Kids Health Info

Developmental dysplasia of the hip (DDH)

  • 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).

    Signs and symptoms of DDH

    Sometimes the signs of DDH are hard to see, even by a doctor. However, if your child has DDH they may:

    • have a stiff hip joint
    • have legs that are different lengths
    • lean to the affected side when standing
    • have an outward-turning leg on the affected side
    • uneven skin folds on their groin or thigh (front or back of the upper leg).

    What causes DDH?

    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.

    When to see a doctor

    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

    Treatment for DDH varies between children and depends on its severity. Your doctor will recommend the best treatment option for your child.

    Splints

    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.

    Closed reduction procedure

    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.

    Open reduction surgery

    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. 

    Hip spicas

    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.

    Osteotomy

    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.

    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, movement of 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.

    For more information

    Common questions our doctors are asked

    Can swaddling the wrong way or using a baby carrier cause DDH?

    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 March 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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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.