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Boston, MA 02115
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My Child Has:
Developmental Dysplasia of the Hip (DDH)
Programs that treat this condition
Adolescent and Young Adult Hip Program   General Orthopedic Program  
What is developmental dysplasia of the hip (DDH)?
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Developmental dysplasia of the hip is a congenital (present at birth) condition of the hip joint. It occurs once or twice in every 1,000 live births. The hip joint is created as a ball and socket joint. In DDH, the hip socket may be shallow, letting the ball of the long leg bone, also known as the femoral head, slip in and out of the socket. The ball may move partially or completely out of the hip socket.

The greatest incidence of DDH occurs in first-born females with a history of a close relative with the condition.

What causes developmental dysplasia of the hip (DDH)?
Hip dysplasia is considered a "multifactorial trait". Multifactorial inheritance means that many factors are involved in causing a birth defect. The factors are usually both genetic and environmental.

Often, one gender (either male or female) is affected more frequently than the other in multifactorial traits. There appears to be a different "threshold of expression", which means that one gender is more likely to show the problem than the other gender. For example, hip dysplasia is more common in females than males.

One of the environmental influences thought to contribute to hip dysplasia is the baby's response to the mothers' hormones during pregnancy. Once a child has been born with hip dysplasia, the chance for it to happen again in a male or female child is about 6 percent overall. In other words, there is a 94 percent chance that another child would not be born with hip dysplasia. (The specific chance for it to happen in a second child who is male is less than if the second child is female. Again, this is because the threshold for the trait to be present is different between males and females.)

What are the risk factors for developmental dysplasia of the hip (DDH)?
First-born infants are at higher risk since the uterus is small and there is limited room for the baby to move; therefore affecting the development of the hip. Other risk factors may include:
  • family history of developmental dysplasia of the hip, or very flexible ligaments
  • position of the baby in the uterus, especially with breech presentations
  • associations with other orthopaedic problems that include metatarsus adductus, clubfoot deformity, congenital conditions, and other syndromes
What are the symptoms of developmental dysplasia of the hip (DDH)?
The following are the most common symptoms of DDH. However, each child may experience symptoms differently. Symptoms may include:

  • the leg may appear shorter on the side of the dislocated hip
  • 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
An infant with developmental dysplasia of the hip may have a hip that is partially or completely dislocated, meaning the ball of the femur slips partially or completely out of the hip socket.

The symptoms of DDH may resemble other medical conditions of the hip. Always consult your child's physician for a diagnosis.

How is developmental dysplasia of the hip (DDH) diagnosed?
Developmental dysplasia of the hip is sometimes noted at birth. The pediatrician or newborn specialist screens newborn babies in the hospital for this hip problem before they go home. However, DDH may not be discovered until later evaluations. Your child's physician makes the diagnosis of developmental dysplasia of the hip with a clinical examination. During the examination, your child's physician obtains a complete prenatal and birth history of the child and asks if other family members are known to have DDH.

Diagnostic procedures may include:

  • x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Treatment for developmental dysplasia of the hip (DDH):
Specific treatment for DDH will be determined by your child's physician based on:
  • your child's age, overall health, and medical history
  • the extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
The goal of treatment is to put the femoral head back into the socket of the hip so that the hip can develop normally.
Pavlik Harness
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Treatment options vary for infants and may include:

  • Pavlik harness - The Pavlik harness is used on babies up to 4 months of age to hold the hip in place, while allowing the legs to move a little. The harness is put on by your baby's physician and is usually worn full time for at least six weeks, then part-time (12 hours per day) for six weeks. Your baby is seen frequently during this time so that the harness may be checked for proper fit and to examine the hip. At the end of this treatment, X-rays (or an ultrasound) are used to check hip placement. The hip may be successfully treated with the Pavlik harness, but sometimes, it may continue to be partially or completely dislocated.

  • Traction and casting - If the hip continues to be partially or completely dislocated, traction, casting, or surgery may be required. Traction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists of pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the soft tissues around the hip and to allow the femoral head to move back into the hip socket. Traction is most often used for approximately 10 to 14 days. Traction can either be set up at home or in the hospital, depending upon your child's physician, hospital, and the availability of the resources.

  • Surgery and casting - If the other methods are not successful, or if DDH is diagnosed after the age of 2 years, surgery may be required to put the hip back into place manually, also known as a "closed reduction." If successful, a special cast (called a spica cast) is put on the baby to hold the hip in place. A spica cast extends from the nipple line to the legs. The spica cast is worn for approximately three to six months. The cast is changed from time to time to accommodate the baby's growth and to ensure the cast's rigidity, as it may soften with daily wear. The cast remains on the hip until the hip returns to normal placement. Following casting, a special brace and physical therapy exercises may be necessary to make the muscles around the hip and in the legs stronger.
    • Cast care instructions:
    • Keep the cast clean and dry.
    • Check for cracks or breaks in the cast.
    • Rough edges can be padded to protect the skin from scratches.
    • Do not scratch the skin under the cast by inserting objects inside the cast.
    • Use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
    • Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.
    • Prevent small toys or objects from being put inside the cast.
    • Elevate the cast above the level of the heart to decrease swelling.
    • Encourage the child to move their fingers or toes to promote circulation
    • Do not use the abduction bar on the cast to lift or carry the child.
    When to call your child's physician:
    Contact your child's physician or healthcare provider if your child develops one or more of the following symptoms:
    • fever greater than 101 degrees F
    • increased pain
    • increased swelling above or below the cast
    • complaints of numbness or tingling
    • drainage or foul odor from the cast
    • cool or cold fingers or toes
    Long-term outlook for a child with developmental dysplasia of the hip (DDH):
    While newborn screening for DDH allows for early detection of this hip condition, starting treatment immediately after birth may be successful. Many children respond to the Pavlik harness, traction, and/or casting. Additional surgeries may be necessary since the hip dislocation can reoccur as the child grows and develops. If left untreated, the child may have differences in leg length, and may limp.
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