Developmental Dysplasia of the Hip (Hip Dysplasia and DDH) in Children

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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 Boston Children’s Hospital, 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 Boston Children’s Hospital 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, Boston Children’s General Orthopedic ProgramOrthopedic Center and Child and Young 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. Boston Children’s Child and Young Adult Hip 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.

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- Sandra L. Fenwick, President and CEO

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