What Is Developmental Dysplasia of the Hip (DDH)?

What is Developmental Dysplasia of the Hip?

• Developmental Dysplasia of the Hip (called DDH) is a problem with the way that a baby's hip forms while in the womb.
• The top of the thigh bone (femur) has a ball that is supposed to stay in the hip joint.
• DDH is the condition where the top of the femur doesn't stay in the hip joint for a variety of reasons. There is a range of severity of DDH.
• DDH is very common. It occurs in about 1 out of 100 births.
• Full dislocation of the hip occurs in 1 out of 1,000 births.

Who Is at Risk for DDH?

• First born babies: It is thought that the womb is tighter in the first pregnancy, and that the child doesn't have enough room to move around.
• Babies that are breech (instead of being "head down," the baby's bottom is facing the birth canal) can have DDH due to not being able to move around the womb very much.
• Girls are affected more often than boys.
• Babies who have a relative that had DDH are more likely to have DDH than other babies.

How Is DDH Diagnosed?

• DDH can be diagnosed when a child is getting a physical exam. During a Well-Child Check, a baby's hips are checked. The pediatrician does special maneuvers on the baby's legs to make sure that their hips don't pop out of the socket.
• The pediatrician checks to make sure that the baby's legs are the same length.
• If the pediatrician is worried about DDH in a child, the doctor will order an ultrasound of the hips.
• If a child is older than 3 months old, an x-ray of the hips is ordered to check the child's bones.

How Is DDH Treated?

• It is important to diagnose and treat DDH early. Getting a hip check is one more reason that it is important for infants to be seen for all their Well-Child Checks.
• The treatment of DDH depends on the child's age and the severity of the DDH
• A child with DDH will see an orthopedic surgeon (bone doctor) to decide the best treatment for the DDH.
• In children younger than 6 months of age, the orthopedic surgeon will generally put the child in a special type of harness (a Pavlik harness) to encourage the hip to stay in the socket. The child will have to stay in the harness for several weeks to months.
• If the harness doesn't work, or the DDH isn't treated when the child is young enough, the child might require a procedure to fix his or her hip(s). The child will be put under anesthesia, and the orthopedic surgeon will put the top of the child's femur back into the hip joint. After surgery, the child will have to wear a large cast for several weeks to months.
• If the child is older than 18 months, the child will have to have a surgery to realign the hip and put the thighbone into the hip. After surgery, the child will have to wear a large cast. This is a very big deal. Surgery can be avoided if DDH is diagnosed early. Going to well-child checks is the best way for DDH to be diagnosed early.

What Happens if DDH Isn't Treated?

• If DDH is not recognized and treated properly, a child can have:
  • Problems crawling
  • Difficulty or delay of walking
  • Uneven leg length
  • Pain in hips and back
  • Waddling walk
• Sometimes these problems happen even after the hip has been repaired.

Content Sources:
Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. 2000. "Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip." Pediatrics 105(4): 896-905.
KidsHealth. "Developmental Dysplasia of the Hip.": www.kidshealth.org
Nemeth, B. A., and V. Narotam. 2012. "Developmental Dysplasia of the Hip." Pediatrics in Review 33(12): 553-61.