Developmental Dysplasia of the Hip (Hip Dysplasia)
What is it?
Developmental dysplasia of the hip (DDH) refers to a problem with the shape of the hip joint. The hip is a ball and socket-shaped joint that is made up of two parts: the top of the thighbone (the femoral head) and the socket (the acetabulum). The top of the thigh bone is normally round and sits inside the hip socket. Children with DDH, or hip dysplasia, have very misshapen or shallow hip socket bones that are not deep enough to completely cover and support the top of the thigh bone.
DDH can refer to a hip that is subluxatable (meaning the top of the thigh bone is loose in the socket), dislocatable (meaning the top of the thigh bone can come out of the socket when stress is applied), or dislocated (meaning the top of the thigh bone is currently out of the socket).
Why come to Children's Hospital Colorado for treatment of DDH?
Children's Hospital Colorado has a dedicated team of health providers who are experts in treating hip dysplasia. Our dedicated team has extensive experience in treating complex hip deformities in children and young adults. We routinely provide treatments for DDH and perform more surgeries for DDH than any other hospital in the region.
What are the signs and symptoms?
Infants and children typically will not experience any symptoms with this condition. Hip pain from DDH usually does not develop until adolescence and sometimes will not occur until ages 30 to 40. Teens and young adults may experience pain in the front or side of the hip.
Who gets it?
Risk factors for DDH include:
- A family history of hip problems
- First-born children
- Female children
- Babies that are born in the breech position (especially with feet up by the shoulders)
How do you diagnose it?
DDH is usually discovered during a child’s check-up with their health care provider. Exam findings may include one leg that is shorter than the other, a limp in the child’s walk or a dislocating hip. See further diagnosis information by age group below.
Birth to one month of age: Diagnosis is based on a physical exam of the hips. If the hip appears normal, your child may be asked to return for an x-ray or ultrasound later to make sure the hip is normal.
One to four months of age: If there is speculation of hip dysplasia based upon a previous exam or because of risk factors for DDH, an ultrasound of the hips may be done. An ultrasound uses high frequency sound waves to view the hip socket, with no radiation risk to the child. In young infants, the bones that make up the hip joint are primarily made of cartilage and x-rays are not helpful.
Four months of age and older: After 4 months of age there is enough bone formed in the hip joint that a simple x-ray of the hips is used to diagnose DDH.
How do we treat it?
The severity of DDH and the age of the patient determine the course of treatment. The goal of treatment is to create a hip that is as normal as possible and to prevent or delay hip arthritis in young adulthood.
Infants up to 6 months of age with severe DDH, who may be experiencing dislocation, may be treated with a Pavlik harness. This is a soft brace that helps hold the baby’s legs in a position that helps the hip develop normally. This brace is worn 24 hours a day, for 6 to 12 weeks.
If the child’s hip is dislocated and the Pavlik harness is not successful in stabilizing it, further treatment options will be discussed with your orthopedic provider. Sometimes a surgical procedure will need to be done in young children to put the hip back in place; after surgery a cast would be applied.
Adolescents and young adults with DDH will often be treated with the Periacetabular Osteotomy (PAO) surgical procedure. The PAO procedure preserves and enhances the patient’s own hip joint rather than replacing it with an artificial part. The goal of this procedure is to decrease the hip pain and delay/decrease the chance of hip arthritis which could lead to hip replacement.
Additional resources
