Hip Dysplasia

Hip Dysplasia

Dysplasia is defined as the abnormal growth or development of a tissue or organ.    Hip dysplasia is an underdeveloped or shallow acetabulum.  This can lead to general joint laxity subluxation or dislocation.

Congenital Hip dysplasia is very common and is considered the most common orthopedic dysfunction in newborns at 1:100.  1:1000 will experience dislocations.  It is more common in females (6:1) and only 20% are bilaterally.
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Risk factors include:


 -First born
 -Female
 -Breech
 -Family history

Presentation:


Physical exam less than 3 months

 -Palpable hip subluxation/dislocation on physical exam and or hip clicking

 -BARLOW

  -Dislocated hip by adduction and depression on femur

 -ORTOLANI

  -Reduces a dislocated hip by elevation and abduction

 -GALEAZZI

-When knees are flexed at 90 degrees, apparent leg length discrepancy due to unilateral dislocation

 
Physical exam greater than 3 months

 -Patient presents with decrease abduction and leg length discrepancy
Physical exam of greater than one year or the child is walking

- Pelvic obliquity
- Lumbar lordosis
- Trendelenburg gait

*Hip abductor weakness

- Toe walking on shorten side

Diagnostic testing:


 -xray

  *Primary diagnosis

 -Ultrasound
 -Arthrogram
 -CT scan

  *Study of choice for reduction on hip

Treatment:


-Non-operative

 -Abduction splinting/bracing (Pavlik harness)

  - < 6 months and hip is reducible
  -Dynamic splint

 -Closed reduction and spica casting

  -6-18 months
  -Failure of Pavlik RX

 -Open reduction and spica cast

*Greater than 18 months
*Failure of closed reduction

-Open reduction and femoral osteotomy

*Greater than 2 years
*Anteversion/coxa valga
*Femoral head should be reduced with adequate ROM
*Less than 4 years old

-Open Reduction with pelvic osteotomy

*Radiographic changes on femoral side
*Usually greater than 4 years old