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Developmental dysplasia of the hip – DDH

  • Initial pre-referral workup

    Clinical history

    Risk factors:

    • female sex
    • breech delivery
    • intrauterine packaging deformities e.g. plagiocephaly, foot deformities or torticollis
    • family history of DDH

    Physical examination

    • hip examination to check for instability with Barlow’s or Ortolani’s test
    • limitation of hip abduction
    • deep uneven gluteal crease
    • leg length discrepancy
    • waddling gait after walking age

    Investigations

    Hip ultrasound if aged under six months (paediatric ultrasound service if possible).

    Plain x-ray if aged over six months (paediatric radiology service if possible).

    GP management

    Screening ultrasound if risk factors present after the age of six weeks if no evidence of clinical instability.

    Refer parents to Developmental dysplasia of the hip (fact sheet).

    Indications for specialist referral

    Urgent

    Abnormal clinical examination:

    • positive Ortolani’s or Barlow’s test – Limited hip abduction
    • leg length discrepancy
    • abnormal ultrasound or X-ray
    • if risk factors and any clinical concerns