Once a diagnosis of DDH is confirmed, the treating specialist will determine a treatment plan specific to the individual's needs. This will include;
- Type of treatment — conservative, non-surgical or surgical.
- Duration of treatment — this includes the wearing time within a 24-hour period, as well as the total duration of one method.
Each treatment plan is unique, as the severity and response to treatment varies from person to person. The path cannot be predetermined, so changes and reviews at regular intervals are normal.
Treatment methods are dependent somewhat on the affected person’s age.
Harnesses or Braces - Common treatment methods for early diagnosis (0-6 months) include use of harnesses and braces. A variety of braces and harnesses are used across Australia. Your specialist will recommend one they feel most suits your child's needs. Many need adjustments as your child grows; just as they outgrow their clothes rapidly in the first year of life, they outgrow the size of their harness or brace.
Closed reduction or Open reduction - Repositioning of the ball and socket may be required when the joint is dislocated and / or the ball and socket are not able to be held in the correct place by a harness or brace. A closed reduction is when no surgery is required and the surgeon is able to reposition the ball and socket whilst the person is under general anaesthetic. An open reduction is when surgery is required to create space to allow the ball and socket to be repositioned. An osteotomy may be required to reshape either of the ball or socket.
Following closed and open reductions or an osteotomy, a cast is usually required for a period of time to hold the hip joint in a fixed position; these are called spica or broomstick casts. Casts vary is length (full or half leg for example) and positioning (angle of flexion / extension required to position the hip joint as needed).
This process can be very overwhelming and you may wonder if what is being recommended for your child is really necessary. Please know that specialists won't take it personally if you request a second opinion. Just keep in mind that when you see the next specialist, you will know more than the first appointment, so you'll probably find you have more questions to ask and will feel like you gain more information. Calling your first specialist back to ask these additional questions is also an option worth considering.
For adults, hip-preservation surgery and/or hip-replacement surgery are aimed at minimising pain and maintaining the integrity of the joint.
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For additional information, please refer to the International Hip Dysplasia Institute (hipdysplasia.org).