Developmental Dysplasia Of The Hip

Overview

Developmental dysplasia of the hip (DDH) means the hip joint did not form properly as a baby grew in the womb or in the first few months of life. The hip is a ball-and-socket joint: the top of the thigh bone (the 'ball') should sit snugly inside a hollow in the pelvis (the 'socket'). In DDH the socket may be too shallow, or the ball may slip partly or fully out of it. 'Dysplasia' simply means the joint did not develop normally. DDH can range from a slightly shallow socket to a hip that is fully dislocated (out of place). It is not painful for babies, and it is much easier to treat when found early.

DDH is one of the more common conditions found in newborns. It affects roughly 1 to 3 babies in every 100 to 200 births to some degree, though only a small number need treatment. Many mild cases settle on their own as the hips grow.

DDH is present at birth or develops in the first few months of life. It is more common in girls, in first-born babies, in babies born bottom-first (breech), and in families where a relative had DDH. It can affect one hip or both. It is also more common in babies born in colder months and in those swaddled with their legs tightly wrapped and straight.

Symptoms

Common symptoms

• Often there are no obvious signs at all, which is why routine baby checks matter.
• One leg may look shorter than the other, or the skin creases on the thighs may not match.
• The hips may open less widely than expected when the nappy is changed or the legs are gently moved apart.
• A 'clunk' or 'click' may be felt by a doctor when examining the hip, though clicking alone is often harmless.

Symptoms in children

• In babies: limited movement of one leg, uneven thigh or bottom creases, or one knee sitting lower than the other when the legs are bent.
• When learning to walk: a limp, walking on tiptoe on one side, or a 'waddling' walk if both hips are affected.
• An inward-turning walk or a sway of the lower back may be noticed in older children.
• Older children may complain of tiredness or aching in the hip, groin, or knee after activity.

Symptoms in older adults

• Adults who had untreated or partly treated DDH may develop hip pain and stiffness earlier than usual, often in their 30s or 40s.
• Pain is usually felt in the groin or outer hip and may spread to the knee.
• Stiffness when turning the leg outwards, or difficulty putting on socks and shoes.
• A limp or a feeling that one leg is shorter may develop over time.

Causes

Main causes

• DDH happens when the hip joint does not develop normally. In most cases the exact reason is not known.
• Squeezing in the womb: if there is less room, the hip can be held in a stretched position that affects how the socket forms.
• Loose ligaments around the hip in early life, which let the ball slip out of the socket more easily.
• Sometimes the socket simply develops more slowly than usual after birth.

Risk factors

• Being a girl — DDH is several times more common in girls.
• Being the first baby, when the womb is tighter.
• Breech position in late pregnancy (baby lying bottom-first).
• A close family member — parent or sibling — with DDH.
• Being born in the colder months or in some regions, which may relate to how babies are wrapped or swaddled.
• Tight swaddling with the legs straight and pressed together, or using carriers that hold the legs together rather than in a natural 'frog' position.
• Other conditions that affect how a baby lies in the womb, such as low levels of fluid around the baby.

When to see a doctor

See a doctor urgently if:

• Your baby or child has a new limp, refuses to walk, or will not move one leg.
• You notice a hot, swollen, or very tender hip or knee.
• Your child seems to be in pain during nappy changes or when the legs are moved apart.
• A brace or harness is causing redness, sores, or seems too tight.

Book a routine appointment if:

• You notice uneven thigh creases, one leg that looks shorter, or one knee lower than the other.
• Your baby's hips seem stiff or hard to open when you change the nappy.
• You have a family history of DDH and want your baby checked even if everything looks fine.
• Your child walks with a limp, walks on tiptoe, or waddles.
• You have any worry about your child's walking or leg position — it is always fine to ask.

Diagnosis

DDH is usually found during the routine newborn and 6-to-8-week baby checks. The doctor or health visitor gently moves your baby's legs apart to feel how the hip moves — this is quick and does not hurt. If anything seems unusual, or if your baby has risk factors such as being breech or a family history, a hip ultrasound scan is usually arranged. In older children who are already walking, an X-ray is used instead because the bones are more solid by then.

Tests that may be done

• Physical examination of the hips (moving the legs apart and checking for a clunk or limited movement).
• Ultrasound scan of the hips — best done in the first few months of life; it is quick, painless, and uses sound waves, not radiation.
• X-ray of the hips — used for older babies and children, usually after about 4 to 6 months of age.
• Sometimes a repeat scan or X-ray a few weeks later, to see how the hip is developing.

What to expect at your appointment

You will usually be seen by a paediatrician, an orthopaedic team, or a hip screening clinic. The examination takes a few minutes. A scan is done with your baby lying on a couch; you can stay close and comfort them. Results are often available the same day or within a week or two. If DDH is confirmed, the team will explain how mild or severe it is and talk through treatment options with you.

