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237: DEVELOPMENTAL DYSPLASIA OF THE HIP

Kay Tasso, PhD, PT, PCS; Patrick S. Pabian, DPT, PT, SCS, OCS, CSCS

CONDITION/DISORDER SYNONYMS

  • Congenital dislocation of the hip (CDH)

  • Developmental dislocation of the hip

ICD-9-CM CODES

  • 754.3 Congenital dislocation of hip

  • 754.30 Congenital dislocation of hip unilateral

  • 754.31 Congenital dislocation of hip bilateral

  • 754.32 Congenital subluxation of hip unilateral

  • 754.33 Congenital subluxation of hip bilateral

  • 754.35 Congenital dislocation of one hip with subluxation of other hip

  • 756.9 Other and unspecified congenital anomalies of musculoskeletal system

ICD-10-CM CODES

  • Q65.00 Congenital dislocation of unspecified hip, unilateral

  • Q65.1 Congenital dislocation of hip, bilateral

  • Q68.8 Other specified congenital musculoskeletal deformities

  • Q79.8 Other congenital malformations of musculoskeletal system

  • Q79.9 Congenital malformation of musculoskeletal system, unspecified

PREFERRED PRACTICE PATTERNS

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Spinal Disorders1

  • 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Bony or Soft Tissue Surgery2

PATIENT PRESENTATION

A 6-month-old infant is referred to physical therapy for congenital muscular torticollis. The mother reports an uneventful pregnancy but difficult delivery requiring forceps. Upon examination, the therapist notes asymmetry of the gluteal folds and limited passive right hip abduction and hip flexion in addition to the typical signs of congenital torticollis and gross motor delay. The therapist contacts the physician to discuss the findings. Subsequently, radiologic studies are completed with a resulting diagnosis of developmental dysplasia of the hip. Following evaluation by a pediatric orthopedist, the infant is placed in a Pavlik harness for 23 hours per day except for bathing and therapy.

FIGURE 237-1

Clinical examination of developmental dislocation of the hip. In all pictures, the child’s left hip is the abnormal side. (A) Asymmetric skin folds. (B) Galeazzi test. (C) Limitation of abduction. (D– F) Ortolani and Barlow tests. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Group of bony abnormalities on hip joint

  • Femoral head does not fit tight into the acetabulum

  • Femoral head can be manually dislocated from the acetabulum easily3

  • Congenital or acquired deformation/misalignment of the hip joint4

  • Hip may be unstable, malformed, dislocated, dislocatable, or subluxated4

Essentials of Diagnosis

  • Imaging studies could show delayed acetabular development

  • Clinical diagnosis from a positive Ortolani sign or Barlow maneuver4

  • Congenital

    • In utero posture of hip flexion and abduction contributes to disorder

    • Link to relaxin hormone

    • Trait runs in families5

  • Acquired

    • Result of swaddling, use of a cradle board

    • Breech birth

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