Developmental Dysplasia of the Hip (DDH)
- What is developmental dysplasia of the hip?
- Who gets DDH?
- How do you evaluate DDH?
- What is your experience with DDH?
- How do you treat DDH?
What is developmental dysplasia of the hip?
Developmental dysplasia of the hip (DDH) is the name for a wide variety of problems in the formation of children’s hips. Some of these problems are present at birth (congenital). Others develop as your child grows.
In general, DDH makes it more likely that your child’s leg bones can come out of the hip joint (dislocation).
DDH can range from mild to serious. In some cases, DDH means the child has shallow hip sockets that make dislocation more likely. Other children are born with leg bones that are already out of the socket.
While we can treat most children who have DDH successfully, it is important to find the problem and start treatment quickly. Children who do not get help can develop a limp and a serious case of arthritis as adults.
Who gets DDH?
About one in every 1,000 children in the United States has some form of DDH. The great majority of them are girls. Babies who are born bottom first (breech) are more likely to have DDH.
Children with family members who have DDH are also more likely to have the problem.
How do you evaluate DDH?
Structures blocking reduction in DDH. These interpositions may block reduction of the hip.
When your baby is born, the doctor will examine both of her hips to make sure they are stable. He will gently move your baby’s legs to look for signs that the bones can come out of the sockets.
Babies change as they grow, so the doctor will examine your child several times as she gets older, often at her regular well-baby exams.
If your child’s doctor thinks she might be inclined to have DDH and she is younger than 4 months, we may ask for an ultrasound image to be taken of her hips. If she is older than 4 months, we may take X-rays.
What is your experience with DDH?
DDH with residual acetabular dysplasia. Radiographs at birth, 3, 10 and 19 years (top to bottom) show persisting dysplasia.
Our doctors are known nationally for their skill in treating DDH. We have an experienced ultrasound unit that produces high-quality images to help your child’s doctor choose the right treatment.
We have years of experience making custom braces and splints to help correct hip problems. Read about braces and splints and our other orthotics and prosthetics services.
How do you treat DDH?
It is important to find DDH early to treat it successfully. In the first few months of life, babies often can wear a type of harness to fix the problem.
But babies older than 6 months often need surgery, and those who are older than 1 year almost always need surgery.
The treatment we choose depends upon how old your child is when DDH is found. All types of treatment have one goal: putting the hip joint back in place and keeping it there.
This kind of treatment is called reduction, and there are several methods.
Treatment from 0 to 6 months of age
The youngest babies may wear a Pavlik harness, a soft harness that flexes and pulls the baby’s legs away from her middle while allowing her to move her legs. The harness keeps the ball (femoral head) at the top of the thighbone positioned deeply in the socket.
This is the simplest form of reduction treatment and works 90% of the time. It allows the baby to exercise her legs while redirecting the thighbone into the hip socket.
Proper fit of Pavlik harness.
Treatment from 6 to 18 months of age
If the Pavlik harness is unsuccessful or if a child is older than 6 months, she may need a body cast or a brace to hold her thighbone in her hip socket.
Doctors either manipulate your child’s joint with a cast or harness (closed reduction) or operate to put the thighbone in the socket (open reduction).
In about 10% to 20% of DDH cases in children 6 to 18 months of age, this operation is necessary. During the procedure, the doctor opens the hip and puts the ball directly into the hip socket.
In some children, the hip (psoas) tendon also is tight and must be released. Doctors do this by making a small cut through the skin to release the tendon.
Treatment for children older than 18 months
Older children usually need surgery to redirect or reshape the bones of the hip, the pelvis or the thighbone so their hips will stay in proper alignment.
After surgery, your child will wear a special body cast, called a spica cast, on her hips and legs for about three months. The cast will be changed once, midway through that time period.
After the doctor removes the cast, your child will wear a plastic-and-metal brace to hold her hips in place until X-rays show that her hip socket is normal.