Congenital dislocation of the hip (CDH), also known as developmental dysplasia of the hip (DDH), is a condition where the femoral head is displaced from the acetabulum. It can occur before, during or after birth. Girls are more commonly affected than boys. Causes may include hereditary joint laxity, breech birth position, or defective acetabulum development. Treatment involves splinting or bracing in infants to encourage reduction, and may require surgery in older children if reduction does not occur. Physiotherapy focuses on maintaining reduction, improving range of motion and strengthening muscles.

1. CONGENITAL DISLOCATION OF THE HIP
(CDH)
OR
DEVELOPMENTAL DYSPLASIA OF THE HIP
(DDH)
Presented by :
UPASANA AGARWAL
BPT 4TH YEAR
12/02/2021

2. DEFINITION :
 It includes :
I. Subluxation
II. Dislocation
III. dysplasia
 Girls : Boys = 6:1 i.e. girls are more affected
 Spontaneous dislocation of the hip occurring before, during or shortly after birth.
Common in the Western races
Uncommon in many Asian countries,
mainly in India

3.  Hereditary – predispose to joint laxity
 Hormone Induced – maternal relaxin (ligament
relaxing hormone)
 Breech Delivery – 10 times more common
 Defective development of Acetabulum
 Swaddling of Infant
causes :

4. pathology :
 BONES :
 Acetabulum
 Shallow acetabulum – upper part fails to
form horizontal roof
 Head of femur rides up on the ilium
 Bone form a pseudo-pocket
 Femoral Head
 Poor development
 Displaced backward - upward
 LIGAMENTS :
 Developmental laxity
 Stretched ligament (due to displacement of femoral head)
 Ligamentum Teres – absent or poorly developed
 MUSCLES :
 Changes from subluxation or dislocation
 Muscles shortening (hamstring, satorius, rectus femoris,
adductors)

5. Clinical presentations :
 In Early Childhood :
1) Not very clear until the child starts to walk.
2) Asymmetry in the buttock or thigh fold.
3) Limited hip movements.
4) A click everytimes the hip is moved.
 In Older Child :
1) Walking – delayed or limping(U/L) or waddling(B/L)
2) Postural Changes – scoliosis, lordosis

6. Pt assessment :
 Demographic Data –
 Name, Age, Gender
 Chief Complains –
 Parents complain about the asymmetrical folds, click during movements.
 If the child has started walking, parents will complain about the peculiar gait pattern.
 History Taking –
 Type of delivery
 Parents carrying the baby

7. Observation –
 In Early Childhood :-
 How the parents are carrying the baby
 Asymmetric folds
 Restricted abduction in hip flexion
 In Older Child :-
 Shortening of affected leg
 Scoliosis
 Lumbar lordosis
 Wider perineum
 Gait
Bilateral Involvement

8. Examination –
 In Early Childhood :-
 Barlow’s Test –
 Test for subluxation of hip.
 Ortolani’s Test –
 Test of reduction of hip.

9.  In Older Childhood :-
 Galeazzi Sign –
 lowering of affected side knee
 Trendelenburg Test –
 Stand on affected side leg
 Opposite ASIS dips down
 Telescopy Sign –
 Test stability of hip
 Positive – piston like movement is present
 Gait –
 Trendelenburg Gait Pattern (U/L)
 Waddling Gait Pattern (B/L)

10. Investigations :
1) X – Ray :-
 Below the Age of 1 Year :
• Difficult to diagnose – as ossification is not completed.
 In Older Child :
• Epiphysis of the head of femur appears small
• Epiphysis – displaced laterally and upward
• Acetabulum – shallow
2) Ultrasonography :-
 Position of head of the femur in newborn

11. physiotherapy management :
 The treatment of CDH is age related.
 Divided into parts :-
1. Up to 6 months
2. 6 months to 2 years
3. 2 years to 8 years
4. Above 8 years
WHAT ARE THE AIMS ?
 to replace the femoral head in the acetabulum.
 To maintain it in position until normal acetabulum development occurs.

12. Up To 6 Months :-
 Splinting –
 Hip Flexion and Abduction maintain
 Pavlik harness
 von Rosen Splint

13. 6 Months To 2 Years :-
 POP Hip Spica –
 With moderate medial rotation and abduction
 For 3 months
 Weight Traction –
 Using a frame
 Gallows traction
 Usually for 3-4 weeks

14. 2 Years to 8 Years :-
 Surgery –
 Open reduction with or without osteotomy.
 Chiari Pelvic Osteotomy.
 Derotation Osteotomy
 Plaster Immobilization continued followed by Physiotherapy
After 8 Years :-
 Surgery –
 No treatment is effective.
 Total Hip Replacement - 2˚ OA followed by Physiotherapy
After 2 years of age, conservative management is not effective.
It requires surgical procedures.

15. Physiotherapy Management
Immobilization :-
1) Active movements to be encouraged
2) Isometrics – if possible
 Gluteal muscle
 Quadriceps
mobilization :-
1) Adduction limited due to immobilization - Relaxed Passive Adduction
2) Improve ROM of hip
3) Strengthening of the Glutei muscles
4) Quadruped knee standing to Kneeling
5) Improve Walking – with enough support.

16. Training the child from QUADRUPED POSITION to KNEELING
Walking Training

17. Physiotherapy Management
mobilization :-
6) Hydrotherapy – general leg activities
5) Hippotherapy
6) After THR –
• Re-educate Gait
• Regain Muscle Strength and Movements
• Regain Patient’s Confidence
Hippo Therapy

18. references :
 Essentials of Orthopedics and Applied Physiotherapy
– JAYANT JOSHI and PRAKASH KOTWAL
 Tidy’s Physiotherapy – ANN THOMAS, ALISON
SKINNER and JOAN PIERCY
 Essential Orthopedics – J. MAHESHWARI
 Physiopedia.com