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

Nicolas Padilla
Professor 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
Developmental (Congenital) Dysplasia of the Hip

Dysplasia Subluxation Dislocation

Teratologic

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 Grafs 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.