Developmental Hip Dysplasia (DDH) in Children
What is Developmental Hip Dysplasia (DDH)?
Developmental Hip Dysplasia (DDH) happens when the hip joint develops abnormally. DDH is the most common developmental hip deformity causing osteoarthritis of the hip in teenagers and adults.
Normal hip anatomy is a ball that fits into a socket joint. Normally, the ball-shaped head of the thigh bone (femoral head) is covered by the hip socket (acetabulum). Children with hip dysplasia complain of hip pain. They may have pain with walking, running or contact sports.
The abnormality puts stress on the soft tissue that coats the inside of the hip socket and also strains the hip cartilage and bone. If left untreated, the cartilage may wear down, causing injury pain and arthritis to develop.
The severity of DDH varies widely. In the mildest types of hip dysplasia, the hip looks normal in appearance and on x-ray, and the child may not notice any symptoms until they are 20 years old or even older.
Hip dysplasia is commonly detected in young females with hip pain or on pelvis x-rays conducted for other health purposes.
Arthritis can often be prevented if the deformities leading to it are corrected before irreversible cartilage damage has been done.
Most mechanical abnormalities in the hip can be treated if they are diagnosed correctly and fixed early enough with joint realignment (osteotomy) or bone trimming procedures.
What tests might my child need?
Special hip x-rays, CT scan and MRI may be required for evaluation of the problem and the status of the labrum and the cartilage.
What treatment options are available for children with developmental hip dysplasia?
Treatment can be non-surgical or surgical depending on the symptoms, deformity and the expected damage in the joint.
These treatments include activity modification and physical therapy (to strengthen muscles), weight loss, and/or pain medication. Although they can alleviate some symptoms, the underlying abnormality is not corrected.
Early and timely intervention can prevent further damage to the joint. The purpose of surgery is to correct a mechanical problem (such as FAI or hip dysplasia) with a mechanically based joint preservation surgery to provide pain relief and improve function and longevity of the hip joint.
Hip Arthroscopy is a minimally invasive technique for treating intraarticular problems in the hip such as mild to moderate FAI. The procedures include labral debridement, labral repair and/or shaving of the bone.
Mini Arthotomy is a procedure in which the capsule surrounding the hip joint is opened. Mild FAI could be treated with shaving of the bone. Some labral tears can be repaired through this approach.
Surgical Hip Dislocation
Surgical Hip Disclocation is a more invasive procedure where the capsule surrounding the hip joint is opened and the femoral head is completely separated from the socket. This approach gives the best view of the femoral head and the socket. Procedures such as shaving of the bone from the head neck junction (osteoplasty), labral repair, trimming of a deep socket and/or microfracture of the damaged cartilage may be used to fix the dislocation.
Triple Innominate Pelvic Osteotomy
Triple Innominate Pelvic Osteotomy is advanced pelvis osteotomy for DDH. It is performed in children 7 years and older until skeletal maturity. The surgery is performed through two incisions and provides excellent coverage for the hip. Since stable fixation is achieved post operatively, a hip spica cast is not required.
Periacetabular Osteotomy (PAO)
Periacetabular osteotomy (PAO) is the primary procedure to fix hip dysplasia. It is done through a single incision and will correct the tilt of the shallow socket. The upward tipped socket is redirected in a way that it is more horizontal. Only realignment operation like PAO can correct the underlying mechanical problem and abnormal tilt of the acetabulum.