Developmental (Congenital) Dysplasia of the Hip.Natural History and Prevention Levels.

Nicolas PadillaProfessor of Pediatrics

School of Nursing and Obstetrics of Celaya

University of Guanajuato

Definition

• It is a lost of the relationships between hip joint components.

• Occurs in neonatal period.

• 1 of each 6 newborn have hip instability.

• Incidence of true hip dislocation is 2-5/1000 live births.

Clasification

Typical

Teratologic

Developmental (Congenital) Dysplasia of the Hip

Dysplasia

Subluxation

Dislocation

Prepatogenic Period.Agent

• Generalized ligamentous laxity increased by maternal estrogens and/or other hormones.

• Genetic influences.

• Multifactorial

Prepatogenic Period.Host.

• > Female sex (5-7:1) to hip dislocation

• > Male sex to dysplasia.

• 20% of DDC associated with congenital abnormalities (congenital muscular torticolis, metatarsus adductus).

Prepatogenic Period.Environment

• Macro environment. Incidence increased during winter in Mexico.

• Maternal environment. First-born

• Micro environment. Breech position (with the hips flexed and the knees extended).

Primary Prevention.First Level.

Health Promotion.

• Community should know the risk factors.

• Better distribution of medical centres, especially in rural areas.

• To promote perinatal and postnatal care for health care professionals.

Primary Prevention.First Level.

Specific Protection.

• To avoid hold the baby by the ankles.

• To avoid extraction of the newborn with traction of groins or tights.

• To avoid dressing the newborn with extension and adduction of the hips.

• Always check the hips of babies in each visit to pediatrician

Patogenic Period.Subclinic Period.

• Dysplasia is a progressive process.

• Teratologic dislocation is accompanied by other serious malformations as neuromuscular disorder (myelodysplasia, arthrogryposis multiplex congenita).

• Subluxable hip has ligamentous laxity and it is possible to move the femoral head without dislocated.

Patogenic Period.Subclinic Period.

• Dislocation: femoral head is out of the acetabulum in supero lateral position.

Patogenic Period.Clinic Period.

• Barlow test

• Ortolani test

• Galeazzi

• Limitation of hip abduction

• Peter-Baden sign (Asymetry of tight folds)

• Compared transmission of the sound tests

Patogenic Period.Complications.

• Avascular necrosis of the femoral head

• Redislocation

• Residual subluxation

• Acetabular dysplasia

• Postoperative complications (wound infections)

Patogenic Period.Sequelae.

• Coxa vara

• Coxa plana

• Claudication

Secondary Prevention.Third Level.

Precocious Diagnosis.

• Clinic diagnosis Clinical maneuvers

• Ultrasonographic diagnosis It is of first election in lesser of 4 months of age It is used Graf’s scale with dynamic and static test

Secondary Prevention.Third Level.

Precocious Diagnosis.

• Radiologic diagnosis It is not useful if the head femoral is not evident. Anteroposterior and AP in abduction. Hilgenreiner line, angle of Winberg, Shenton line.

Secondary Prevention.Third Level.

Timely Treatment.

• Pavlik harness

• Fredjka splint

• Double and triple diapers are controversial

Secondary Prevention.Fourth Level.

Limitation of Damage.

• Treatment of complications is surgical and the patients should be treated by expert.

• Patients should be checked monthly, then each six months, until adult life.

Tertiary Prevention.Fifth Level.

• Excercise of hips and knees

• Reducation of the gait

References• Padilla N, Figueroa RC. Pruebas de transmision del

sonido en el diagnostico de la luxacion de cadera en el neonato. Rev Mex de Pediatr 1996;63: 265-8.

• Padilla N, Figueroa RC. Displasia congenita de la cadera. Historia natural y sus niveles de prevencion. Rev Mex de Pediatr 1991;58:337-45.

• Padilla N, Figueroa RC. Diagnostico de luxacion congenita de cadera mediante la transmision comparada del sonido. Rev Mex de Pediatr. Rev Mex de Pediatr 1992;59:149-51.