Doç.Dr.İlker Sarıkaya

Developmental Dysplasia of the Hip (Congenital Hip Dislocation) (DDH)

The congenital mismatch between the bones that make up the hip joint is called developmental ” dysplasia of the hip”. All problems seen from a simple mismatch between the bones to the later stage of hip dislocation are classified as developmental hip dysplasia.

What are the Risk Factors for Hip Dislocation?

Pathologies such as breech presentation of the baby during normal delivery, multiple pregnancies, problems with low or excess amniotic fluid, first birth, and the position of the child in the womb increase the risk. Girls are also more prone to Developmental Hip Dysplasia because their ligaments are more flexible. Swaddling the baby in the traditional way also increases this risk. The legs are not spread and remain immobilized as a result of swaddling, so it is necessary to free the legs to allow the natural development of the hips. Today, there are also methods of carrying and wrapping that are not like traditional swaddling and only wrap the baby around the torso, leaving the legs free. These are different from traditional swaddling because the legs are free.

How is DDH Diagnosed?

When the baby is born, the hip is evaluated in the first examination performed by pediatricians, and if a dislocation is noticed, treatment is started immediately by the pediatric orthopedist. At the same time, height difference between the legs and the presence of asymmetry in the skin folds on the thighs of the baby should also raise suspicion of hip dislocation. Hip ultrasound (USG), which is recommended to be performed between 4-6 weeks after birth, is extremely important in terms of detecting a possible problem. It should not be forgotten that the earlier the problem in the hip is diagnosed, the easier it is to treat.

How should DDH treatment be?

A baby diagnosed with DDH is treated with the help of a special bandage. Orthoses such as the Pavlic bandage or the Tubingen device are easier to apply than plaster casts and have a very high success rate. The baby should wear the bandage for 24 hours and should not remove it until the next doctor’s visit. In cases where the bandage must be changed, the family is told how to do it. However, it is better to have the bandage removed by a pediatric orthopedist unless absolutely necessary. During bandage treatment, ultrasound checks are performed at three-week intervals. The bandage may need to be worn for up to 6 – 8 months. If the problem is not severe, the effect can be seen in a period of 2-3 months. In dislocations noticed after six months or in case of unsuccessful treatment; if the hip is not dislocated, only plastering, but if the hip is dislocated, it is first placed in place with the closed method and then plastering is performed. Plaster cast application is a more difficult treatment method than bandage. It should be replaced six weeks after application as the child grows. If the problem in the hip is recognized even later, closed reduction will not be sufficient after the age of 1 year. In this case, open reduction (open reduction) is necessary. The joint is accessed through a small incision and the structures inside the joint are cleaned and the hip is put back into place and then placed in a plaster cast.

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