Developmental Dysplasia of the Hip (DDH)

Hip dysplasia, also called developmental dysplasia of the hip (DDH), is a condition in which the hip joint does not form normally. The hip is a ball-and-socket joint, and in hip dysplasia, the socket may be too shallow to fully support the ball. This can cause the hip to be loose, partially dislocated, or fully dislocated. Hip dysplasia can be present at birth or develop during early childhood. With early diagnosis and proper treatment, most children develop healthy, stable hips and grow up without long-term problems.

What Causes Hip Dysplasia in Children?

Hip dysplasia occurs when the hip joint fails to develop normally during infancy. Risk factors include:

• Family history of hip dysplasia
• Being the firstborn child
• Breech position during pregnancy
• Tight space in the womb (such as low amniotic fluid or multiple births)
• Being female (hip dysplasia is more common in girls)
• Swaddling with the legs held straight and together

In many cases, there is no single known cause.

What Are the Symptoms?

Symptoms depend on your child’s age:

In infants:

• One leg appears shorter than the other
• Limited movement of one hip
• Uneven skin folds on the thighs
• A clicking or popping sensation during diaper changes

In toddlers and older children:

• Limping or walking with a waddle
• Hip, thigh, or knee pain
• Difficulty running or keeping up with peers
• Decreased hip motion

Some babies show no obvious symptoms, which is why screening exams are so important.

When Should My Child See a Specialist?

You should see a pediatric orthopedic specialist if:

• Your baby has abnormal findings on a newborn hip exam
• Your pediatrician notes hip looseness or asymmetry
• Your child has a limp or uneven walking pattern
• Your child complains of hip or knee pain
• There is a family history of hip dysplasia

Early evaluation leads to simpler and more effective treatment.

How Is Hip Dysplasia Diagnosed?

Diagnosis depends on age:

• In infants, ultrasound is often used to look at hip development
• In older babies and children, X-rays are used
• A physical exam is always part of diagnosis

These tests help determine hip stability and development.

How Is Hip Dysplasia Treated?

Treatment depends on:

• Your child’s age
• Severity of the dysplasia
• Whether the hip is stable, partially dislocated, or dislocated

Treatment goals focus on:

• Creating a stable hip joint
• Allowing normal hip development
• Preventing future arthritis or hip problems

Nonsurgical Options

For young infants, treatment often includes:

• A Pavlik harness or similar brace that holds the hips in proper position
• Regular follow-up visits and imaging
• Parental education on safe handling and positioning

Bracing is most effective when started early, usually in the first few months of life.

Surgical Options

Surgery may be recommended if bracing is ineffective or the diagnosis is delayed. Options may include:

• Closed reduction, where the hip is gently placed back into position under anesthesia
• Open reduction, if tissues are blocking the hip from moving into place
• Osteotomy, where the bones are reshaped to improve hip stability

Your child’s surgeon will choose the safest and most effective approach.

What Are the Risks of Surgery?

When surgery is needed, potential risks include:

• Infection
• Stiffness
• Differences in leg length
• Need for additional procedures
• Problems with bone growth

All risks will be discussed in detail before treatment.

What Does Recovery From Treatment Involve?

• Recovery depends on the type of treatment:
• After bracing, most babies continue normal development
• After surgery, your child may wear a body cast (spica cast) for several weeks
• Physical therapy may be needed for older children

Parents play an important role in caring for braces or casts at home.

How Long Does Recovery Take?

• Bracing treatment usually lasts several months.
• After surgery, initial recovery often takes 6–12 weeks, with continued follow-up as your child grows.

What Is the Outlook for My Child?

The outlook for children with hip dysplasia is excellent when treated early. Most children develop normal hip joints and participate fully in sports and daily activities without limitations.