Developmental Dysplasia of the Hip

What is developmental dysplasia of the hip (DDH)?

Developmental dysplasia of the hip (DDH) is a condition in which the hip joint is abnormal. Some babies are born with the condition. The head of the thigh bone (femur) does not fit properly into the joint. It can lead to limping and pain. In more severe cases, this condition can be disabling.

This condition affects about 1 in 1,000 babies. A slight instability of the hip can be seen in as many as 1 in 3 newborns. Girls are more likely to develop dysplasia of the hip. The condition can run in families.  

Signs and symptoms of DDH

A baby with DDH may not show signs of the condition. The signs may be very subtle.  They may vary depending on the age of the child. Some of the signs your doctor will look for include the following:

  • an audible “clunk” during the opening and closing of the hips
  • inability to move the thigh outward at the hip
  • one leg shorter than the other
  • unevenness in the fat folds of the thigh around the groin or buttocks
  • limping or walking on the toes of one foot in older children
  • a spine curve in older children

Causes of developmental dysplasia of the hip

Doctors do not know exactly what causes DDH. Some risk factors can increase your child’s chances of being born with DDH. These risk factors include:

  • family history of DDH
  • breech position when the baby was born
  • a decrease of amniotic fluid in the womb
  • problems with the muscular or skeletal system

Complications

If DDH is not treated early, the hip joint does not form properly. This will result in difficulty moving the hips normally. This may become obvious when the child starts to walk. It may cause pain as he grows older.

How a doctor can help your child

The family doctor will do a physical examination . If he thinks your child has DDH, he may refer your child to an orthopaedic surgeon. An ultrasound or X-ray will usually be done.

Treatment

Treatment depends on your child’s age and how severe the DDH is. Mild cases correct without any treatment after a few weeks. More serious cases will need treatment.

Harness

If a diagnosis is made early enough, the doctor may order your child to wear a device called the Pavlik harness orthosis. This is a set of soft straps that keep your child in a “frog-like” position. It allows the hip joint to develop normally. Your orthopaedic surgeon will tell you how long your baby should wear the orthosis.

For more information, please read Pavlik Harness Orthosis.

About 1 in 20 babies with DDH need more than the Pavlik harness to correct the condition.

Surgery

Older children may need one of two treatments.

Closed reduction is usually performed on children younger than 18 months. This treatment manually puts the bone back into the hip socket while the child is under anaesthesia.

Open reduction is usually done with children 18 months or older. During this surgery, muscles and tissues around the hip are loosened while the hip is realigned and the thigh bone is placed back into the socket. The muscles and tissues are tightened once the hip is realigned.

When to seek medical assistance

If you suspect your child’s hips are not developing properly, see a doctor as soon as possible.

Key points

  • DDH means that the head of the thigh bone is not properly inserted into the hip joint.
  • Babies who are breech or have a family history of DDH are more likely to have this condition.
  • Signs include a baby’s inability to move the thigh outward at the hip and, later on, difficulty walking and pain.
  • The Pavlik harness orthosis is used to correct DDH.
  • About 1 in 20 babies with DDH may need surgery to correct the condition.

Sheila Jacobson, MBBCh, FRCPC

3/5/2010

Rudolph, Colin (editor). Rudolph's Pediatrics. Chapter 27.6.1 Developmental Dysplasia of the Hip. New York : McGraw-Hill, Medical Pub. Division, 2003.  





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