Introduction

Developmental dysplasia of the hip (DDH) is gradually replacing the old term 'congenital dislocation of the hip' (CDH). It affects around 1-3% of newborns.

Epidemiology

  • Incidence: 15.00 cases per 100,000 person-years
  • Most commonly see in infants
  • Sex ratio: more common in females 6:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Risk factors
  • female sex: 6 times greater risk
  • breech presentation
  • positive family history
  • firstborn children
  • oligohydramnios
  • birth weight > 5 kg
  • congenital calcaneovalgus foot deformity

DDH is slightly more common in the left hip. Around 20% of cases are bilateral.

Clinical examination is made using the Barlow and Ortolani tests:
  • Barlow test: attempts to dislocate an articulated femoral head
  • Ortolani test: attempts to relocate a dislocated femoral head

Investigations

Ultrasound is used to confirm the diagnosis if clinically suspected.

Management

Management
  • most unstable hips will spontaneously stabilise by 3-6 weeks of age
  • Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
  • older children may require surgery