• Developmental Dysplasia of the Hip

    (DDH; Congenital Dysplasia/Dislocation of the Hip [CDH]; Congenital Dysplasia of the Hip; Congenital Dislocation of the Hip; Congenital Subluxability of the Hip; Congenital Hip Dysplasia; Congenital Hip Dislocation; Congenital Hip Subluxability; Dysplasia of the Hip, Developmental)

    Definition

    The hip is where the leg bone and pelvis meet. The thigh bone has a ball-shaped top. This ball fits into a cup shape area on the pelvis. Developmental dysplasia of the hip (DDH) is a problem with how these bones fit together. The exact problem can vary between children but may include:
    • Ball of the thigh is loose inside the cup of the pelvis—makes the hip unstable
    • Ball moves easily out of the cup—causing a dislocation of the hip
    • Ball and cup do not meet at all
    DDH can make the hip unstable and loose. It can make it difficult or impossible to walk.
    The Hip Joint
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The exact cause of DDH is not known. Some factors that may play a role include:
    • How the baby is positioned in the womb
    • Maternal hormones
    • Genetics
    Certain carrying or wrapping techniques may also affect the growth of the hip. Particularly methods that have child tightly bound in a position with the hips straight out and turned in.

    Risk Factors

    Factors that may increase your baby’s chance of developing DDH include:
    • Family history of DDH
    • Breech birth (feet first), especially females born in breech position
    • Gender: More common in females than males
    • Low levels of amniotic fluid during pregnancy
    • Late delivery—birth after 42 weeks of pregnancy
    • Birthweight greater than 8 pounds 13 ounces (4 kg)

    Symptoms

    Symptoms may depend on the age of your child:
    • Uneven folds in the area of the thigh or hip—may be visible in newborns
    • Poor mobility and flexibility when they start crawling (around 9 months)
    • One leg shorter than the other may see when child starts to stand at 10-11 months
    • Limping, lurching, walking on toes, or other unevenness in walk (duck-like gait) at about 1 year
    DDH more commonly affects the left hip. Sometimes both hip joints are affected. The doctor may be able to detect the condition when the baby is born.

    Diagnosis

    Your child's doctor will look for signs of DDH during the first physical exam. The doctor will gently move the hip to see if it makes a clunking or popping noise. This may indicate a dislocating hip. Your doctor may assess the hip with:
    • A test done by placing the baby on his back and checking the height of the knees.
    • Looking for uneven folds in the hip or thigh
    • Difficulty moving the hip outward
    Detailed pictures of the hip may help confirm the diagnosis or determine treatment. The pictures can be made with:
    • Ultrasound—in babies less than 4 months old or babies with risk factors but a normal physical exam
    • X-rays —in babies older than 3 months

    Treatment

    Talk with the doctor about the best treatment plan for your baby. Depending on your baby’s age and the severity of the condition, treatment options include:
    • For newborns: harness (called Pavlik harness) to keep hip in place, worn for 1-2 months
    • For babies aged 1-6 months:
      • Harness to reposition hip
      • Manual adjustment—the doctor moves bones into proper positions, and then places baby in a lower body cast
      For babies aged six months to two years:
      • Manual adjustment
      • Hip surgery, then body cast
    • For children over two years: hip surgery, then body cast
    If your baby was diagnosed with DDH at birth, the doctor may not treat the condition until the baby is older than two weeks. Early DDH may improve on its own.
    The doctor will monitor the hip during follow-up exams and x-rays. This will be done until your child is done growing.

    Prevention

    Because the exact cause is unknown, it is difficult to prevent DDH. But if you are pregnant and have a family history of DDH, tell your doctor.
    Avoiding certain swaddling positions may also help decrease some types of hip dislocation.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Academy of Pediatrics http://www.aap.org/

    CANADIAN RESOURCES

    Canadian Institute of Child Health http://www.cich.ca/

    Canadian Pediatric Society http://www.cps.ca/

    References

    Developmental dysplasia of the hip. American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00347 . Updated April 2009. Accessed December 10, 2012.

    Developmental dysplasia of the hip. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 25, 2012. Accessed December 10, 2012.

    Developmental dysplasia of the hip. Shriners Hospital for Children website. Available at: http://www.shrinershospitalsforchildren.org/CareAndTreatment/Orthopaedics/HipDysplasia.aspx . Accessed December 10, 2012.

    Hart ES, Albright MB, Rebello GN, Grottkau BE. Developmental dysplasia of the hip: nursing implications and anticipatory guidance for parents. Orthopaedic Nursing. 2006;25:100-111.

    Shipman SA, Helfand M, Moyer VA, Yawn BP. Screening for development dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. EBSCO Publishing Nursing Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/nrc-about . Updated July 2008. Accessed November 18, 2008.

    Shorter D, Hong T, Osborn DA. Screening programmes for developmental dysplasia of the hip in newborn infants. Cochrane Database Syst Rev. 2011;9:CD004595.

    Stedman’s Medical Dictionary . 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005; 599-600.

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