Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) is the most common joint condition in infants, encompassing a complex spectrum of pathologic states that can result in hip instability and dislocation. The most significant risk factors for DDH are breech positioning in the third trimester and family history of hip dysplasia. The condition is more common in females. Diagnosis is based on age-specific physical examination maneuvers and imaging studies. The Ortolani and Barlow maneuvers are the recommended physical examination techniques used to screen infants up to 3 months of age. Ultrasonography is the preferred imaging modality to evaluate younger infants, whereas plain radiography is preferred after 4 months of age. If DDH is identified, abduction bracing is the first-line treatment in infants younger than 6 months. Operative management is reserved for infants older than 6 months or if abduction bracing fails. Early diagnosis may prevent the need for invasive surgical procedures and reduce the risk of early degenerative changes of the hip in adulthood.