Developmental Dysplasia of hip Definition Etiology Tests Clinical Features Imaging Treatment

1. DEVOLOPMENTAL
DYSPLASIA OF HIP
BY
E.D.PRASANNA

2. DEFINITION
• The definition of developmental dysplasia of the hip
(DDH) is not universally agreed upon.
• Typically, the term DDH is used when referring to
patients who are born with dislocation or instability of the
hip
• Developmental dysplasia of the hip is the condition in
which the femoral head has an abnormal relationship to
the acetabulum.
• DDH encompasses a spectrum of disorders

3. DYSPLASIA
• A shallow or underdeveloped acetabulum
• It can either be stable or unstable

4. DISLOCATION
• reducible or non reducible

5. SUBLUXATION

6. This refers to antenatal dislocation of the hip.
TERATOLOGIC DISLOCATION

7. ETIOLOGY

8. FAMILIAL
• Incidence is more in First Degree Relatives
• Hereditary predisposition to joint laxity

9. FEMALE SEX
Maternal hormone relaxin
Crosses the placenta
If foetus is female , it causes laxity of
foetal joint
Dislocation

10. BREECH PRESENTATION
Breech
presentation
Extreme
flexion at the
hip
Stretching of
capsule and
ligaments
Dysplasia

11. Reduced
Uterine
volume
First born
Multiple pregnancy
oligohydramnios
Packaging Disorders Like
Plagiocephaly , Torticollis , Foot Deformities

12. RACE AND CULTURE
• Swaddling of the baby
• Increased incidence in Native
Americans

13. PATHOLOGICAL CHANGES

14. Elongated capsule
Femoral head
displaced upwars
and laterally

18. • Hip joint fills w/
fibrofatty debris known
as pulvinar
• Acetabular labrum
- becomes
enlarged along the
superior, posterior, and
inferior rim;
- may infold into
joint (inverted limbus);
- limbus blocks
reduction of femoral
head;

19. CLINICAL FEATURES

20. FROM BIRTH TO 3 MONTHS
• Mainstay for diagnosis are
•Ortolani test
•Barlow test
•Galeazzis sign

21. BARLOW’S TEST
• Facing childs perineum
• Hold upper part of the childs thigh
• fingers behnd the greater trochanter
• thumbs in front
• Position – knees fully flexed , hips flexed to right angle
• Hip is now adducted
• simultaneously pressure is exerted in proximal direction trying to
push out the hip
• If the hip is dislocatable abnormal posterior movement will be felt
along with a distinct clunk
• Nothing is noted then hip is either stable or it has already been
dislocated

24. • Hips are in 90֯ flexion and fully adducted
• Thighs are gently abducted
• Forward pressure is exerted on the greater trochanter
while abduction
• If the hip was dislocated , a clunk will be heard or felt as
femur is reduced into acetabulum
• If nothing is noted , there my be no dislocation or
irreducible dislocation is present

25. ORTOLANI’S TEST
• Hips and knee of child – held in flexed position
• Gradually abducted
• Clunk of entrance felt as dislocated femoral head slips back into
acetabulum
• Test is negative if no dislocation or irreducible dislocation is
present

28. ASYMMETRICAL GLUTEAL AND THIGH
FOLDS

29. GALEAZZI’S SIGN
Seen in Unilateral dislocation
Limb length is shorter on affected side

30. AFTER 3 MONTHS
• Ortolani and barlow become negative due to development of
adaptive shortening

31. LIMITATION OF ABDUCTION

32. ASYMMETRICAL GLUTEAL AND THIGH
FOLDS

33. POSTIVE TELESCOPY

34. • Hip to be tested in flexed postion
• Place thenar eminence of one hand on ASIS and finger on
trochanter
• Using other hand , hold knee and give a gentle push pull along
long axis of femur
• Up and down movement of femur indicates positive telescopy

35. Place the middle finger over the greater trochanter, and
the index finger on the anterior superior iliac spine
With a normal hip, an imaginary line drawn
between the two fingers points to the umbilicus
When the hip is dislocated, the trochanter is
elevated and the line projects halfway
KLISIC TEST

36. WALKING AGE OR > 1 YEAR

37. TRENDELENBERG TEST

38. LORDOSIS OF LUMBAR SPINE

39. GAIT
Trendelenberg gait
• Waddling gait
Waddling gait

40. IMAGING

41. X ray

42. Perkin’s line:
This is a vertical line drawn at the outer border of the acetabulum
Hilgenreiner’s line:
This is a horizontal line drawn at the level of triradiate cartilage
Shenton’s line:
This is a smooth curve formed by the inferior border of the neck
of the femur with the superior margin of the obturator foramen
Acetabular index:
The angle is formed by Hilgenreiner line and a line which extends
along the acetabular roofs.
Normal is < 30 degrees

43. IMAGING
• the head lies in the
upper and outer
quadrant
• the continuity of
Shenton’s line is
broken

44. ULTRASOUND
Femoral head
Abductors
Ilium

45. Alpha angle is formed by the acetabular roof
to the vertical cortex of the ilium.

46. GRAFS CLASSIFICATION

47. COMPUTED TOMOGRAPHY
• Document reduction
postoperatively
• Pre – operative planning

48. • Done preoperatively
• Assess the position of
femoral head in relation to
other structures
• Find out any obstructions to
reduction
ARTHOGRAPHY

49. TREATMENT

50. TREATMENT PRINCIPLES
Birth to 6
months
•Closed
reduction
•Splinting
6 months to 2
years
•Traction if
required
•Closed
reduction
2 to 6 years
•Open
reduction
•Acetabular
reconstruction

51. 6 – 10 years
• Unilateral cases
• Open reduction
• Acetabular reconstruction
• Bilateral cases
• Decide whether treatment is
necessary
• Because
• Limp is less noticeable
• Apart from gait abnormalities
, patients are relatively
normal live
>11 years
• Indicated for pain
• Total knee replacement
• arthodesis

52. TECHNIQUES OF REDUCTION
•Closed reduction
•Traction followed by closed reduction
•Open reduction

54. MAINTENANCE OF REDUCTION
• Plaster cast

55. Von Rosen Splint

56. ACETABULAR RECONSTRUCTION
PROCEDURES
•Satlers osteotomy
•Chiaris Osteotomy
•Pemberton Osteotomy

57. SALTER’S OSTEOTOMY
• Roof of acetabulum is rotated so that it covers head of
femur
• Fulcrum through pubic symphysis

58. PEMBERTON OSTEOTOMY
• Roof of acetabulum is deflected downwards so that it
covers head of femur
• Fulcrum through triradiate cartilage

59. CHIARI’S OSTEOTOMY
• Used when no other
osteotomy can be
performed
• Iliac bone is divided
transversely above
acetabulum
• Lower portion is
displaced medially
• Margin of upper
portion provide depth
to acetabulum

60. Closed
reduction
Successful
Maintain in a
cast for 3
monthes
Brace
Acetabulum
develops
Remove the
brace
Physiotherapy
Acetabulum
does not
develop
Acetabular
reconstruction
physiotherapy
DISLOCATION
DIAGNOSED AT
BIRTH

61. Not successful
Traction
Closed reduction
successful
Treat as before
Not successful
Open reduction
acetabular
reconstruction
Derotation
osteotomy

62. DISLOCATION AT LATER AGES
Diagnosed at a later
stage
Closed reduction
usually not possible
Open reduction +
acetabular
reconstruction +
Derotation osteotomy

63. THANK YOU