Dysplasia of the Hip (DDH)

Dysplasia of the hip is a condition of the hip joint. The hip socket may be shallow, letting the ball of the long leg bone, also known as the femoral head, slip in and out of the socket. The ball may move partially or completely out of the hip socket.

Hip dysplasia can occur at birth (developmental dysplasia of the hip, or DDH) or develop later (adolescent hip dysplasia). It occurs most often in first-born females with a family history of the condition.

A tight uterus that prevents fetal movement or a breech delivery may also cause hip dysplasia in a baby at birth. The left hip is involved more frequently than the right due to intrauterine positioning.

What are the symptoms of hip dysplasia?

Common symptoms of hip dysplasia in a baby may include:

• The leg may appear shorter on the side of the dislocated hip
• The leg on the side of the dislocated hip may turn outward
• The folds in the skin of the thigh or buttocks may appear uneven
• The space between the legs may look wider than normal

In adolescents, hip and leg pain may be the first symptom of hip dysplasia. Other symptoms may include:

• Pain in the groin
• Weakness in the leg
• Difficulty walking
• Loss in range of motion
• A grinding or clicking in the hip joint
• A sensation of “giving way” or catching in the hip

How is hip dysplasia diagnosed?

Hip dysplasia is sometimes noted at birth. Your child’s pediatrician or newborn specialist will screen newborn babies in the hospital for this hip problem before they go home. However, hip dysplasia may not be discovered until later.

At CHOC, we offer a comprehensive newborn screening, including a physical exam and ultrasound by three months of age and a hip X-ray by six months of age.

How is hip dysplasia treated?

For babies, treatment options may include:

• Pavlik harness. The Pavlik harness is used on babies up to 6 months of age to hold the hip in place, while allowing the legs to move a little. The harness is put on by your baby’s doctor and is usually worn for one to two months. Your baby is seen frequently during this time so that the harness may be checked for proper fit and to examine the hip. At the end of this treatment, X-rays or an ultrasound are used to check hip placement. The hip may be successfully treated with the Pavlik harness, but sometimes, it may continue to be partially or completely dislocated.
• Bracing. In some cases, the Pavlik harness is followed by a hip abduction brace (cruiser brace). A brace may also be used for babies who are diagnosed after 6 months of age. The hip abduction brace is worn full or part time (depending on the degree of dysplasia). This brace allows a child to walk, and it will not slow your child’s developmental milestones.
• Surgery. If the other methods are not successful, or if the hip condition is diagnosed at age 6 months to 2 years, we may perform surgery to put the hip back into place manually, also known as a closed reduction. Children older than 2 years may require an open surgery to realign the hip.

After surgery, a special cast (called a spica cast) is then put on to hold the hip in place. The spica cast is worn for approximately three to six months. The cast is changed from time to time to accommodate the baby’s growth and hold up to daily wear. The cast remains on the hip until the hip returns to normal placement. Following casting, a special brace and/or physical therapy exercises may be necessary to make the muscles around the hip and in the legs stronger.

Additional surgeries may be necessary since the hip dislocation can reoccur as the child grows and develops. If left untreated, differences in leg length, a duck-like gait and a decrease in agility may occur.

For adolescents, treatments include:

• Physical therapy, activity restriction and weight loss.
• For adolescents who have pain and have limited damage to their cartilage, we may perform a Ganz periacetabular osteotomy (PAO). This procedure involves a series of cuts to the bone to move the socket over the thigh bone head. Screws are then placed in the bones to stabilize this position.
• In rare cases, we may also perform a femoral osteotomy or triple pelvic osteotomy. An osteotomy is a surgical procedure to reshape the bone and reduce stress on the area.
• A total joint replacement (arthroplasty) removes and replaces the damaged joint with an artificial joint and may be considered only after other treatment options have failed.

For many adolescents, surgery allows them to return to normal activities after a recovery period.

While these treatments are proven to be successful, any patient with hip dysplasia may develop deformity of the hip or osteoarthritis later in life.