Developmental dysplasia of the hip from six months to four years of age

Abstract

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologic conditions, ranging from subtle acetabular dysplasia to irreducible hip dislocation. When DDH is recognized in the first 6 months of life, treatment with a Pavlik harness frequently results in an excellent outcome. In children older than 6 months, achieving a concentrically reduced hip while minimizing complications is more challenging. Bracing, traction, closed reduction, open reduction, and femoral or pelvic osteotomies are frequently used treatment modalities for children aged 6 months to 4 years. In the past, treatment recommendations have often been based on the patient's age. However, recent practice has placed more emphasis on addressing the specific disorder and avoiding iatrogenic osteonecrosis. The incidence of osteonecrosis of the femoral head has been reduced by avoiding immobilization of the hip in extreme abduction and by using femur-shortening osteotomies when appropriate. Pelvic osteotomy continues to gain favor for the treatment of selected patients over 18 months of age.