In this section
Developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint. In children with DDH, the ball at the top of the thigh bone (called the head of the femur bone) is not stable within the socket (called the acetabulum). The ligaments of the hip joint that hold it together
may also be loose. Sometimes, the hips can dislocate early in life and this may not be noticed until your child starts to walk.
Treatment may involve use of a brace, a non-surgical procedure under sedation, or an operation to correct the dysplasia and hip position.
DDH used to be called congenital dislocation of the hip (CDH).
Sometimes the signs of DDH are hard to see, even by a doctor. However, if your child has DDH they may:
Pregnant women release hormones in their bloodstream that allow 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, which 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 dislocate or become loose.
DDH is more common in girls, firstborn children, babies born in the breech position (bottom first) and in families where a parent/sibling has had a dislocated hip joint. DDH can be in one or both hip joints.
It is important to check for and treat DDH as early as possible. 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 and may ultimately need a hip replacement.
Your doctor may ask for an ultrasound or X-ray of the hip joint to diagnose DDH.
Treatment for DDH varies between children and depends on its severity. Your doctor will recommend the best treatment option for your child.
Babies with DDH can be successfully treated with a special brace. This holds the hip joint in the correct position so that the joint develops properly. Your child may need to wear the brace for several months, until the hip is stable. See our fact sheets
Pavlik Harness for DDH and
Denis Browne Bar for DDH.
If splinting does not work, your child may need a procedure called a closed reduction. Closed reduction means the hip joint is repaired without surgery. The hip joint is moved into the correct position while your child is asleep under anaesthetic.
Sometimes, when the above treatments do not work or DDH is diagnosed later than six months of age, your child may need open reduction surgery (when surgery is done through a cut in the body).
For DDH open reduction surgery, the hip joint is moved into the correct position while your child is asleep under anaesthetic. The hip joint is made more stable by operating on the surrounding ligaments. This is all done through a small cut near the groin.
After open reduction surgery (and sometimes after closed reduction surgery) your child will need a hip spica – a plaster cast that covers your child's body from the knees to the waist. Hip spicas may need to be worn for several 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 our fact sheet Hip spica plaster.
Occasionally, when DDH is diagnosed late, more surgery to the thigh or pelvic bones may be needed to make sure the hip joint stays in place. This surgery is called an osteotomy.
Can swaddling the wrong way or using a baby carrier cause
There are several different causes of DDH. Sometimes DDH
develops before a baby is born, or it happens during childbirth. Incorrect
swaddling is thought to be the cause of DDH in some babies. When wrapping your
baby, make sure the legs are free to move. They should be able to bend up and
out at the hips. Baby carriers can be good for your baby’s hip development if a
healthy hip placement is used. It’s best if the thighs are spread around your
torso, with hips bent and knees slightly higher than the buttocks. Ask your
Maternal and Child Health Nurse to show you if you are unsure.
Is my baby’s DDH causing her pain?
No – DDH does
not typically cause pain in babies.
Developed by The Royal Children's Hospital Orthotic and Prosthetic department. We acknowledge the input of RCH consumers and carers.
Reviewed August 2020.
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