Developmental dysplasia hip awareness

Overview

Developmental dysplasia of the hip (DDH) is a condition where the hip joint does not form properly in babies and young children. The hip is a ball-and-socket joint. In DDH, the 'ball' at the top of the thighbone is loose inside the 'socket' of the pelvis. It may slip partially or completely out of place. Early treatment can help the hip develop normally.

Yes, developmental dysplasia of the hip is fairly common. About 1 to 2 in every 1,000 babies is born with a dislocated hip. Many more have a hip that is unstable or shallow.

DDH is most often diagnosed in newborns and infants, especially in girls, babies born in the breech position (feet first), and those with a family history of the condition.

Symptoms

Common symptoms

• Uneven leg lengths
• Limited range of motion in one hip
• A clicking or popping sound when moving the hip
• Asymmetry of skin folds on the thighs or buttocks

Symptoms in children

• Limping when walking
• Walking on tiptoes on one side
• A waddling gait
• One leg may appear shorter than the other

Symptoms in older adults

• Hip pain or stiffness that gets worse over time
• Pain in the groin or outer hip
• Limping or difficulty walking
• Feeling that the hip is unstable or gives way

Causes

Main causes

• The exact cause is not always clear, but it involves the hip joint not forming completely or staying in place.
• It is related to how the baby is positioned in the womb, especially breech position.
• Loose ligaments (connective tissues) around the hip can make the joint unstable.

Risk factors

• Female gender (girls are more likely to have DDH)
• Breech birth (baby is born feet or bottom first)
• Family history of DDH (parent, sibling, or close relative)
• Firstborn children (the womb may be tighter)
• Conditions like torticollis (tight neck muscle) or metatarsus adductus (curved foot)

When to see a doctor

See a doctor urgently if:

• If your baby's leg appears to be in an odd position or you cannot move it normally
• If your child suddenly stops walking or refuses to put weight on one leg

Book a routine appointment if:

• If you notice any uneven leg lengths or clicking in your baby's hip during diaper changes
• At well-child checkups, your doctor will routinely screen for DDH

Diagnosis

DDH is usually found during routine newborn exams and well-baby checkups. The doctor will gently move your baby's hips to check for looseness or clicking. If they suspect DDH, they may order an ultrasound (a safe imaging test using sound waves) for babies under 6 months or an X-ray for older babies.

Tests that may be done

• Physical exam: The doctor moves the baby's hips to feel for instability (Barlow and Ortolani maneuvers).
• Ultrasound: Uses sound waves to see the hip joint in babies under 6 months.
• X-ray: For babies over 6 months to see the shape and position of the hip bones.

What to expect at your appointment

If your baby is diagnosed with DDH, you will be referred to a pediatric orthopedist (a bone specialist for children). They will discuss treatment options. Early diagnosis usually leads to very good outcomes.

Treatment

Treatment for DDH depends on the child's age and how unstable the hip is. The goal is to keep the hip joint in the correct position so it can develop normally. Most infants are treated with a soft brace or harness.

Self-care at home

• Follow your doctor's advice on using the brace exactly as directed — do not remove it without guidance.
• Place your baby on their back to sleep (always safe for healthy sleep).
• Change diapers carefully to keep the brace in place.
• Do not use double or triple diapering unless your doctor specifically recommends it.

Medical treatments

For babies under 6 months, the most common treatment is a Pavlik harness — a soft brace that holds the baby's hips in a stable position. The harness is usually worn full-time for several weeks to months. For babies older than 6 months or if the harness does not work, a hip spica cast (a hard plaster cast from chest to feet) may be used. In some cases, a short procedure to gently reposition the hip (closed reduction) is done under general anesthesia. For older children or severe cases, surgery (open reduction) may be needed.

When is surgery considered?

Surgery is considered if the hip remains unstable after bracing or casting, or if DDH is diagnosed after 12 months of age. The surgeon will reposition the hip joint and may reshape the socket or shorten the thighbone to keep the joint stable.

Living with this condition

Caring for a baby in a harness or cast requires some adjustments. You will need to dress your baby in loose-fitting clothes and check the skin under the brace daily for irritation. Most babies adapt well and are comfortable. Follow-up appointments with the doctor are important to monitor progress.

Lifestyle tips

• With treatment, most children with DDH grow up to have normal hip function and can play sports and lead active lives.
• If treatment is started early, there are usually no lifelong restrictions.
• Older children and adults with a history of DDH should tell their healthcare provider so their hips can be monitored for arthritis.

Diet and exercise

A balanced diet helps bone and joint health, but no special diet is needed for DDH. Once treatment is complete, children can enjoy all normal activities. Gentle exercises like swimming are good for hip muscles.

Mental health and emotional wellbeing

Having a child with DDH can be stressful for parents because of the treatment and follow-up. It is normal to feel worried, but remember that early treatment is effective. Talk to your doctor or a counselor if you need support.

Prevention

DDH cannot always be prevented because it often develops during pregnancy. However, early detection through newborn screening and routine baby checkups is key to preventing long-term hip problems.

Vaccines

There is no vaccine for DDH.

Screening programmes

All newborns should have a hip exam as part of their routine checkups. In some countries, ultrasound screening is offered to babies at higher risk (like breech births or family history). Ask your doctor about screening recommendations.

Complications

If left untreated

• Hip osteoarthritis (joint wear and tear) starting in young adulthood
• Chronic hip pain and stiffness
• Limping and difficulty walking
• One leg being shorter than the other
• Reduced mobility and quality of life

Long-term outlook

The outlook for DDH is excellent when it is found and treated early. Most babies treated with a brace or cast develop normal hips and have no long-term problems. Even when treatment starts later, surgery can often improve hip function. With proper care, most people with DDH lead active, healthy lives.

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