Developmental Dysplasia (DDH) and Congenital Dislocation of the Hip (CDH)

Abstract

Developmental dysplasia of the hip (DDH) is a spectrum of gradually progressive disorders of the hip that occur in different forms. Most abnormalities in DDH are on the acetabular side. In recent decades, there has been considerable evolution in the diagnosis and treatment protocols of DDH and many epidemiological aspects have been studied. The white race and the female sex are more frequently associated with the condition, and the risk factors include gender, positive family history, oligohydramnios, and breech position.

In neonates, the predominantly cartilaginous parts of the hip are not visible on plain radiographs and clinical detection of DDH requires high practical experience and is unreliable. As a consequence, ultrasound examination in infants younger than 6 months is used to monitor the acetabular development during treatment.

The main goal in the management of DDH is to obtain and maintain a concentric reduction of the femoral head. In infants, conservative treatment with reduction braces, splints, plaster casts, or traction methods (closed reduction) is indicated. In cases of late diagnosis or if a secondary deterioration after successful treatment occurs, particularly after walking age, reduction of the femoral head is achieved by surgical management. Every treated hip must be monitored until adulthood to avoid persisting residual dysplasia.