Congenital dislocation of the hip (CDH) is a multi-factorial condition where the femoral head is displaced from the acetabulum. It is more common in females and risk factors include family history, breech presentation, and foot deformities. Clinical examination involves assessing range of motion and special tests like Ortolani and Barlow. Treatment depends on age but aims to reduce the hip concentrically without disrupting blood supply to the femoral head, ranging from harness or casting for young infants to open reduction and acetabuloplasty for older children. Early detection and treatment provide the best outcomes for this endemic pediatric condition.

1. CDH
CONGENITAL DISLOCATION OF THE
HIP
Dr. ABDULMONEM ALSIDDIKY , MD , SSCO.
Assistant Professor & Consultant
pediatric Ortho.& Spinal Deformities
KSU,KKUH
Riyadh , Saudi Arabia

2. Nomenclature
 CDH : Congenital Dislocation of the Hip
 DDH : Developmental Dysplasia of the Hip

3. NORMAL PELVIS

4. Normal hip Dislocated hip

5. Patterns of disease
 Dislocated
 Dislocatable
 Sublaxated
 Acetabular dysplasia

6. Radiology
 After 6 months: reliable

8. Causes (multi factorial)
 Hormonal
 Relaxin, oxytocin
 Familial
 Lig.laxity diseases
 Genetics
 Female 4 X male --- twins 40%
 Mechanical
 Pre natal
 Post natal

9. Mechanical causes
 Pre natal
 Breach , oligohydrominus , primigravida , twins
 (torticollis , metatarsus adductus )
 Post natal
 Swaddling , strapping

11. Infants at risk
 Positive family history: 10X
 A baby girl: 4-6 X
 Breach presentation: 5-10 X
 Torticollis: CDH in 10-20% of cases
 Foot deformities:
 Calcaneo-valgus and metatarsus adductus
 Knee deformities:
 hyperextension and dislocation

12. Infants at risk
When risk factors are present
 The infant should be reviewed
 Clinically
 radiologically

13. Clinical examination
 The infant should be
 quiet
 comfortable

14.  Look:
 External rotation
 Lateralized contour
 Shortening
 Asymmetrical skin folds
 Anterior – posterior

16.  Move
 Limited abduction

17.  Special test
 Galiazzi
 Ortolani , Barlow test
 Trendelenburgh sign
 Limping ( waddling gait if bilateral)

18. Special test
Galiazzi test

19. Special test
Ortolani test

20. Special test
Barlow test

21. Special test
Trendelenburgh sign

22. Screening programs
 Clinical screening proven to be effective
 Performed by trained personnel
 Must be dynamic
 Repeated with periodic examination
 U/S screening is controversial

23. Investigations
 0-3 months U/S
 > 3months X-ray pelvis AP + abduction

24. U/S Screening
 Incidence of hip stability declines rapidly to
50% within the first week of neonatal life.
 Better to delay U/S screening

25. U/S - Problems
 Too sensitive:
 Detects a lot of hip abnormalities, most of which
would develop normally if left alone
 Operator-dependant

26. Radiology
 Early infancy: not reliable

27. Radiology
 After 2-3 months: more reliable

28. Radiology
 After 2-3 months: more reliable
27o 39o

29. Radiology
 After 2-3 months: more reliable
in out
in out
Von Rosen view
in out

30. Radiology
 After 2-3 months: more reliable
in out

31. Radiology
 After 6 months: reliable

32. Radiology
 After 6 months: reliable

33. Treatment - Aims
 Obtain concentric reduction
 Maintain concentric reduction
 In a non-traumatic fashion
 Without disrupting the blood supply to
femoral head

34. Treatment
 Method depends on age
 The earlier started, the easier it is
 The earlier started, the better the results are
 Should be detected EARLY

35. Treatment
 Birth – 6m
 Pavlik harness or hip spica
 6-12 m:
 Closed reduction under GA and hip spica
 12 - 18 m:
 Open reduction
 18 – 24 m:
 Open reduction and Acetabuloplasty
 2-8 years:
 Open reduction, Acetabuloplasty, and femoral shortening
 Above 8 years:
 Open reduction, Acetabuloplasty cutting all three pelvic bones, and
femoral shortening

36. Treatment: Neonatal hip instability
 Most resolve spontaneously
 Can initially wait
 Avoid adduction swaddle
 Apply double diapers – to bring back!!
 See at 2weeks of age

37. Treatment: Neonatal hip instability
Unstable at 2 weeks:
 Double / Triple diapers: inadequate
 Gives illusion that patient is “in treatment” while
wasting valuable time

38. Treatment: Neonatal hip instability
Unstable at 2 weeks:
 Pavlik Harness
 Dynamic, effective, safe

39. Treatment: 6-12 m
 Initially non-operative closed reduction UGA and
immobilization in hip spica cast
 Position:
 Avoid sever abduction
 Avoid frog position
 Must obtain stable concentric reduction,
otherwise needs surgery

40. Treatment: 6-12 m
 Possibly closed reduction
 Stable and concentric reduction
 Possibly open reduction
 Unstable or un-concentric reduction
 Arthrography-guided

41. Treatment: 6-12 m
 Arthrography-guided Closed Reduction

42. Treatment: 6-12 m
Arthrography-guided Closed Reduction
Too lateralized Acceptable

43. Treatment: 18-24 m
 Open reduction – surgery
 Possibly: Acetabuloplasty

44. Treatment: Above 2 years
 Open reduction, and
 Acetabuloplasty, and
 Femoral shortening

45. Acetabuloplasties
 Many types

47. Treatment
 Birth – 6m
 Pavlik harness or hip spica
 6-12 m:
 Closed reduction under GA and hip spica
 12 - 18 m:
 Open reduction
 18 – 24 m:
 Open reduction and Acetabuloplasty
 2-8 years:
 Open reduction, Acetabuloplasty, and femoral shortening
 Above 8 years:
 Open reduction, Acetabuloplasty cutting all three pelvic bones, and
femoral shortening

48. CDH - Summary
 Complex multi-factorial, endemic disease
 Health education and Drs. awareness
 Screening programs are needed
 Learning proper examination methods
 Identify at risk groups
 Efficient referral system
 Proper management by specialized Drs

51. Examples