DDH

It’s an incompetence of hip development that leads to hip dislocation. This occurs in neonates and children in 0.4% of all labors, and occurs in females more than males.

DDH

Causes:

The cause is unknown, but some congenital or acquired environmental factors may lead to this hip anomaly:

Narrow uterus or uterine anomalies hindering normal baby intrauterine motion.
Decrease uterine fluid.
Previous family history of hip anomalies.
Breech baby “presenting 1st with feet”.
First baby especially if a female.
Relaxin hormone which is transferred from mother to baby during delivery making the hips unstable.

Clinical picture:

The most important warning signs are:

Limb length discrepancy.
Unequal skin crease in upper medial thigh.
Decreased motion in one joint.
Unequal gait or tiptoeing on one limb.
Pain after walking or prolonged standing.

Diagnosis:

By hip ultrasonography up to one year of age,

After one year by plain x-ray.

Treatment:

According to the age of the baby:

Neonates up to 3 months: treated by wearing “Pavlick Harness” brace.

At 6 months: treated by surgery through an approach in the upper medial thigh.
After one year: treated by full attack surgery to remove excess tissues from the acetabulum, repair of the hip capsule, pelvic osteotomy and/or femoral shortening osteotomy.

One of our cases treated with full attack surgery:

Preoperative plain x-ray showing bilateral dislocated hip joint.
3 years follow up after surgery:
7 years follow up after surgery:

Preoperative plain x-ray showing bilateral dislocated hip joint.

3 years follow up after surgery

7 years follow up after surgery