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Developmental dysplasia of the hip: an update on diagnosis and management from birth to 6 months
Ishaan Swarup1, Caitlin L Penny, Emily R Dodwell
1Hospital for Special Surgery, New York, New York, USA.
Insights
Developmental dysplasia of the hip (DDH) affects 1-7% of infants. Early diagnosis and treatment with a harness yield high success rates, with specific factors influencing failure risk.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
- Epidemiology
Background:
- Developmental dysplasia of the hip (DDH) is a condition affecting infant hip development.
- Understanding of DDH epidemiology, diagnosis, and management is continually advancing.
Purpose of the Study:
- To review the latest literature on developmental dysplasia of the hip (DDH) in infants from birth to six months.
- To provide an updated perspective on DDH management strategies.
Main Methods:
- Literature review focusing on recent studies concerning DDH in infants.
- Analysis of epidemiological data, diagnostic approaches, and treatment outcomes.
Main Results:
- Key risk factors include family history, female sex, breech presentation, and higher birth weight; prematurity may be protective.
- Screening involves physical examination and selective imaging; harness treatment in the first six months shows 70-95% success.
- Factors like late initiation of treatment, irreducible hips, and specific hip classifications (Graf-IV) are associated with treatment failure.
Conclusions:
- Early detection and intervention are crucial for optimal outcomes in DDH.
- All infants require examination, with selective screening for those with risk factors or abnormal findings.
- Treatment strategies should be initiated promptly, without delaying for ossific nucleus presence.
Purpose Of Review:
Our understanding of the epidemiology, diagnosis, and management of developmental dysplasia of the hip (DDH) is evolving. This review focuses on the most up-to-date literature on DDH in patients from birth to six months of age.
Recent Findings:
Well known risk factors for DDH include family history, female sex, and breech positioning. Recent evidence suggests higher birth weight is a risk, whereas prematurity may be protective. Screening includes physical examination of all infant hips and imaging when abnormal findings or risk factors are present. Treatment in the first six months consists of a harness, with 70-95% success. Failure risk factors include femoral nerve palsy, static bracing, irreducible hips, initiation after seven weeks of age, right hip dislocation, Graf-IV hips, and male sex. Rigid bracing may be trialed if reduction with a harness fails and closed reduction is indicated after failed bracing. If the hip is still irreducible, nonconcentric, or unstable, open reduction may be required following closed reduction. Evidence does not support delaying hip reduction until the ossific nucleus is present.
Summary:
DDH affects 1-7% of infants. All infants should be examined and selective screening with imaging should be performed for abnormal physical exams or risk factors. Early treatment is associated with optimal outcomes.
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