Developmental Dysplasia of the Hip (DDH) | Treatments

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How is hip dysplasia treated?

Boston Children’s Hospital hip specialists provide comprehensive treatment — including evaluation, diagnosis, consultation and follow-up care for infants and children with developmental dysplasia of the hip (DDH). How we’ll treat your child’s DDH depends on the complexity and severity of the condition — as well as age, overall health, medical history and the expectations for the course of the child’s condition as he or she grows.

DDH non-surgical treatment

Hip dysplasia ranges from a mild abnormality of the hip socket formation to a complete dislocation of the femoral head (ball) from the acetabulum (socket). The goal of all treatments for DDH is to put the ball back into the hip socket, so the hip can develop normally.

Observation

If the socket of a child 6 months of age or younger is only slightly shallow and there is no instability, the doctor may follow the hip closely, since often, the joint will form normally on its own.

Pavlik harness

A Pavlik harness is used on babies up to four months of age to hold the hip in place, while allowing the legs to move a little. The baby usually wears it full time until the hip is stable and the ultrasound is normalized. Typically, the length of treatment is around eight to 12 weeks for unstable hips. It is possible that treatment will start full time (24 hours per day) and then change to part-time (12 hours per day), depending on the severity of hip dysplasia.

During this time the doctor frequently examines the hip, checks the harness for proper fit and obtains a hip ultrasound to check the hip position and success of Pavlik Harness treatment. After successful treatment, your child will need to continue with follow up and repeat imaging and examination during the first few years of life to monitor the development and growth of the hip joint.

Typically, the baby’s hip is successfully treated with the Pavlik harness, but sometimes it may continue to be partially or completely dislocated. When the Pavlik harness fails to stabilize the hip, your doctor will decide whether another type of brace called abduction brace is recommended. If the hip becomes stable with an abduction brace, then the brace is used for around eight to 12 weeks.

DDH surgical treatment

Closed reduction

If the hip continues to be partially or completely dislocated despite the use of the Pavlik harness, a cast may be required. Under anesthesia, the doctor will insert a very fine needle in the baby’s hip and inject contrast to clearly view the ball and the socket. This test is called an “arthrogram.” The process of setting the ball back into the socket after arthrogram is called closed reduction.

If the hip can be set into place, then a “spica cast” is applied. This cast extends from the nipple line to the legs to hold the hip in place. It is changed from time to time as the baby grows and remains on the hip for about three to six months.

Open reduction

If closed reduction does not work, then an open-reduction surgery is typically recommended. This surgery repairs the hip with an incision to reposition the hip so it can grow and function normally. The type of procedure needed depend on the child’s specific problem, such as reshaping the hip socket, redirecting the femoral head or repair of a dislocation.

Follow-up care

Success rates are high for hip dysplasia treatments at Boston Children’s. Even so, any child who’s been treated for hip dysplasia must still be followed periodically by an orthopedist until skeletal growth is complete. The doctor will monitor the repaired hip, since it needs to grow normally through the whole growth period in order to be durable for a lifetime and minimize risk for early arthritis.

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