Kids Health Info

Developmental dysplasia of the hip DDH - treatment and hospital stay

  • Developmental dysplasia (or dislocation) of the hip (DDH) is an abnormal development of the hip joint. The ball at the top of the thighbone (called the femoral head) is not stable within the socket (called the acetabulum). The ligaments of the hip joint which hold it all together may also be stretched and loose. Sometimes, the hips dislocate after birth and this may not be noticed until your child starts to walk.

    Signs and symptoms

    • a stiff hip joint
    • the legs are different lengths
    • your child may lean to the affected side when standing
    • your child's leg may turn outward on the affected side
    • the skin folds may be uneven on their bottom

    Sometimes the signs are hard to see, even by a doctor.

    Causes

    Pregnant women secrete hormones in their bloodstream which allows their ligaments to relax. These hormones help the delivery of the baby through the mother's pelvis. Some of these hormones enter the baby's blood and can make the baby's ligaments relaxed as well. This can make the hip joint loose in the socket. The way the baby lies in the uterus can also cause the hip joint to become loose or dislocate.

    DDH is more common in girls, firstborn children, babies born in the breech position (i.e. bottom first) and in families where a parent has had a dislocated hip joint. DDH can be in one or both hip joints.

    Treatment

    It is important to check for and treat DDH as early as possible.

    Splints

    Babies with DDH can be successfully treated with a special splint. The splint holds the hip joint in the correct position so that the ligaments tighten. Your child may need to wear the splint for several months, until the hip is stable or X-rays are normal. One commonly used splint is called a 'Pavlik Harness'.  

    'Closed reduction' procedure

    If splinting does not work, your child may need a procedure called a 'closed reduction'. The hip joint is moved into the correct position while your child is asleep under anaesthetic. Children then need to wear a 'hip spica' plaster cast to keep the hip in the right position.  

    'Open reduction' surgery

    Sometimes, when the above treatments do not work or DDH is diagnosed late, your child may need what is called an 'open reduction'. The hip joint is moved into the correct position while your child is asleep under anaesthetic. The hip joint is made more stable by surgery to the surrounding tendons. This is done through a small cut in the groin. Children then need to wear a 'hip spica' to keep the hip in the right position.

    Hip spicas

    A hip spica is a plaster cast that covers your child's body from the knees to the waist. Hip spicas may need to be worn for a number of months. Children may then need to wear different splints or braces to make sure the hip joint remains stable and in the right position.

    See the Kids Health Info fact sheet: Hip Spicas

    Osteotomy

    Occasionally, when DDH is diagnosed late, more surgery to the thigh or pelvic bones may need to be done to make sure the hip joint stays in place.  This surgery is called 'osteotomy'.

    Staying in hospital

    Splints and bracing, such as Pavlik Harness, can be done as an outpatient at the RCH. It is done through the Orthotics Department.

    Children needing closed reduction or open reduction need an anaesthetic and will be admitted to hospital.  How long they stay in hospital depends on what treatment they are having. Usually it is between one day (called 'day stay') and three days.

    While in hospital, your child will have the following treatment and care:

    • Your child's pain will be managed with pain relief. This is usually a liquid such as Panadol; or may sometimes be IV (intravenous), for example if morphine is needed after open reduction surgery.
    • Nurses will check your child's legs frequently to make sure that there is plenty of blood circulating to their feet and toes after the splint or hip spica plaster cast is put on.
    • An X-ray, MRI or CT scan will be done after each procedure to make sure the hip joint is in the right position.
    • Staff will teach you how to look after the hip spica.
    • Staff will also teach you how to care for your child while wearing a splint or hip spica
    • You will need to bring your child's normal pram and car seat into the hospital as they need to be fitted for the hip spica.

    Care at home

    • You will be taught how to look after your child in a hip spica.
    • You will also be taught about pain relief and wound care if your child has had surgery.
    • When putting the brace on, make sure the foam tabs are on top and the buckle is facing you. Straps come from the back of the brace, run over the top of the thigh through the buckle, then back upon themselves to attach to the back of the cuff.

    Follow-up

    • Your child may have an MRI or CT scan before they go home. If not, they may need to come back and have this as an outpatient.
    • Your family doctor or the surgeon will need to check the wound seven-14 days after surgery.
    • Your child may have to come back around six weeks after surgery to have the plaster changed under anaesthetic (usually as a day stay) or for repeat splinting.
    • Regular X-rays or scans are needed after DDH treatment until your child has stopped growing.

    If DDH is not treated, your child may develop a painless limp when walking, they may walk on their toes rather than in a heel-and-toe action, or they may develop a 'waddling' walk. In time, arthritis will develop in the untreated hip joint which will become painful.

    Key points to remember

    • Treatment for DDH varies between children and depends on how bad the condition is.
    • Treatment may include a brace, a plaster cast called a hip spica, that moves the hip into position under anaesthetic or surgery to the ligaments around the joint.
    • Children will often need to wear a brace or cast for several months.
    • If DDH is not treated, your child may develop a painless limp. Over time, painful arthritis will develop in the untreated hip joint.

    More information

    Developed by the RCH Orthopaedic Unit. First published: July 2006. Updated November 2010.

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.