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)
Of the above factors, the most critical risk factors are: being female, positive family history, race/ethnicity, and intrauterine position.
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
1https://www.physicaltherapy.com/pt-ceus/course/lab-values-and-vital-signs-3363Lab Values and Vital Signs in the Neonatal Intensive Care UnitThis 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.auditory, textual, visual
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.
2https://www.physicaltherapy.com/pt-ceus/course/orthopedic-conditions-in-pediatrics-primer-3067Orthopedic Conditions in Pediatrics: A Primer for Physical Therapy ProfessionalsThis 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.auditory, textual, visual
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.
3https://www.physicaltherapy.com/pt-ceus/course/impact-motor-learning-for-child-3870Impact of Motor Learning For The Child With Autism Spectrum DisorderMaster 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.auditory, textual, visual
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.
4https://www.physicaltherapy.com/pt-ceus/course/power-to-go-meeting-needs-3615Power to Go: Meeting the Needs of Pediatric Power Mobility LearnersRecent research identifies three different groups of pediatric power mobility learners. Clinically-based intervention strategies, including tools to monitor intervention outcomes, to meet the specific learning needs of children in each power mobility group will be presented and discussed. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.auditory, textual, visual
Recent research identifies three different groups of pediatric power mobility learners. Clinically-based intervention strategies, including tools to monitor intervention outcomes, to meet the specific learning needs of children in each power mobility group will be presented and discussed. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
5https://www.physicaltherapy.com/pt-ceus/course/tools-you-can-use-enhancing-3616Tools You Can Use: Enhancing Outcomes Assessment in Children with Cerebral PalsyThis session will focus on outcome measures reflecting the various domains of the International Classification of Functioning, Disability, and Health (ICF) that can be used with children who have cerebral palsy. Guidelines related to the use and application of these various tools will be presented and discussed whilst case scenarios and vignettes will be used to illustrate the application of these evidence-based tools to pediatric practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.auditory, textual, visual
This session will focus on outcome measures reflecting the various domains of the International Classification of Functioning, Disability, and Health (ICF) that can be used with children who have cerebral palsy. Guidelines related to the use and application of these various tools will be presented and discussed whilst case scenarios and vignettes will be used to illustrate the application of these evidence-based tools to pediatric practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
