Developmental Dysplasia of the Hip (DDH)

Developmental dysplasia of the hip, easy and tricky

Comment on the original podcast with Eduardo Novais on Residual Dysplasia of the Hip RDH after hip reduction in Developmental Dysplasia of the Hip DDH by Pablo Casta?eda.

In Operating Room, we are urgent to know if reduction is perfect during open or closed hip reduction.

Looking for signs to get the reduction just like we could see or feel in a hip biopsy is our impossible ideal because it is not allowed in real life.

Additionally, how to be sure if hip correctly reduced will growth properly is another challenge.

Hip arthrography in OR and Hip ultrasound can provide good information on hip reduction quality but they need a correct interpretation.

Additionally, repeated attempts or failed reduction have a bad impact in hip development prognosis.

Has Open reduction a negative effect on growth hip tissues despite we achieve a perfect reduction or are the delicate surgical maneuvers the main factor?

In the end, many questions and mysteries on baby hip. #pediatrics #orthopedics #DDH #Pavlik #Developmentaldysplasiaofthehip

Why don't we solve problems before they happen? The curious case of Developmental Dysplasia of the Hip (DDH).

Here's my story as a physician who suffered DDH baby hip medical complications during his career. Now, I'm remembering baby cries and parent′s desperation. Thanks to the inspirational podcast by Pablo Casta?eda (International Hip Dysplasia Institute IHDI, USA) interviewing Emily Schaeffer, PhD (Hip Hop Network, Canada), on hip global registry and pathways, now I can elaborate this rationale.

Current medical paradigm is prophylactic.

Sometimes, parents claim in the office, “why don′t they perform a clinical exam/hip ultrasound on my baby on time?”. It's a tricky question, especially if it's the first time you are viewing the baby at 6 months of age with developmental dysplasia of the hip or hip dislocation.

Just waiting to have the baby hip problem clear for diagnosis could be discouraging. In my region, we have no DDH screening and registry programs.

Therefore, parents acting as “doctors only for today” are taking care of their babies with hip braces. Sometimes parents ask in the middle of the night, “are you sure this brace is good for my baby, he/she can′t sleep?” …??Parent′s education is mandatory: if they don′t understand the goal of brace treatment on hip development, they can abandon this treatment and waste time.

Moreover, in complicated cases, we're performing more surgical treatments than expected, all of them with highly demanding surgical skills. Sometimes, demanding hip procedures are so delicate that one could prefer “don′t touch”.

Surgical risks are the best reasons to have DDH screening and registry programs. For example, even in high level specialized hospitals to be sure if hip reduction after a treatment of hip dislocation is not easy, having risks of hip re-dislocation, proximal femur growth disturbing or residual hip dysplasia with a final outcome of hip osteoarthritis.

Anesthesia risk in young baby is a concerning as well. Postoperative exams to evaluate hip reduction, just like Magnetic Resonance Imaging, need anesthesia or sedation, toxic contrast, etc. Radiographs and sonographs need careful interpretation. Further, it's important the surgeon′s ability who must achieve a good hip reduction and/or bony reconstruction with the minimum of blood loss, surgical manipulation, and surgical time.

This is the way, we (family and health providers) are living inside the DDH problem.

Now, we're waiting for the demonstration that this problem is a problem. Yes, that's the way science works. When we have more data from national and global registries, we will be able to answer more key questions and be accurate in diagnosis and treatments.

Finally, to prevent DDH and hip dislocation is less complicated than treating them. Going upstream to face this problem (being early in diagnosis and treatment) is better than going downstream (arriving delayed to solve the problem with avalanche-effect). #pediatrics #orthopedics #DDH #Pavlik #Developmentaldysplasiaofthehip

Cooperation for national screening and registry programs of Developmental Dysplasia of the Hip (DDH)

Developmental Dysplasia of the Hip (DDH) is a public health problem in the world because of delayed diagnosis and treatment.

