Hip dysplasia (developmental dysplasia of the hip)

If your baby or child has been diagnosed with developmental dysplasia of the hip (also known as DDH or hip dysplasia), you’ll have concerns and questions about her treatment, recovery, outlook and other issues. It may comfort you to know that at Children’s Hospital Boston, we’ll provide support every step of the way.

• Developmental dysplasia of the hip is a condition in which the hip joint doesn’t develop normally.
  • DDH occurs on a spectrum of abnormality—ranging from just a minor laxity (looseness) of the ligament that holds the ball in the socket to a complete dislocation, in which the ball is entirely out of the socket.
     
• In DDH, the hip socket may be too shallow and/or the ligaments too loose, allowing the ball (head) of the thigh bone (femur) to slip in and out of the socket, partially or completely.
   
• The socket and/or the femoral head can be out of position or otherwise not programmed to develop properly.
   
• The hip joint’s ligaments can be looser than normal.
   
• Some common signs can include:
  • the leg on the side of the dislocated hip may appear shorter
  • the leg on the side of the dislocated hip may turn outward
  • the folds in the skin of the thigh or buttocks may appear uneven
  • the space between the legs may look wider than normal

• Treatments range from simple observation, to harnessing/casting/bracing, to surgery.
   
• The condition can be congenital (present at birth), or can develop as the child grows.
   
• Often, the condition corrects itself without medical intervention as the child grows.
   
• DDH affects one or two out of 1,000 babies.
   
• The highest incidence of DDH occurs in:
  • females (who have looser ligaments than males)
  • first-born babies (whose fit in the uterus is tighter than in later babies)
  • breech babies (whose constrained position tends to strain the joint’s ligaments)
  • children in families where there’s a genetic predisposition for the condition
     
• DDH is the most common cause of hip problems in children.
   
• If untreated or undertreated in childhood, DDH is the most common cause of osteoarthritis (and its attendant disability) in adults.
  • Untreated, the condition can also cause pain, a limp and/or differences in leg length.
     

How Children’s Hospital Boston approaches developmental dysplasia of the hip

Whether your child’s hip needs non-surgical or surgical treatment, you can have peace of mind knowing that, as national and international orthopedics referral centers, Children’s General Orthopedic Program, Orthopedic Center and Child and Adult Hip Preservation Program have treated a large volume of hip conditions that few pediatric hospitals have ever seen. As a result, we can provide expert diagnosis, treatment and care for every level of complexity and severity of DDH.

Unique expertise in problems of the adolescent hip. Many adolescents and young adults with hip problems need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Children’s Child and Adult Preservation Program , led by Michael Millis, MD, and Young-Jo Kim, MD, is the only such program in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.

Leaders in Bernese periacetabular osteotomy (Bernese PAO).  At Children's, we’ve performed over 1,400 Bernese periacetabular osteotomies since 1991 to correct dysplastic hips in teens and adults, whose hip sockets have finished growing. Our large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world. The Bernese PAO—the most powerful procedure for repositioning the hip socket—is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing (typically from age 13 or 14 through adult).

One of the first programs. Our Orthopedic Center was one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more 5,000 procedures each year. Our program, ranked among the top three in the country by U.S.News & World Report in 2012-2013, is the nation’s preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

Developmental dysplasia of the hip: Reviewed by Michael Millis, MD
© Children’s Hospital Boston, 2011