Developmental Dysplasia of the Hip – DDH Information

Starting my blog was all based around wanting to raise awareness and share our journey with DDH. As I have shared our journey so far, I want to share some very crucial information about DDH, because before Amelia was diagnosed, I didn’t know myself what DDH even was!
Developmental dysplasia of the hip (DDH) is when the ball shaped part of the end of the thighbone and the socket do not fit correctly together. There are varying levels of hip dysplasia, from mild to severe.
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If the ball (femoral head) is not held correctly in place, the socket (acetabulum) may be more shallow than usual. Sometimes this makes the joint less stable and the ball may slide in and out of the socket. This is called a dislocatable or ‘subluxatable’ hip. If the ball loses contact with the socket and stays outside the joint it is called a dislocated hip. One or both hips may be affected.
About 1 or 2 in every 1,000 babies has a hip problem needing treatment. In fact, many more babies (about 6%) will have immature hips that will get better without treatment. With DDH, the problem persists, needing early diagnosis to help reduce the severity and length of time needed for treatment.
DDH can happen to any baby but some factors make the condition more likely.
The two most important risk factors are:
•    a baby born by breech or who was in the breech position in the last three months of pregnancy
•    a close family history of DDH or hip problems that came on in early childhood.
•    DDH is more common in first pregnancies and in baby girls
In more than half of cases, however, there is no identified risk factor and the cause is unknown.
Things that could hinder normal hip development are; tight swaddling or spending long periods of time in car seats. Anything that pulls the hips straight or restricts their natural movement should be avoided.
How is DDH Detected?
ALL babies’ hips are checked at birth and at 6-8 weeks as part of a national screening programme called the Newborn Infant Physical Examination (NIPE). The baby’s hips are gently manipulated to see if they are correctly in joint by tests known as the Ortolani and Barlow Tests.
Even if the physical examination is normal
The physical examination is not 100% accurate as this only detects hip instability at the time of the examination. This means that some babies might appear to be normal at the tests but develop problems later or that DDH has not been picked up at the initial examination. As routine hip examinations finish after the 6-8 week check, family members are best placed to identify a problem.
Early diagnosis gives the best chance for effective treatment.
The condition becomes more difficult to treat as child gets older and there is a risk of developing arthritis of the hip at a young age.
Possible signs of DDH include;
•    Deep unequal creases in the buttocks or thighs
•    When changing a nappy one leg does not seem to move outwards as fully as the other or both legs seem restricted
•    The child drags a leg when crawling
•    One leg looks longer than the other
•    A limp (if one leg is affected) or a ‘waddle’ if both hips are affected
The child is unlikely to feel pain even if displaying these symptoms.
How is DDH Treated?
From birth to six months, babies with developmental dysplasia of the hip are usually fitted with a special fabric harness, the most common types being the Pavlik harness. The type of harness will vary, depending the treating hospital.  Studies have shown that the best time for this treatment is between the ages of 6 to 12 weeks. The harness needs to be worn for several weeks and in most cases this will correct the condition.
Harness
 For some children, when a splint such as the Pavlik harness has not worked or DDH is not diagnosed until after they are approximately six months
old, the consultant may recommend surgery. The most common type of surgery is a reduction, a procedure in which the femoral head (ball) is relocated into the acetabulum (socket). Some children may also go on to need bone surgery to correct bony deformities: careful controlled surgical division of a bone is called an osteotomy.
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After surgery, your child will be put into a hip spica cast for a minimum of
6 weeks. At around 6 weeks your child will need a review of their hip under
a general anaesthetic to check the reduction and the stability of the hip – an xray with dye (arthrogram) may be performed under general anaesthetic to confirm the hip reduction.
It is probable that a further period of at least 6 weeks in a hip spica will be needed to allow the hip to stabilise securely.
You can read our personal story here. If you have a story to share, please feel free to leave a comment (even with a link if you’ve written about it!)
Screenshot 2019-04-25 at 11.13.21

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