Next are some words of wisdom from a parent trying to teach me how to cooperate with my partners to solve DDH problem. Please don′t forget most of parents are updated on science and arts because they help educating their children. She said that it′s incredible what we can achieve if we cooperate. In human history, small and great events are possible when people cooperate. ?Examples: arriving to the moon thanks to 400.000 people cooperating, daily going to the supermarket for food thanks to people from cities and farmers cooperating, surfing on internet or artificial intelligence developing thanks to planetary cooperation, etc. It is a fantasy to have something done in isolation.

Every region could do their best efforts to face DDH issues, and it depends on who is sensitized to the health problem. Parents who suffered complications during the processes of hip diagnosis and treatment or physicians who are involved in these processes are sensitized to this health problem. After such an experience, they use to be concerned and supportive each other and become a booster for social mind changing on DDH. Institutions are surprised taking parent′s concerning and physicians hope a new paradigm to face this public health problem on time.

Stablishing a national registry or national screening programs take time, but the principle is clear: early diagnosis and early treatment in DDH are the best. DDH diagnosis is mandatory, so we must clarify if treatment, follow-up, or discharge are recommended. Parents need explanations based on evidence; therefore, screening and registry are crucial for having data now and conclusions in the future.

This is not matter of being afraid of having complications during DDH diagnosis or treatment, but it is matter of taking care of the problem in any way, from parents’ side and health providers′ side. So, if we are sensitized to this problem, we must take a decision and act right now. This is real life. On the other hand, evidence-based medicine can take its time and wait for demonstrations that screening and registry programs are good ideas. We think so.

Therefore, these both decisions are fine for moving forward: professional decision in the office performing an early clinical exam/hip ultrasound screenings or politician decision funding a national screening and registry programs. Although, on this public health issue, final responsibility is on cooperating community, so government health agency must oversee these responsibilities instead of isolated physician initiative, like vaccination national programs. International Hip Dysplasia Institute #pediatrics #orthopedics #DDH #Pavlik #Developmentaldysplasiaofthehip

Some ideas to discuss on Developmental Dysplasia of the Hip DDH

Thanks Pablo Casta?eda for this space for open and educative dialogue.

The following are some ideas to discuss on DDH.

Developmental Dysplasia of the Hip (DDH) is a public health problem in the world because of delayed diagnosis and treatment. This is the “minority report” on DDH for now. We are not talking on science fiction issue, like “Minority Report” (Phillip K. Dick, 1956; Spielberg, 2002). Through years of growth, development, maturation and degeneration, we recognize DDH as a pre-condition, and its outcome of hip osteoarthritis as a preventable condition. We may consider early DDH diagnosis and treatment as modifying agent-like of hip osteoarthritis condition. DDH definition should include the idea of prophylaxis.

On changing minds on DDH. We have another good example in Pediatric Orthopedics. ?In 1990′s, parents spread the good news about the effectiveness of the Ponseti Method as treatment of clubfeet. Then, parents, surfing on internet, share their war motto, “instead of surgery, do casting on your clubfoot baby”. Therefore, the world knew on the Ponseti Method developed by Dr. Ignacio V. Ponseti in the 1940′s. We suspect, we will have a similar effect on DDH early diagnosis and treatment, so we can name this phenomenon, “Ponseti effect”.?We should trigger the Ponseti effect on DDH.

Hip diagnosis is based on 2D imaging studies (radiographs and ultrasounds), but real hip is on 3D, plus hip is growing and developing until 18 years/21 years of age which is a four dimension, afterwards hip starts a normal degenerative process for the rest of life. It seems limited knowledge on hip is because of our limitations to discover hip multidimensional reality.?Therefore, hip diagnosis should be based not only on images but on main clinical findings and available biomarkers of hip growth, development, maturation, and degeneration. #pediatrics #orthopedics #DDH #Pavlik #Developmentaldysplasiaofthehip