Plain radiographs are of a limited value in evaluation of DDH in a new born, because unossified femoral head and partly cartilaginous acetabulum are not visible on the X rays. Static ultrasound combined with dynamic study (Harcke’s method) is the modality of choice in infants younger than 6 months of age, while X-ray pelvis including both hip joints is more useful in older children. Physical examination of a newborn is usually a part of screening for DDH. For the purpose of routine screening, CT is falling into disrepute due to the radiation related adverse effects on growing immature skeleton and on the gonads. CT and MRI are reserved for problem-solving during the course of treatment and in the follow-up of cases. Thus, radiographs become the strength in evaluation of DDH at an older age. Ultrasound loses its efficacy after 6 months of age. Public awareness programs can help disseminate information about the role of ultrasound and radiographs in the management of DDH at various ages.
Hence it becomes a joint responsibility of all concerned including the obstetricians to keep the high-risk population appropriately counselled about the need for an early surveillance. Lack of awareness and understanding of DDH amongst general population is an important factor that leads to late presentations and an increase in morbidity. The average age of presentation in India is about 1–2 years, depending upon the gender of the child, astuteness of the parents and the stage at which the child begins to stand or walk. However, X-ray facilities are quite well established across the nation with the presence of qualified radiologists to interpret DDH findings. Majority of the medical centres do not have an access to a trained ultrasonologist or a Radiologist to evaluate DDH by ultrasound. Complications, such as an abnormal gait, leg-length discrepancy, early adult-hood osteoarthritis and rarely avascular necrosis can ensue. Left untreated beyond a certain age, such as when the child begins to walk, leads to an increase in surgical interventions and high probability of sub-optimal results. The treatment of DDH is most effective and remains non-surgical if the diagnosis is made early. Despite the fact that these numbers look small, the end result of missed or neglected cases is a big let-down, since the disability resulting from DDH is preventable. in various studies, with the incidence being higher in northern region. In India, the incidence has been reported to be 1.0–9. DDH is a common musculoskeletal disorder in the paediatric population, with an incidence of approximately 3– live births. DDH encompasses a wide spectrum of clinical presentations which include acetabular dysplasia, subluxation of the femoral head or complete dislocation of femoral head from the true acetabulum.
Femoro-acetabular relationship works in a synergistic manner, that is, a well-placed femoral head within the acetabulum helps the acetabulum to develop optimally and vice versa. Developmental dysplasia of the hip (DDH) is a multifactorial derangement of the femoral head and acetabular relationship starting in-utero.