Complications
Also called proximal femoral growth disturbance. Can occur following any of the treatment methods used for DDH.
It has a range of severities, and reported incidence varies from 0% to >60%.[50]
It is a poor prognostic indicator for the affected hip.[6][47]
Thought to be caused by excessive pressure on the femoral head and compression of the extrinsic blood supply of the femoral epiphysis.
Close radiographic monitoring is required to make the diagnosis.
This may be identified after closed or open treatment of hip instability and can result in the need for secondary surgical procedures.
Acetabular dysplasia has been shown to lead to radiographic degenerative joint disease, especially in females.
If further associated with subluxation, more rapid degenerative joint disease is likely to occur, earlier, and with more severe changes.[33]
Presence of a false acetabulum is associated with earlier degenerative arthritis and pain.
Symptoms of degenerative changes include pain and limitation to range of motion.
Diagnosis is confirmed on plain x-ray.
Treatment includes use of non-steroidal anti-inflammatory drugs, physiotherapy, and activity modification. If symptoms warrant it, hip arthroplasty may be considered in the skeletally mature individual.
Caused by untreated unilateral hip dislocations.[6]
An untreated unilateral hip dislocation will result in a functional leg length inequality. This inequality can be meaningful in magnitude and not uncommonly is the clinical finding that leads to diagnosis.
The hip dislocation, in addition to the limb length inequality, can become symptomatic. The untreated hip dislocation can become painful due to degenerative changes. The leg length inequality may contribute to gait alteration and low back and/or knee pain.
A shoe lift can be used on the affected side to limit the symptoms secondary to functional leg length.
Caused by untreated unilateral hip dislocations.[6] An untreated unilateral hip dislocation can result in limited hip range of motion with fixed adduction, which then alters stress across the knee, resulting in knee valgus. This can further result in knee pain and malalignment.
Diagnosis is made on clinical examination and with a standing lower extremity alignment x-ray.
Treatment includes use of non-steroidal anti-inflammatory drugs, physiotherapy, activity modification, and/or a varus knee brace.
Caused by untreated unilateral hip dislocations.[6] An untreated unilateral hip dislocation can result in limited hip range of motion, which can cause increased mobility and stress across the lumbar spine.
Diagnosis is made on clinical examination and with lumbar spine x-rays and potentially an MRI.
May occur secondary to suboptimal positioning within the brace (e.g., Pavlik harness), forced abduction, and/or excessive flexion. Results in limitations of active range of motion of lower extremities.
Most common nerve palsy seen with the use of a Pavlik harness is femoral nerve palsy. Infants with femoral nerve palsy will have lost active knee extension.
When nerve palsy due to a Pavlik harness is identified, adjustments and occasionally discontinuation of the harness is required; however, nerve palsies typically recover.
Efficacy of Pavlik harness treatment is lower in those cases associated with nerve palsy.[56]
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