Congenital Hip Dislocation (Infantile Hip Dislocation) (Congenital Dislocation of the Hip) (CD) (Developmental Dysplasia of the Hip) (DDH)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
In utero dislocation of hip is unusual. Most dislocations occur after birth and are related to unstable or dislocatable hips. Major etiologic factors are ligamentous laxity of the joint capsule and intrauterine (breech) presentation. Acetabular dysplasia is a secondary sign of CDH and does not cause CDH. Ninety percent of dislocatable hips will stabilize in first 2 months of life if not treated, but the ones which will stabilize cannot be predicted so all patients are treated with a flexion-abduction-external rotation device.

Pathology:
Not applicable

Imaging Findings:
Ultrasound of the hips is very useful in making the diagnosis in the newborn.

Femoral head ossification centers appear at 3-6 months so radiographs are not useful in the newborn. By 2-4 months old you begin to see lateral displacement of the femur and an increased acetabular angle. In older children on pelvic films superolateral displacement of the proximal femur, increased acetabular angle, delay in appearance of capital femoral ossification center, loss of the lateral margin of acetabulum, abnormal sclerosis of acetabular rim, and formation of a false acetabulum are seen.

DDX:

• Subluxation of hip due to neuromuscular disease and myelodysplasia
• Epiphyseal fracture
• Proximal focal femoral deficiency
• Pyogenic arthritis

References:
See References Chapter.

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