Developmental dysplasia of the hip factsheet
Introduction
Developmental dysplasia of the hip (DDH) is a condition where a baby’s hip joint does not grow normally
The hip joint is made up of:
- the femoral head – the round top of the thigh bone
- the acetabulum – the cup-shaped socket in the pelvis where the femoral head sits
- tendons and muscles hold the femoral head in the socket.
The femoral head might move out of the socket if the:
- tendons are loose or stretched
- socket of the pelvis is too shallow
- femoral head is too small.
Dislocation means the femoral head easily moves in and out of the socket. The hip will not grow normally if the femoral head becomes dislocated and stays out.
If DDH is not found before your child starts to walk, they may develop a “waddle”. As they grow older, the hip can become stiff and painful, and they may develop a condition called arthritis.
Signs and symptoms
Signs that your child might have DDH include:
- uneven skin creases near the bottom
- not being able to move their leg normally
- leaning to one side when they stand or walk, which might be caused by uneven leg length
- not sitting by ten months of age
- not walking by 18 months of age
- having a foot that is turned out
- walking with a waddle
- having difficulty parting their legs for nappy changes.
Diagnosis
All children need regular hip checks until they finish growing.
Common ages for checking are:
- at birth
- one week after birth
- six weeks after birth
- six months after birth
- when they begin to walk.
DDH can still be found in older children. X-rays are used to look at your child’s hips after six months of age if they are showing signs of DDH.
Treatment
Treatment of DDH depends on how old your child is and how severe their hip development is.
The Pavlik Harness
Babies with DDH can be treated with a Pavlik harness, a soft brace worn for six to ten weeks to help the hips grow normally.
Most babies have normal hip growth after using the Pavlik harness. However, some babies may continue to have hip problems as they grow. Babies who do not improve with the Pavlik harness early will need surgery.
Surgery
Some children may need surgery if they do not improve after treatment with a Pavlik harness. The type of surgery will depend on the child's age and how severe their hip development. After surgery, a lower body cast called a hip spica will hold your child's hips in place for several months while they recover.
Some children may need more surgery between two and four years of age.
Management
Risk factors
Some things may increase the likelihood that your baby will have DDH. These include:
- being born in the breech position - feet first
- being female
- oligohydramnios – a condition where there is low fluid around the baby during pregnancy
- birth weight over 4kg
- being a first-born baby
- being overdue for birth by more than two weeks
- a family history of DDH
- being born with talipes equinovarus or club foot
- developing torticollis or neck stiffness.
Newborn hip checks are very important for babies, especially if they are at risk of DDH.
