The hip is a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.
Although DDH is most often present at birth, it may also develop during a child’s first year of life. Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. As swaddling becomes increasingly popular, it is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH.
In all cases of DDH, the socket (acetabulum) is shallow, meaning that the ball of the thighbone (femur) cannot firmly fit into the socket. Sometimes, the ligaments that help to hold the joint in place are stretched. The degree of hip looseness, or instability, varies among children with DDH.
In the United States, approximately 1 to 2 babies per 1,000 are born with DDH. Pediatricians screen for DDH at a newborn’s first examination and at every well-baby checkup thereafter.
DDH tends to run in families. It can be present in either hip and in any individual. It usually affects the left hip and is predominant in:
Some babies born with a dislocated hip will show no outward signs.
Contact your pediatrician if your baby has:
In addition to visual clues, your doctor will perform a careful physical examination to check for DDH, such as listening and feeling for “clunks” as the hip is put in different positions. Your doctor will use specific maneuvers to determine if the hip can be dislocated and/or put back into proper position.
Newborns identified as at higher risk for DDH are often tested using ultrasound, which can create images of the hip bones. For older infants and children, x-rays of the hip may be taken to provide detailed pictures of the hip joint.
When DDH is detected at birth, it can usually be corrected with the use of a harness or brace. If the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated, with less predictable results.
Treatment methods depend on a child’s age.
Parents play an essential role in ensuring the harness is effective. Your doctor and healthcare team will teach you how to safely perform daily care tasks, such as diapering, bathing, feeding, and dressing.
How long the baby will require the harness varies. It is usually worn full-time for at least 6 weeks, and then part-time for an additional 6 weeks.
If the hip will not stay in position using a harness, your doctor may try an abduction brace made of firmer material that will keep your baby’s legs in position.
In some cases, a closed reduction procedure is required. Your doctor will gently move your baby’s thighbone into proper position, and then apply a body cast (spica cast) to hold the bones in place. This procedure is done while the baby is under anesthesia.
Caring for a baby in a spica cast requires specific instruction. Your doctor and healthcare team will teach you how to perform daily activities, maintain the cast, and identify any problems.
In some cases, the thighbone will be shortened in order to properly fit the bone into the socket. X-rays are taken during the operation to confirm that the bones are in position. Afterwards, the child is placed in a spica cast to maintain the proper hip position.
In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. The cast may be needed for 2 to 3 months. Your doctor may change the cast during this time period.
X-rays and other regular follow-up monitoring are needed after DDH treatment until the child’s growth is complete.
Children treated with spica casting may have a delay in walking. However, when the cast is removed, walking development proceeds normally.
The Pavlik harness and other positioning devices may cause skin irritation around the straps, and a difference in leg length may remain. Growth disturbances of the upper thighbone are rare, but may occur due to a disturbance in the blood supply to the growth area in the thighbone.
Even after proper treatment, a shallow hip socket may still persist, and surgery may be necessary in early childhood to restore the normal anatomy of the hip joint.
If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or a “duck-like” gait and decreased agility.
Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2 years.
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In order to assist doctors in the treatment of DDH, the American Academy of Orthopaedic Surgeons has done research to provide some useful guidelines. These are recommendations only and may not apply to each and every case. For more information:.
Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)