For parents, a diagnosis of Development Dysplasia of the Hip (DDH) brings a wide range of emotions and responses. Parents want to understand not only the condition but what the future holds for their child after diagnosis. As a Paediatric Orthopaedic Specialist, sharing a diagnosis with parents sparks many questions. Luckily, we can offer answers to many questions backed with long term research findings.
What is DDH?
DDH is a problem that occurs when a child’s hip joint hasn’t formed normally. Similar to a car’s tyres wearing out faster when they are out of alignment, DDH prevents the hip joint functioning properly causing the joint to wear out faster than normal, the hip socket is shallow, allowing the head to slip in and out, moving partly or completely out of the socket.
What causes DDH? Is my child at risk?
Each year, while approx 1-9 per 1000 newborns report with some form of hip instability, only 2-5% ultimately require treatment. Several mechanical, hormonal, genetic, and environmental factors can lead to DDH. Firstborn females carry the highest risk for DDH as the uterus is typically smaller firstborns, resulting in limited room for movement. A breech delivery or a baby’s response to the mother’s hormones during pregnancy may play a role in DDH. After birth, DDH can occur if an infant is held with extended and abducted hips while swaddled. At birth, DDH is more common in girls than boys, while this condition is often detected early on, as a child grows, hip pain may not be felt until later stages of development.
What are the symptoms of DDH?
Symptoms present differently from child to child. However, common symptoms of DDH include the leg on the side of the dislocated hip appearing shorter or turning outward, uneven skin folds in the thigh or buttocks, and the space between the legs seeming wider than normal.
How is it diagnosed?
For many children, DDH is detected by routine history and physical examination during the neonatal period. Clinical screening is crucial for diagnosis with hip exams carried out at birth and subsequent visits throughout childhood. In addition, tests may be administered including ultrasounds or X-rays.
If my child is diagnosed with DDH, what does the future hold?
At DDH presents different for every child, treatment looks different as well. Stable hips that become normal do not need treatment. However, close follow-up and routine exams are required through the child’s development. The goal of treatment is to put and ensure that the head of the femur is placed into the hip socket so that the hip can develop normally. Treatment options may include braces/Pavik harness to hold the hip in place or Spica casting. Some babies may need surgery.
Why is screening important?
Early diagnosis and treatment for DDH are crucial to a child’s development down the road. Many children treated within the first six months recover and develop normally with no long-term problems. However, the older the child or less successful the responding, the greater the possibility for future problems including early onset of degenerative hip diseases, arthritis, and pain.
Dr. Avi Shah | Consultant – Pediatric Orthopaedics | NH SRCC Children’s Hospital, Mumbai