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Developmental Dysplasia of the Hip

Alicia Fernandez-Fernandez, PT, DPT, PhD, CNT

September 25, 2018

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Question

What are the risk factors and the etiology of developmental dysplasia of the hip?  

Answer

DDH is multifactorial. Many factors may contribute to DDH. These factors include:

  • Malpositioning or mechanical factors in utero.
  • Hormone-induced ligamentous laxity. This is one of the reasons we see DDH more in females because they're more responsive to hormonal levels (e.g., relaxin, estrogen) in their mother. There may be some degree of ligament hyperlaxity related to those hormones that result in instability of the hip.
  • Genetics. If someone in your family had hip dysplasia, you're more likely to have hip dysplasia.
  • Cultural or environmental factors. There are some cultures in which women carry children in flexion external rotation and abduction, which helps position the femoral head directly in contact with the acetabulum. However, in some cultures, children are swaddled with their hips and knees in extension and limited abduction. At that point, you're putting that hip at risk because it's not in good contact with the acetabulum. If you keep doing that on a regular basis, that predisposes a child to develop hip dysplasia.
  • Concurrent pathology 

DDH in infancy is the most common abnormality in the neonate. One out of 20 full-term babies has some degree of instability. Two to three out of 1000 babies will need therapy. There are several risk factors associated with DDH in otherwise healthy children, including:

  • Sex (female; related to hormonal response)
  • Genetics (parents or siblings)
  • Race and ethnicity (non-black)
  • Intrauterine position (breech; higher birth weight)
  • Maternal age (older than 35 years)
  • Oligohydramnios
  • Clicking hips on clinical exam
  • Postural deformities (torticollis; lower extremity deformities)

Of the above factors, the most critical risk factors are: being female, positive family history, race/ethnicity, and intrauterine position.


alicia fernandez fernandez

Alicia Fernandez-Fernandez, PT, DPT, PhD, CNT

Alicia Fernandez-Fernandez graduated from the University of Oviedo (Spain) with a diploma in physical therapy and
practiced in a variety of settings as a physical therapist in Spain before moving to the US and obtaining her M.S. in Physical Therapy, a post-professional Doctorate in Physical Therapy, and a PhD in Biomedical Engineering. She has practiced at the South Miami Hospital Neonatal Intensive Care Unit (NICU) 2003-present. In 2011 she joined Nova Southeastern University, where she is currently an Associate Professor and teaches Pediatrics, Kinesiology, Prosthetics and Orthotics, and Gender Issues. She continues to practice in the NICU on a per diem basis and she is a Certified Neonatal Therapist. Her research interests encompass pediatrics, biomechanics, use of technology in education, and nanotechnology applications in cancer.


Related Courses

Lab Values and Vital Signs in the Neonatal Intensive Care Unit
Presented by Alicia Fernandez-Fernandez, PT, DPT, PhD, CNT
Recorded Webinar

Presenter

Alicia Fernandez-Fernandez, PT, DPT, PhD, CNT
Course: #3363Level: Introductory2 Hours
  'Real life examples'   Read Reviews
This course is designed to be an introductory overview of the interpretation of laboratory values and vital sign measurements in the neonatal intensive care unit (NICU). The aim is to provide neonatal therapists with a framework for clinical decision-making so that they can recognize imbalances that may require modifications in the plan of care, or discussion with the nurse or neonatologist before further treatment.This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Spina Bifida Through the Life Span: Management Considerations From Infancy to Adulthood
Presented by Alicia Fernandez-Fernandez, PT, DPT, PhD, CNT
Recorded Webinar

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This course provides an overview of the management of children and adolescents with spina bifida, including current evidence for best practices in this patient population, as well as a discussion of challenges and health complications related to spina bifida in the adult age. We will review pathology, clinical presentation, current medical and surgical intervention approaches, and key precautions. We will also explore evidence-based therapeutic management in different life stages, with a focus on interventions that promote participation and functional gains. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Editor's Note: Regarding IL EITP credits, this course is awarded partial credit, .5 hours. Only a portion of the content reviewed directly addresses infants and toddlers 0-36 months of age.

Orthopedic Conditions in Pediatrics: A Primer for Physical Therapy Professionals
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This course is designed to be an introductory overview of select orthopedic conditions in children, including presentation, examination, intervention, and possible causes for a referral. The aim is to provide clinicians with a framework for orthopedic evidence-based clinical decision-making in order to recognize and address orthopedic problems, optimize patient outcomes, and refer patients who may require care out of their scope of practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

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Individuals with ASD often struggle with sensory processing disorder, dyspraxia, overweight and obesity, social-communication impairments, anxiety, and impaired cognition and executive functioning, all of which persist into adulthood and can interfere with independent living, paid employment, quality of life, and community participation. This course will explore current knowledge on the impact of ASD throughout the lifespan, discuss the role of physical therapy in serving this population, and identify resources and strategies to empower patients and families for successful transitions to adulthood. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

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Mariah Woody, OTR/LLisa Roehl, PT, DPT, Board-Certified Clinical Specialist in Pediatric Physical Therapy
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Master skills to implement in your practice immediately with continued Master Class. Children with ASD face challenges as they form the motor programs that serve as the basis for daily life and play. This interdisciplinary course series will expand upon the theory of praxis and the child’s ability to adaptively respond to their environment in a way that is meaningful and efficient. Through practical and clinical demonstrations, the learner will develop a deeper understanding of the importance of motor learning for the child with ASD. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.