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Developmental dysplasia of the Hip (DDH)

Developmental dysplasia of the Hip (DDH). Natural history, management and outcomes. West Bank, Autumn 2009. Aetiology. Genetic: polygenic syndromic sex-linked Hormonal: oestrogen ; relaxin Mechanical: breech liquor deficiency.

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Developmental dysplasia of the Hip (DDH)

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  1. Developmental dysplasia of the Hip (DDH) Natural history, management and outcomes West Bank, Autumn 2009

  2. Aetiology • Genetic: polygenic syndromic sex-linked • Hormonal: oestrogen ; relaxin • Mechanical: breech liquor deficiency

  3. Mechanical • Left : Right – 4 : 1 • Breech : DDH ≥ x 10 (N.B. frank) • Liquor ↓ : moulded baby - plagiocephaly - scoliosis - foot deformity - skew pelvis

  4. Genetic / mechanical Joint laxity Acetabular and femoral version

  5. Birth pathology in DDH Simple: Acetabulum normal Femoral head normal Labrum normal Capsule stretched

  6. Neonatal DDH Ligamentumteres True socket

  7. Teratological DDH • Irreducible • False acetabulum • Defective anterior acetabulum “anteverted” • Increased femoral neck anteversion

  8. False acetabulum Arthrogryposis with dislocations & delivery fracture

  9. Untreated dysplasia without dislocation in the Navajo 18 children • 15 became normal • 3 stayed dysplastic Pratt, Freiberger, Arnold. CORR; 1982

  10. Which hip dysplasia pain? • Complete dislocation with no false acetabulum: NO • Complete dislocation with falseacetabulum: YES • Subluxation: YES Wedge, Wasylenko. CORR, 1978

  11. Untreated dislocations at 86 yrs.

  12. Untreated subluxations at 45 yrs.

  13. 45-year old Subluxation False acetabulum Severe OA

  14. ... and adult unrecognised dysplasia?

  15. Early treatment • Diagnose! • Splint • Review

  16. Ortolani test

  17. Ultra Sound !

  18. UK Screening Committee: the problems • Poor science • Poor testers • No national training programme • No national audit • Litigation

  19. U.K. National Screening Committee (2006) Universal U.S. not recommended Clinical exam. by properly trained ( at birth & 6 weeks) Refer “at risk” babies

  20. The extended rolepractitioner&orthopaedic team working

  21. Thequestionnaire

  22. Ultrasonographer at work

  23. Annie: extended role physio.

  24. Oxford experience • 1500 new screenings / year • 700 follow-up screenings / year • 95% successful splints

  25. Challenges in hip dysplasia Subluxation Incongruity Early arthritis

  26. The older child

  27. Closed reduction • E.U.A. • Adductor tenotomy • Safe position in POP

  28. The "Human plaster"

  29. Room to move

  30. Open reduction • Bikini incision • Psoastenotomy • Ligamentumteres? • Transverse ligament • Limbus? • Capsulorraphy

  31. Head shape Cover Congruity Articular cartilage Labrum Arthrogram

  32. DDH: what influences arthritis risk? • Age at treatment • Quality of reduction • Stability • AVN

  33. Oxford DDH follow-up Annual clinical and X-Ray review

  34. Opposite hips 4%: moderate/ severeOA Affected hips 40%:moderate/ severe OA Results - Arthritis

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