Developmental dysplasia of the hip: Clinical features and diagnosis
- Scott B Rosenfeld, MD
Scott B Rosenfeld, MD
- Assistant Professor of Pediatric Orthopaedic Surgery and Scoliosis
- Baylor College of Medicine
Developmental dysplasia of the hip (DDH) describes a spectrum of conditions related to the development of the hip in infants and young children. It encompasses abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint (table 1).
Newborns often have physiologic laxity of the hip and immaturity of the acetabulum during the first few weeks of life. In most cases, the laxity resolves, and the acetabulum proceeds to develop normally. With assessment of risk factors, serial physical examination of the hips, and appropriate use of imaging studies, most children with pathologic hips can be correctly diagnosed and treated without long-term sequelae. (See "Developmental dysplasia of the hip: Treatment and outcome".)
Typical DDH, which generally occurs in otherwise healthy infants, will be the focus of this topic review. Hip dysplasia and instability also occur in association with other conditions. Teratologic hip dysplasia occurs in association with various syndromes (eg, Ehlers-Danlos, Down syndrome, arthrogryposis), and neuromuscular hip dysplasia occurs when there is weakness and/or spasticity in some or all of the hip muscle groups (eg, in spina bifida or cerebral palsy). The diagnosis and management of teratologic and neuromuscular hip dysplasia differ from the diagnosis and management of hip dysplasia in otherwise healthy infants.
The clinical features and diagnosis of DDH in otherwise healthy children will be reviewed here. The epidemiology, pathogenesis, treatment, and outcome are discussed separately. (See "Developmental dysplasia of the hip: Epidemiology and pathogenesis" and "Developmental dysplasia of the hip: Treatment and outcome".)
The clinical features of DDH depend upon the age of the child and the severity of the abnormality (table 2). The spectrum of presentation ranges from instability on the newborn examination, to subtle limited abduction in the infant, to asymmetric gait in the toddler, to activity-related pain in the adolescent, to osteoarthritis in the adult. The earlier DDH is detected, the simpler and more effective the treatment and the better the long-term outcome [1,2]. (See "Developmental dysplasia of the hip: Treatment and outcome".)
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- CLINICAL FEATURES
- - Overview
- - General examination
- - Age-specific findings of DDH
- - Hip instability
- - Asymmetry
- - Range of motion
- - Klisic test
- - Bilateral dislocation
- - Dysplasia without dislocation
- Natural history
- DIAGNOSTIC IMAGING
- Plain radiographs
- Other imaging
- APPROACH TO DIAGNOSIS AND REFERRAL
- Positive Ortolani or limited/asymmetric abduction
- Positive Barlow
- Suboptimal or inconclusive examination
- Normal examination and risk factors
- Normal examination and no risk factors
- DIFFERENTIAL DIAGNOSIS
- SCREENING FOR DDH
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS