Developmental Hip Dysplasia

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LB74 Structural developmental anomalies of pelvic girdle

ICD-11 beta - LB74 
LB74 Structural developmental anomalies of pelvic girdle
Exclusions - Clicking hip (MG40)

This is the beta version of the future ICD-11 classification code.

  • LB74.1 Developmental dysplasia of hip
  • LB74.2 Congenital subluxation of hip
  • LB74.3 Unstable hip
  • LB74.4 Congenital coxa vara
  • LB74.5 Congenital coxa valga
  • LB74.6 Wide symphysis pubis
  • LB74.Y Other specified structural developmental anomalies of pelvic girdle
  • LB74.Z Structural developmental anomalies of pelvic girdle, unspecified
ICD-10  
ICD-10 Q65 Congenital deformities of hip Excl.: clicking hip (R29.4)

This is the current ICD-10 classification code.

Q65 Congenital deformities of hip

Excl.: clicking hip (R29.4)

  • Q65.0 Congenital dislocation of hip, unilateral
  • Q65.1 Congenital dislocation of hip, bilateral
  • Q65.2 Congenital dislocation of hip, unspecified
  • Q65.3 Congenital subluxation of hip, unilateral
  • Q65.4 Congenital subluxation of hip, bilateral
  • Q65.5 Congenital subluxation of hip, unspecified
  • Q65.6 Unstable hip Dislocatable hip Subluxatable hip
  • Q65.8 Other congenital deformities of hip Anteversion of femoral neck Congenital acetabular dysplasia Congenital coxa: valga vara
  • Q65.9 Congenital deformity of hip, unspecified

OMIM: Developmental Dysplasia Of The Hip 1 | Developmental Dysplasia Of The Hip 2

Introduction

This skeletal abnormality is described alternately as developmental hip dysplasia (DDH, developmental dysplasia of the hip, congenital hip dislocation, acetabular dysplasia, subluxation of the hip joint). Note that both the current ICD-10 and future ICD-11 code exclude "clicking hip" (MG40).

Development of the pelvis, acetabulum and femur are complex processes involving ongoing ossification, joint and ligament development. This condition is one of the most common skeletal congenital anomalies usually detected in the early (less than 1 year) clinical examination of the musculoskeletal function. Currently the American Academy of Pediatrics recommends that all newborns be clinically examined for developmental hip dysplasia initially and then at every health supervision visit until the child walks normally.[1]


Features include:

  • Instability: 1:60 at birth; 1:240 at 1 wk: Dislocation untreated; 1:700
  • congenital instability of hip, later dislocates by muscle pulls or gravity
  • familial predisposition female predominance
  • Growth of femoral head, acetabulum and innominate bone are delayed until the femoral head fits firmly into the acetabulum


Congenital dislocation hip.jpg Renal agenesis 01.jpg
X-Ray Hip Dysplasia X-Ray Hip Dysplasia and renal agenesis[2] "Developmental dysplasia of the hip (DDH) occurs in 3-5 of 1000 live births and is associated with known risk factors. In most countries, formal practice for early detection of DDH entails the combination of risk factor identification and physical examination of the hip, while the golden standard diagnostic instrument is hip ultrasonography (US)....Of the 115,918 infants born during the study period, 67,491 underwent at least one hip US. Of these, 60.6% were female, mean age at performance: 2.2 months. Of those who underwent US, 625 (0.93%) were treated with a Pavlik harness: 0.24% of the male infants and 1.60% of the female infants (p < 0.001). ...Current pattern of hip US utilization for early detection of DDH resembles universal screening more closely than selective screening."


Musculoskeletal Links: Introduction | mesoderm | somitogenesis | limb | cartilage | bone | bone timeline | shoulder | pelvis | axial skeleton | skull | joint | skeletal muscle | muscle timeline | tendon | diaphragm | Lecture - Musculoskeletal | Lecture Movie | musculoskeletal abnormalities | limb abnormalities | developmental hip dysplasia | cartilage histology | bone histology | Skeletal Muscle Histology | Category:Musculoskeletal
Historic Musculoskeletal Embryology  
1853 Bone | 1885 Sphenoid | 1902 - Pubo-femoral Region | Spinal Column and Back | Body Segmentation | Cranium | Body Wall, Ribs, and Sternum | Limbs | 1901 - Limbs | 1902 - Arm Development | 1906 Human Embryo Ossification | 1906 Lower limb Nerves and Muscle | 1907 - Muscular System | Skeleton and Limbs | 1908 Vertebra | 1908 Cervical Vertebra | 1909 Mandible | 1910 - Skeleton and Connective Tissues | Muscular System | Coelom and Diaphragm | 1913 Clavicle | 1920 Clavicle | 1921 - External body form | Connective tissues and skeletal | Muscular | Diaphragm | 1929 Rat Somite | 1932 Pelvis | 1940 Synovial Joints | 1943 Human Embryonic, Fetal and Circumnatal Skeleton | 1947 Joints | 1949 Cartilage and Bone | 1957 Chondrification Hands and Feet | 1968 Knee

Some Recent Findings

  • Developmental dysplasia of the hip: why are we still operating on them?[3] "Developmental dysplasia of the hip (DDH) is a common orthopaedic condition at birth. Non-surgical management with Pavlik harness can effectively treat DDH with early clinical diagnosis at newborn, but open surgeries continue to be performed. We aimed to elucidate the reasons for this. A retrospective review was performed of all open surgeries related to DDH from 2006 to 2016. Patients were either born at our institution (Group 1) or outside of it (Group 2). All Group 1 newborns were routinely screened for DDH at birth. RESULTS: 27 patients (Group 1: n = 5; Group 2: n = 22) presented at 25 ± 19 months old. Left-sided DDH (n = 21; 77.8%) and girls (n = 22; 81.5%) were more common. Mean age at surgery was 40 ± 31 months. The most commonly performed procedure was soft tissue release open reduction with acetabuloplasty (n = 20; 74.1%). Gender, site, median age at presentation and surgery, and prevalence of risk factors were matched for both groups. Both groups were mostly made up of late presenters (presenting after three months) (p = 0.68), with a few patients having had prior treatment (p = 0.64). Newborn screening was the only variable with statistical difference between the groups (p < 0.01). CONCLUSION: Lack of institutionalised newborn clinical screening appears to be the root cause for the late presentation of DDH leading to open surgeries for its management. We recommend quality institutionalised newborn clinical screening to reduce the number of late presentations leading to open surgeries for DDH."
  • Review - Ultrasonography to detect developmental dysplasia of the hip[4]
More recent papers  
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This table shows an automated computer PubMed search using the listed sub-heading term.

  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
  • References appear in this list based upon the date of the actual page viewing.

References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.

Links: References | Discussion Page | Pubmed Most Recent | Journal Searches


Search term: Developmental Hip Dysplasia

Mike Reidy, Caitlin Collins, Jamie G B MacLean, Donald Campbell Examining the effectiveness of examination at 6-8 weeks for developmental dysplasia: testing the safety net. Arch. Dis. Child.: 2018; PubMed 30518519

Wenjin Yan, Zheng Hao, Shuyan Tang, Jin Dai, Liming Zheng, Pengjun Yu, Wenqiang Yan, Xiao Han, Xingquan Xu, Dongquan Shi, Shiro Ikegawa, Huajian Teng, Qing Jiang A genome-wide association study identifies new genes associated with developmental dysplasia of the hip. Clin. Genet.: 2018; PubMed 30511388

Yu-Bo Liu, Tian-Ming Zou Giant monostotic osteofibrous dysplasia of the ilium: A case report and review of literature. World J Clin Cases: 2018, 6(14);830-835 PubMed 30510951

Mariana Callil Voos, Soares de Moura Maria Clara Drummond, Renata Hydee Hasue Hip Mobilization at Preterm Age May Accelerate Developmental Dysplasia Recovery. Case Rep Med: 2018, 2018;8625721 PubMed 30510581

Tomonori Tabata, Nobuhiro Kaku, Hiroaki Tagomori, Hiroshi Tsumura Influence of hip center position, anterior inferior iliac spine morphology, and ball head diameter on range of motion in total hip arthroplasty. Orthop Traumatol Surg Res: 2018; PubMed 30509621

Textbooks

  • The Developing Human: Clinically Oriented Embryology (8th Edition) by Keith L. Moore and T.V.N Persaud - Moore & Persaud Chapter 15 the skeletal system
  • Larsen’s Human Embryology by GC. Schoenwolf, SB. Bleyl, PR. Brauer and PH. Francis-West - Chapter 11 Limb Dev (bone not well covered in this textbook)
  • Before we Are Born (5th ed.) Moore and Persaud Chapter 16,17: p379-397, 399-405
  • Essentials of Human Embryology Larson Chapter 11 p207-228

Neural Exam

The following examination movies relate more to normal neurological development and muscle tone, but they do also show the movement of the hip at different postnatal ages.

Newborn Tone

This 5-day-old infant is in the alert, quiet state.
  • Assessing motor function of the lower extremities begins with passive range of motion.
  • This is done by flexing the hips, then abducting and adducting the hips.
  • Next, flex and extend the hips, the knees and ankles.
  • Further testing helps to better define the tone and any tone abnormalities.

3 Months Tone

  • Tone in the lower extremities is present with the appropriate resistance to passive range of motion.
  • The tight flexor tone of the newborn is no longer present.
Neural Exam Movies  
Neural Exam Movies: normal behaviour | cranial nerves | Newborn Tone - resting posture | upper extremity‎ | arm traction | arm recoil | scarf sign | hand position | lower extremity | leg traction‎ | leg recoil‎‎ | popliteal angle‎ | heel to ear | neck tone | head lag‎ | head control | Newborn Positions - prone | ventral suspension | vertical suspension | Newborn Reflexes - deep tendon reflexes | plantar reflex‎ | suck, root | Moro | Galant | stepping‎ | grasp | Newborn Head - head shape and sutures‎ | head circumference‎ | Neonatal Diagnosis
3 Months Neural Exam Movies: normal behaviour | cranial nerves | Tone - head and trunk control | upper extremity‎ | hand movements | lower extremity Positions - supine | prone | ventral suspension | vertical suspension | Reflexes - Deep tendon reflexes | Plantar reflex‎ | Root | Moro | Galant | Grasp | Asymmetric tonic neck‎ | Neural Exam Movies | Neonatal Diagnosis

Barlow Test

(Barlow maneuver) A clinical term to describe a physical examination of the newborn for developmental dysplasia of the hip (DDH). The examiner adducts the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. A positive sign is the hip being dislocatable, if the hip can be popped out of socket with this test. This test is then combined with the Ortolani test (maneuver).

The test is named after Thomas Barlow (1845 – 1945) a British royal physician.

Ortolani Test

(Ortolani maneuver) A clinical term to describe a physical examination of the newborn for developmental dysplasia of the hip (DDH). This is a test for posterior dislocation of the hip. Using the examiner's thumb, abduct the infant's leg, while using the examiner's index finger to place anterior pressure on the greater trochanter. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum, usually becomes negative after 2 months of age. This test is combined with the Barlow test (maneuver).

The test is named after Marino Ortolani, the test developer in 1976.

Acetabular Index

Acetabular angle[5]

This clinical measurement is based upon radiograph analysis of the acetabular inclination before ossification of the triradiate cartilage. The index is defined as the angle between Hilgenreiner's line and a line from the inferior margin of the iliac bone through the acetabular bony rim.

Triradiate cartilage is the Y-shaped growth plate region within the hip that does not complete ossification postnatally in humans until 14 - 16 years of age.

Ultrasound

The ultrasound screening method is often called the "Graf method and classification".

Measures by ultrasound:

  1. bony rim
  2. bony acetabular roof modelling (α-angle)
  3. cartilaginous roof (β- angle)
Links: Ultrasound

X-ray

X-ray screening has been generally replaced by ultrasound. Below are some of the radiographic landmarks.

  • Hilgenreiner's line - a horizontal line drawn between the two triradiate cartilage centers of the hips, defines a horizontal plane and an approximation to flexion axis of the hips.
  • Perkin's line - a perpendicular line to the horizontal line drawn at the edge of the boney part of the acetabular socket.
  • Shenton's line - an oval that traces the lower pubis contour, that should smoothly continue on to trace the lower edge of the neck of the femur.


Abduction Splints

There is variable evidence for the use of abduction splinting during onset of walking in children on the maturation of mild dysplastic hips.[5]


Links: Screening for developmental dysplasia of the hip: recommendation statement. PMID16510673

References

  1. Goldberg MJ. (2001). Early detection of developmental hip dysplasia: synopsis of the AAP Clinical Practice Guideline. Pediatr Rev , 22, 131-4. PMID: 11283326
  2. Acién P, Galán F, Manchón I, Ruiz E, Acién M & Alcaraz LA. (2010). Hereditary renal adysplasia, pulmonary hypoplasia and Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a case report. Orphanet J Rare Dis , 5, 6. PMID: 20388228 DOI.
  3. Lee WC, Gera SK & Mahadev A. (2018). Developmental dysplasia of the hip: why are we still operating on them? A plea for institutional newborn clinical screening. Singapore Med J , , . PMID: 29774363 DOI.
  4. Wilf-Miron R, Kuint J, Peled R, Cohen A & Porath A. (2017). Utilization of ultrasonography to detect developmental dysplasia of the hip: when reality turns selective screening into universal use. BMC Pediatr , 17, 136. PMID: 28583152 DOI.
  5. 5.0 5.1 Windhagen H, Thorey F, Kronewid H, Pressel T, Herold D & Stukenborg-Colsman C. (2005). The effect of functional splinting on mild dysplastic hips after walking onset. BMC Pediatr , 5, 17. PMID: 15958160 DOI.

Reviews

Swarup I, Penny CL & Dodwell ER. (2018). Developmental dysplasia of the hip: an update on diagnosis and management from birth to 6 months. Curr. Opin. Pediatr. , 30, 84-92. PMID: 29194074 DOI.

Wilf-Miron R, Kuint J, Peled R, Cohen A & Porath A. (2017). Utilization of ultrasonography to detect developmental dysplasia of the hip: when reality turns selective screening into universal use. BMC Pediatr , 17, 136. PMID: 28583152 DOI.

Coobs BR, Xiong A & Clohisy JC. (2015). Contemporary Concepts in the Young Adult Hip Patient: Periacetabular Osteotomy for Hip Dysplasia. J Arthroplasty , 30, 1105-8. PMID: 25865812 DOI.

Miller SD, Juricic M, Hesketh K, Mclean L, Magnuson S, Gasior S, Schaeffer E, O'donnell M & Mulpuri K. (2017). Prevention of hip displacement in children with cerebral palsy: a systematic review. Dev Med Child Neurol , 59, 1130-1138. PMID: 28574172 DOI.

Shorter D, Hong T & Osborn DA. (2013). Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health , 8, 11-54. PMID: 23878122 DOI.

Kosuge D, Yamada N, Azegami S, Achan P & Ramachandran M. (2013). Management of developmental dysplasia of the hip in young adults: current concepts. Bone Joint J , 95-B, 732-7. PMID: 23723265 DOI.

Bracken J, Tran T & Ditchfield M. (2012). Developmental dysplasia of the hip: controversies and current concepts. J Paediatr Child Health , 48, 963-72; quiz 972-3. PMID: 23126391 DOI.

Jackson JC, Runge MM & Nye NS. (2014). Common questions about developmental dysplasia of the hip. Am Fam Physician , 90, 843-50. PMID: 25591184

Guille JT, Pizzutillo PD & MacEwen GD. (2000). Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg , 8, 232-42. PMID: 10951112


Articles

McAllister DA, Morling JR, Fischbacher CM, Reidy M, Murray A & Wood R. (2018). Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997-2013. Arch. Dis. Child. , , . PMID: 29436408 DOI.

Musielak B, Idzior M & Jóźwiak M. (2015). Evolution of the term and definition of dysplasia of the hip - a review of the literature. Arch Med Sci , 11, 1052-7. PMID: 26528350 DOI.

Search PubMed

Search Pubmed: Developmental Hip Dysplasia

Additional Images

Terms

  • Barlow test - (Barlow maneuver) clinical physical newborn examination where the examiner adducts the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. A positive sign is the hip being dislocatable, if the hip can be popped out of socket with this test.
  • Ortolani test - (Ortolani maneuver) clinical physical newborn examination for posterior dislocation of the hip. Using the examiner's thumb, abduct the infant's leg, while using the examiner's index finger to place anterior pressure on the greater trochanter. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum, usually becomes negative after 2 months of age.
  • preaxial - referring to the lateral (radial) aspect of the upper limb, and the medial (tibial) aspect of the lower limb.
  • postaxial - referring to the medial ( ulnar) aspect of the upper limb, and the lateral (fibular) aspect of the lower limb.

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Cite this page: Hill, M.A. (2018, December 9) Embryology Developmental Hip Dysplasia. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Developmental_Hip_Dysplasia

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© Dr Mark Hill 2018, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G