What is Developmental Dysplasia of the Hip (DDH)?
Developmental dysplasia of the hip (DDH) is a range of conditions within the hip. Mild conditions include when ligaments and other soft tissues around the hip joint are not tight, and allow the thighbone (femur) to move around the hip socket more than normal. In severe cases, the joint is loose enough for the thighbone to slip partway out of the hip socket.
Actual hip “dysplasia” is when a hip socket doesn’t fully cover the ball portion of the upper thigh bone, which allows the thigh bone to partially or fully dislocate. DDH can affect one or both hip joints.
What causes DDH?
Most patients with hip dysplasia are born with the condition. The exact cause is not known, but a number of risk factors can raise your child’s chance of having DDH, including a family history of DDH and your child’s position in the womb and at birth.
What are the symptoms?
A baby with DDH may have:
- A hip joint that is loose or slips out of place during examination
- One leg that appears shorter than the other
- A hip joint that moves differently than the other
- Extra folds of skin on the inside of the thighs
A child who is walking may:
- Walk on the toes of one foot with the heel off the floor because one leg is shorter than the other
- Walk with a limp or with a waddle if both hips are affected
Children with DDH who go untreated may develop permanent deformities in their hips. Untreated DDH may also lead to hip joint degeneration, which is an early exhaustion of the socket. Osteoarthritis develops when degeneration occurs in the cartilage that cushions joints. The bones that have been separated by the cartilage start rubbing against each other and eventually damage the tissue and bone, causing pain.
How is DDH diagnosed?
Usually, DDH is diagnosed during your newborn’s physical examination or well-baby checkup. It is generally more difficult to diagnose the condition in a baby that is older than 1 to 3 months because the only visible sign may be less mobility or flexibility of the affected hip joint.
If the results of a physical exam are unclear, an X-ray or ultrasound may be needed to evaluate your child’s hip joints.
An orthopedic surgeon or a pediatric orthopedist usually confirms a diagnosis and provides treatment options for DDH. Your health professional will refer you to one of these specialists if he or she suspects your child has DDH.
How is it treated?
If hip dysplasia is diagnosed at early infancy, a brace or cast can usually correct the problem. Moving your baby’s upper thighbone into the hip socket and keeping it in place while the joint grows will allow the it to heal and strengthen. A Pavlik harness is most often used on babies younger than 6 months, and a spica cast is used for older babies.
Most children born with looseness (laxity) of the hips will not have problems, but a child will not outgrow severe cases of DDH in which the hip sockets are too shallow. The condition must be treated by a doctor to prevent possible permanent disability. You should not try to treat DDH on your own, such as by diapering a baby with multiple diapers at a time or trying to put your baby’s legs in certain positions. These are not proper treatments of DDH and could cause the joint to develop abnormally.
Some people with DDH don’t develop symptoms until later in life. In those cases, surgery may be needed to reduce pain and improve function.
Early disease detection
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