When is treatment indicated for developmental dysplasia of the hip (DDH)?

Updated: Feb 26, 2018
  • Author: Junichi Tamai, MD; Chief Editor: William L Jaffe, MD  more...
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Answer

Indications for treatment depend on the patient's age and the success of previous techniques. Children younger than 6 months with instability upon examination are treated with a form of bracing, usually a Pavlik harness. If this is not effective or if the hip instability or dislocation is noted when the child is older than 6 months, closed reduction is typically recommended, with or without the administration of traction before the reduction.

When the child is older than 2 years or with failure of the previous treatment, open reduction is considered. If the patient is older than 3 years, femoral shortening is performed instead of traction, with additional varus applied to the femur, if necessary. A patient with residual acetabular dysplasia who is older than 4 years should be treated with an acetabular procedure.

Treatment of DDH diagnosed when the patient is a young adult can be considered for residual DDH. Unfortunately, radiographic characterization of DDH that is severe enough to lead to early osteoarthrosis is difficult. A center-edge angle smaller than 16º often has been used to predict early osteoarthrosis, [52] but other authors have found this measurement to be less reliable. [53, 54] Subluxation, defined as a break in the Shenton line (see Workup), has been shown to be associated with osteoarthrosis and decreased function. [53]

Relative contraindications for surgery include older age (>8 years for a unilateral hip dislocation or >4-6 years for bilateral hip dislocation, especially if a false acetabulum is not present). Other contraindications for surgery include a neuromuscular disorder, such as a high myelomeningocele or spinal cord injury, or cerebral palsy in a patient who has had a hip dislocation for longer than 1 year.


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