like lifting a baby by the feet can negatively impact hip development.

Why is Early Diagnosis Important?

Early detection directly impacts treatment success. If DHD is diagnosed within the first 6 months, non-surgical treatments like Pavlik harness or bracing can be effective. Delayed diagnosis may require more complex treatments, such as casting or surgery. Therefore, every baby should undergo a hip ultrasound at one month old to ensure early intervention if needed.

How is DHD Diagnosed?

Clinical Examination and Physical Assessment

  • Newborn Screening: Pediatric orthopedic specialists perform specific tests (Ortolani and Barlow tests) to detect hip instability immediately after birth.

Imaging Techniques

Ultrasound (USG)

  • Since a newborn’s hip joint is mostly cartilage, ultrasound is the most effective diagnostic method in the first 6 months.
  • Hip ultrasound should be performed within the first month to ensure early treatment.
  • Since ultrasound does not use radiation, it is safe for babies.

X-Ray (Radiography)

  • After 6 months, as the hip bones harden, ultrasound becomes less effective.
  • X-rays are used for diagnosis and follow-up after this period.
  • X-rays show whether the femoral head fits properly into the acetabulum.
  • Although useful, X-rays expose the baby to radiation, so they should not be performed unnecessarily.

Treatment Options for DHD

Early Treatment (Babies Under 6 Months Old)

  • Adjustable braces (such as Pavlik harness or Tübingen orthosis) help keep the hip joint in an optimal position for normal development.

Closed Reduction and Casting (Babies Over 6 Months Old)

  • If DHD is detected after 6 months or if Pavlik harness treatment is ineffective, the hip is manually repositioned under general anesthesia.
  • A pelvipedal cast (spica cast) is applied to maintain proper hip positioning.

Open Reduction Surgery and Casting

  • If closed reduction is unsuccessful or if the child is older, open reduction surgery is performed.
  • A small incision is made near the groin to remove any tissue blocking proper hip alignment.
  • The hip is placed in the correct position, followed by spica casting.

Surgical Intervention for Severe Cases

  • If DHD is severe or diagnosed late, a more extensive surgery is required to reshape the hip joint properly.

Conclusion

Developmental Hip Dysplasia (DHD) is a treatable condition. Newborn screening, hip ultrasound, and X-rays (when necessary) play a crucial role in diagnosis. If detected early, simple treatments can ensure proper hip development, preventing walking difficulties and other complications in later life. A pediatric orthopedic evaluation and hip ultrasound during the first month are essential for early detection and successful treatment.