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Child diagnosed with bilateral DDH. Concern about low back and knees. Any resources?

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Orthopaedic Surgeon
Practicing since : 2000
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my soon to be 8 year old was just diagnosed with bilateral DDH. complete dislocation. i have taken her to see two specialist who recommend no action. She is pretty functional but I have concerns about her low back and knees if left untreated. Help. any suggestions, resources?? I am in california. I see online there have been a few small long term studies involving no treatment. how can I direct her activity to best insure she has best result now and best result for possible THR when the time comes. It seems hard to believe that no action is the right action. I don't want her to be deformed (lordosis) Would it be good to have her evaluated by an adult ortho?
Posted Mon, 30 Apr 2012 in Child Health
Answered by Dr. Atul Wankhede 2 hours later
Thanks for posting your query.

Since your daughter is at an age when her bones are still developing, I would suggest that every action which is taken is backed by sufficient evidence. If the heads of femurs are not always in reduced positions in the respective acetabuli, one has to be certain of the disease process which is preventing this from happening. If the head does not articulate in acetabulum for a long time, then the acetabulum eventually fails to develop and never looks like a natural cave, or at times a false acetabulum develops at femoral head position elsewhere.

So if she has a deformity in back due to developmental dysplasia of the hip (DDH) or vice versa, we need to start treating the causes. Overall, I can say that an unreduced hip in long run can cause other problems/deformities like those in the back, knees and ankles. In most cases, procedures for containment of head are required. These involve a surgery that keeps the head in position. If your paediatric orthopaedicians are of the view that no active intervention is necessary, which at times is the right thing to do, I would suggest that you ask them if the development of acetabulum is on a normal course and what the possible outcomes are as per development.

Even if so, a second opinion with an adult orthopaedician would not hurt. So go right ahead and do not hesitate to ask questions. It would be great if you can upload soft copies of latest X rays and/or magnetic resonance imaging scans (MRI scans) of your daughter. You can upload them on the “Upload your reports” section on the right.
If you need more help, I'm available for follow up.
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