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Hip Dysplasia-summary-NATURAL HISTORY

Developmental Dislocation (Dysplasia) of the Hip (DDH)-summary-NATURAL HISTORY

 
■The hip is a ball-and-socket joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.
 
■Although DDH is most often present at birth, it may also develop during a child's first year of life. Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. Given the popularity of swaddling, it is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH.
■DDH  caused by abnormal development of the hip joint that presents clinically in infancy as a wide spectrum of abnormalities. 
These abnormalities can range from instability to complete dislocation of the joint.
■ In utero, the hip with DDH is thought to form normally during the fetal period of development and to undergo abnormal growth of the chondroosseous components during the embryonic period. 
■The precise etiology of DDH is unknown; however, both genetic and environmental factors have statistical associations.
 In some infants, mild dysplasia will resolve spontaneously; however, in others the untreated hip abnormality will become progressively worse, resulting in pain, limited motion, an abnormal gait, and eventually degenerative arthritis in adulthood. 
 
■Untreated severe dysplasia or dislocation of the hip results in an abnormal gait and degenerative arthritis in young adulthood. 
 
■When the abnormalities of DDH are diagnosed and treatment is started soon after birth, the outcome is generally good; however, when treatment is delayed, the outcome is often poor.

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NATURAL HISTORY

■ Many patients with acetabular dysplasia develop subluxa-
tion or dislocation of the femoral head. This can lead to early
arthritis in the middle adult years.
■ The degree of subluxation does not necessarily correlate
with the time to onset of symptoms or the degree of arthritic
changes.