Developmental dysplasia of the hip (DDH)
What is DDH?
In DDH, the ball and socket of the hip joint do not fit snugly together, making the joint less stable.
The ball may slide in and out of the socket. This is called a subluxatable hip if the ball can pop back in.
If the ball loses contact with the socket and stays outside the joint, it is called a dislocated hip.
What are the risk factors for DDH?
The most common risk factors are:
- breech position (at any time during pregnancy or at birth) and
- family history of DDH or hip problems in early life.
Other risk factors include:
- multiple pregnancy (twins, triplets or more)
- oligohydramnios (low levels of amniotic fluid during pregnancy)
- torticollis (baby born with a crooked or wry neck) and
- foot abnormalities (including positional talipes, where the foot is turned down and in but is flexible, metatarsus adductus, where the front of the foot is hooked or turned in, and calcaneovalgus, where the foot is turned upwards and outwards)
When should I suspect it as a clinician or parent?
In addition to the above risk factors, you should suspect it clinically if:
- When changing a nappy, one or both legs/thighs do not seem to move outwards or open as fully as the other
- Deep unequal creases may be present in the buttocks or thighs
- One leg appears shorter than the other (bend both knees up and compare their heights - one will be lying lower than the other)
- When moving one or both hip joints e.g. when changing nappies, you may feel a click and/or a clunk
- There are additional clinical tests such as Ortolani's and Barlow's - these tests are best performed by an experienced children's orthopaedic surgeon
- In older children, one leg may be shorter than the other and your child walks with a limp, tiptoes on the shorter leg or bends the knee on the longer leg. If both hips are dislocated, your child may walk with a waddling limp.
What should I do if I suspect a child may have DDH?
If any of the above applies to your child, then this may well have been picked up at the newborn and 6-8 week baby check.
If not, then go and see your GP/family clinician who will refer your baby on for an ultrasound scan of the hip.
What test should be done in babies with suspected DDH?
One type of ultrasound we should probably all have is a hip ultrasound as an infant to rule out hip dysplasia.
This affects 1 in 30 people and is easily treated by wearing a harness as a baby, but if missed, can lead to a life of suffering from premature osteoarthritis.
In DDH, the ball and socket of the hip joint do not fit snugly together, making the joint less stable.
The ball may slide in and out of the socket. This is called a subluxatable hip if the ball can pop back in.
If the ball loses contact with the socket and stays outside the joint, it is called a dislocated hip.
What are the risk factors for DDH?
The most common risk factors are:
- breech position (at any time during pregnancy or at birth) and
- family history of DDH or hip problems in early life.
Other risk factors include:
- multiple pregnancy (twins, triplets or more)
- oligohydramnios (low levels of amniotic fluid during pregnancy)
- torticollis (baby born with a crooked or wry neck) and
- foot abnormalities (including positional talipes, where the foot is turned down and in but is flexible, metatarsus adductus, where the front of the foot is hooked or turned in, and calcaneovalgus, where the foot is turned upwards and outwards)
When should I suspect it as a clinician or parent?
In addition to the above risk factors, you should suspect it clinically if:
- When changing a nappy, one or both legs/thighs do not seem to move outwards or open as fully as the other
- Deep unequal creases may be present in the buttocks or thighs
- One leg appears shorter than the other (bend both knees up and compare their heights - one will be lying lower than the other)
- When moving one or both hip joints e.g. when changing nappies, you may feel a click and/or a clunk
- There are additional clinical tests such as Ortolani's and Barlow's - these tests are best performed by an experienced children's orthopaedic surgeon
- In older children, one leg may be shorter than the other and your child walks with a limp, tiptoes on the shorter leg or bends the knee on the longer leg. If both hips are dislocated, your child may walk with a waddling limp.
What should I do if I suspect a child may have DDH?
If any of the above applies to your child, then this may well have been picked up at the newborn and 6-8 week baby check.
If not, then go and see your GP/family clinician who will refer your baby on for an ultrasound scan of the hip.
What test should be done in babies with suspected DDH?
One type of ultrasound we should probably all have is a hip ultrasound as an infant to rule out hip dysplasia.
This affects 1 in 30 people and is easily treated by wearing a harness as a baby, but if missed, can lead to a life of suffering from premature osteoarthritis.
2D static imaging
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Conventional 2D hip ultrasound is difficult even for experts to perform reliably.
We are testing and refining deep learning algorithms to simplify the diagnostic process in 2D static hip images. With instant upload to our secure cloud servers, an accurate answer can be returned the family almost instantly. |
2D dynamic imaging
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2D dynamic images are taken moments before static images are captured.
We are working on technology to instantly diagnose normal and dysplastic hips during the dynamic phase of scanning. |
3D imaging
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3D ultrasound captures the entire hip almost instantly to generate incredibly detailed images for analysis.
We are working on generating 3D surface models from these scans and to use deep learning to determine whether that hip is normal or dysplastic.
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CMA Joule Grant
Please take a look at the video below outlining some of our work we in hip ultrasound, specifically in 3D imaging.