Developmental dyplasia of the hip (DDH) is the most common hip deformity in children. Early diagnosis and treatment of DDH is associated with improved outcomes. Young-Jo Kim, MD, PhD, director of Children's Hospital Boston's Adolescent and Young Adult Hip Program, explains the signs and symptoms of DDH and the various treatment approaches.
What is developmental dysplasia of the hip?
It is a condition that results from abnormal development of the hip joint. The severity of DDH ranges from minor loosening of the hip ligaments to complete dislocation of the hip joint. In DDH, the acetabulum of the pelvis may be too shallow or the hip ligaments may be loosened, allowing the head of the femur to slip partially or completely in and out of the ball-and-socket hip joint. Left untreated, DDH can eventually cause osteoarthritis in adulthood and increase the likelihood of a patient needing total hip replacement.
How common is this condition?
DDH is the most common pediatric hip problem, affecting roughly one to two out of every 1,000 children. The condition is approximately four times more common among girls than boys. DDH is also more common among first-born babies, breech babies and children with a family history of DDH. Tight swaddling can also increase the risk of developing this condition.
How is DDH diagnosed?
Infants and young children generally do not experience pain from DDH; however, adolescents and young adults with DDH may present with activity-related hip pain. DDH can be diagnosed by a physical exam demonstrating hip instability (using either the Ortolani or Barlow test) or by imaging studies of the hip joint (ultrasound for infants and X-ray in children and young adults). Hip examination is recommended at each well visit until a child is walking normally. In infants, mild hip instability is relatively common and frequently resolves without treatment within the first few weeks of life.
What treatment options are available?
Treatment varies significantly based on the age of the patient and the severity of the dysplasia or dislocation. In cases of minor joint instability, the condition may correct itself without specific medical intervention as the child develops. When necessary, a variety of interventions may be used depending on the child's age.
- Abduction splinting - In infants up to 6 months of age, a specialized harness or brace can be worn for several weeks to hold the hip in place and gradually correct the abnormality by positioning the joint up and out to promote gradual stabilization. The most commonly used splint is the Pavlik harness. With early diagnosis, this treatment is generally enough to correct the abnormality.
- Closed reduction - In children roughly 6 to 18 months old, abduction splinting is less effective and closed reduction may be indicated. In a closed reduction, the hip joint is reduced under anesthesia. Following the procedure, a spica cast (covering the trunk and one or both legs) may be used to hold the hip joint in place.
- Open reduction - For children who have begun walking or for whom closed reduction is not successful, open surgical reduction of the hip is generally necessary. In general, the older a child is at the time of diagnosis, the more likely it is that surgery will be needed. Open reduction may involve repositioning or reorienting the hip socket, redirecting the head of the femur, repairing any hip dislocation or reconstructing hip ligaments. In younger child, a spica cast may be applied following an open reduction procedure.
- Bernese periacetabular osteotomy - This procedure can be used to correct DDH in teens and adults whose bones have finished growing. The surgery involves cutting the dyplastic acetabulum from its surrounding bone and repositioning the bone into a more stable alignment to support the femoral head.
It is important for children and young adults with symptoms of DDH to be evaluated by an orthopedist. Without treatment, unresolved DDH can ultimately lead to osteoarthritis in adults and related pain and disability.
What is the long-term outlook for children with DDH?
In the vast majority of cases, DDH can be corrected, and children can grow up to live normal, fully active lives. Earlier diagnosis and treatment of DDH is associated with improved outcomes. Regardless of the age at which they are treated, children with DDH should be followed periodically by an orthopedist until skeletal development is complete.
Our orthopedic experts have extensive experience in the treatment of developmental dysplasia of the hip, including surgical and non-surgical interventions. The treatment needs of older children and adolescents with DDH can differ significantly from those of infants. At Children's Adolescent and Young Adult Hip Program, our experts are uniquely experienced in the management of DDH in young adults and are available at various convenient Children's locations.
More information: childrenshospital.org/DDH
Make a referral: 617-355-6021