Developmental Dysplasia of the Hip

Topic Overview

What is developmental dysplasia of the hip (DDH)?

Developmental dysplasia of the hip (DDH) is the name for a range of conditions of a child's hip. It can affect one or both hip joints.

• In mild cases, the ligaments and other soft tissues around the hip joint are not tight, and they allow the thighbone (femur) to move around more than normal in the hip socket.
• In more severe cases, the joint is loose enough to let the ball at the top of the thighbone (femoral head) come partway out of the hip socket. This is called subluxation.
• Dislocation is the most severe form of DDH. The ball at the top of the thighbone fully slips out of the hip socket (dislocates).

With subluxation or dislocation, the socket is often too shallow, more like a saucer than the deep cup that it should be.

See pictures of normal hip anatomy in a child and a dislocated hip .

What causes DDH?

The exact cause of DDH is not known. But a number of risk factors can raise your child's chances of having DDH, including a family history of DDH and your baby's position in the womb and at birth.

What are the symptoms?

Having DDH does not cause pain. A baby with DDH may have:

• A hip joint that feels loose or slips out of place when examined.
• One leg that appears to be shorter than the other.
• Extra folds of skin on the inside of the thigh(s).
• A hip joint that moves differently than the other.

A child who is walking may:

• Walk on the toes of one foot with the heel up off the floor. The child walks this way because one leg is shorter than the other.
• Walk with a limp (or waddling gait if both hips are affected).

How is DDH diagnosed?

Usually, DDH is diagnosed during your newborn's physical exam. If your baby is older, DDH may be diagnosed during a well-baby checkup. But it may be more difficult to diagnose the condition in a baby older than 1 to 3 months, because the only outward sign may be less mobility or flexibility in the movement of the affected hip joint(s).

If the results of a physical exam are unclear, an imaging test such as an ultrasound or X-rays may be used to evaluate your child's hip joints.

How is it treated?

Doctors treat DDH by moving your baby's upper thighbone into the hip socket and keeping it in place while the joint grows. A harness, called a Pavlik harness , is most often used to keep the joint in place in babies younger than 6 months. A hard cast, known as a spica cast , is used for older babies. Other forms of treatment, such as surgery or a brace, also may be needed.

It's important to treat DDH early. Most children born with looseness (laxity) of the hips will not have problems. But children with untreated DDH may develop lasting hip problems. Don't try to treat DDH on your own, such as by diapering a baby with 3 or 4 diapers at a time or by trying to put your baby's legs in certain positions. These are not effective treatments for DDH and may cause the joint to develop abnormally.

Frequently Asked Questions

Learning about developmental dysplasia of the hip (DDH):	What is developmental dysplasia of the hip (DDH)? What are the signs of DDH? Why might a child be born with DDH? How common is DDH?
Being diagnosed:	How is DDH diagnosed?
Getting treatment:	How is DDH treated?
Living with DDH:	How can I care for my child at home? How do I care for my child in a spica cast?

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Author:	Debby Golonka, MPH	Last Updated: May 11, 2009
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas S. Renshaw, MD - Orthopedics
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