Treatment

Treatment depends on your child's age and how severe the hip problem is. Some mild cases need only monitoring with repeat scans. When treatment is needed, the aim is to hold the hip in a good position so the socket can deepen and the joint can develop normally. The earlier treatment starts, the simpler it usually is.

Self-care at home

• Keep up with all baby checks and any follow-up scan appointments — DDH often has no visible signs.
• Use a hip-healthy way of carrying and swaddling: legs bent up and out, not straight and pressed together. Ask your health visitor or clinic for advice on safe wrapping.
• Follow your treatment team's instructions about how long the harness or brace should be worn each day — consistency is what makes it work.
• Check your baby's skin under the harness or brace daily for redness or rubbing, and keep the area clean and dry.
• Continue normal feeding, cuddles, and tummy time as advised; most babies adapt to a harness within a few days.
• Ask about feeding and weight checks if your baby seems unsettled at first — the team can help you adjust.

Medical treatments

For young babies, the usual first step is a soft harness or brace (often called a Pavlik harness) that holds the hips bent and spread apart. It is worn for several weeks, usually most of the day at first, and is slowly reduced as the hip improves. It does not hurt, and most babies settle into it quickly. If a harness does not work, or if the diagnosis is made later, the hip may be gently guided back into place under a short general anaesthetic, held with a cast or brace. Your specialist team will explain what is suitable for your child, including how to care for the harness or cast at home and how often to come back for checks.

When is surgery considered?

Surgery is only needed for a small number of children — for example if the hip will not stay in place with a harness or cast, if the diagnosis is made when the child is older, or if the socket stays too shallow as the child grows. Operations aim to put the ball firmly into the socket and, if needed, reshape the socket so it holds better. Children usually stay in hospital for a short time and wear a cast or brace afterwards, followed by physiotherapy. Most children recover well and return to normal play and sport.

Living with this condition

Life with a harness, brace, or cast takes some adjusting at first, but families usually find a routine within a week or two. Nappy changes, dressing, bathing, and car seats all need small adaptations — your clinic team can show you practical tips. Babies often feed and sleep just as well once they are used to the position. Older children may need a little extra help at nursery or school, and staff should be told about any cast or brace.

Lifestyle tips

• Choose clothing one size larger or use dungarees and skirts that fit over a harness or cast.
• Ask about the correct way to use a car seat with a harness or cast — some children need a specialist seat or a modified position.
• Keep up gentle play and movement as advised; the team will tell you what is safe.
• Keep follow-up appointments, even when everything looks fine — hip development is checked over months and years.
• Write down your questions before appointments so you do not forget them.

Diet and exercise

No special diet is needed. Continue your baby's usual milk feeds and start solid foods at the normal time. Older children should eat a balanced, varied diet with enough calcium and vitamin D for healthy bones — ask your health visitor or pharmacist about vitamin D drops or supplements if you are unsure. Physical activity is encouraged as guided by your child's team; swimming and gentle stretching are often suggested once the harness or cast is off. Contact sports may be paused for a while after surgery, and your surgeon will say when it is safe to return.

Mental health and emotional wellbeing

It is completely normal to feel worried, guilty, or overwhelmed when your child is diagnosed with DDH. Remember that nothing you did caused it. Seeing your baby in a harness or cast can be emotional, and the extra appointments can be tiring for the whole family. Talk to your partner, family, or friends, and tell your healthcare team how you are feeling — they can connect you with support. If you or your child feel very anxious or low for more than a couple of weeks, please speak to your doctor. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local crisis helpline or emergency services straight away.

Prevention

DDH cannot be fully prevented, because it starts before birth and the causes are mostly outside anyone's control. But there are things that help: avoid tight swaddling with the legs straight and pressed together, and use baby carriers, slings, and seats that support the hips with the knees bent up and out. Keep all newborn and baby check appointments, and mention any family history of DDH so your baby can be checked carefully.

Screening programmes

Many countries offer a hip examination for every newborn and again at around 6 to 8 weeks, plus an ultrasound scan for babies with risk factors (such as breech position, family history, or an abnormal examination). Screening finds DDH early, when treatment is simplest and most effective. Ask your midwife, health visitor, or doctor when your baby's hip checks are due.

Complications

If left untreated

• A hip that stays out of place can develop a shallow socket and lead to early wear-and-tear arthritis (osteoarthritis) in adulthood.
• One leg may end up shorter than the other, or the way the child walks may change.
• The lower back may take extra strain, causing ache or discomfort later in life.
• Older children or adults may need more complex surgery than would have been needed in infancy.

Long-term outlook

The outlook is very good when DDH is found and treated early. Most babies treated with a harness in the first few months go on to have normal, pain-free hips and take part in sport and everyday life without limits. Some children need more than one stage of treatment and long-term check-ups, but the great majority do well. Your team will keep an eye on your child's hips as they grow, and there is plenty of support available along the way.

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