Children's Hospital Colorado

Developmental Dysplasia of the Hip (DDH)

What is developmental dysplasia of the hip?

Developmental dysplasia of the hip, also referred to as DDH, is a condition in which the hip joint develops abnormally.  The hip joint is made up of the thigh bone (the femur) and the pelvic bone. The upper end of the femur is shaped into a ball (femoral head) that fits into a socket (the acetabulum).  

In a normally developed hip, the round femoral head will sit inside of the socket.  In a patient with DDH, the bone of the hip socket is either too shallow, misshapen, or not deep enough to completely cover and support the femoral head.

Most commonly, there are four variations of hip and ball placement that can lead to DDH in a child. They are:
•    A hip that has a shallow socket.
•    A hip where the femoral head (the ball) is loose in the socket. This is called subluxatable.
•    A hip that is dislocatable. This happens when the femoral head (the ball) can come out of the socket when stress is applied.
•    A hip that is currently dislocated (the femoral head is already out of socket).

The severity of DDH and the age of your child will determine the course of treatment.  The goal of treatment is to manipulate the femoral head (ball) to fit deep inside the socket to allow the hip to properly develop.

What causes developmental dysplasia of the hip?

The actual causes of DDH are still unknown; however, it seems that hip dysplasia is a developmental problem. It can occur before birth, after birth and less often during infancy.

Who gets developmental dysplasia of the hip?

There are several recognized risk factors for hip dysplasia:
•    A family history of hip problems
•    Being the first-born child
•    Female (versus male) gender
•    Babies who are born in the breech position (head up and feet down)

Helpful resources for developmental dysplasia of the hip:

•    The Hip Program at Children’s Hospital Colorado
•    Pediatric Orthopedic Society of North America
•    International Hip Dysplasia Institute

What are the signs and symptoms of developmental dysplasia of the hip (DDH)?

In infants and young children with DDH, there may be no symptoms present.  Possible symptoms include:

  • Clicking or popping of the hip
  • Asymmetric thigh folds
  • Uneven leg lengths
  • Decreased range of motion of the hip joint
  • Difficulty spreading the legs to put on a diaper

How is developmental dysplasia of the hip diagnosed?

There are several different approaches, based on the age of your child, which can help determine the diagnosis of developmental dysplasia of the hip (DDH).

Birth to one month of age: Diagnosis is based upon a physical examination of the hip(s).  If the hip(s) appear normal upon exam, but your child is showing signs or symptoms of DDH, you may be asked to return for an x-ray or ultrasound at a future date to make sure the hip socket is developing correctly.

One to four months of age: If there is a question of hip dysplasia, either by an exam or due to the risk factors, your child’s doctor will request an ultrasound of the hip(s).  An ultrasound uses high frequency sound waves to view the hip socket.

Hip joints of babies in this age group are primarily made up of cartilage, so x-rays are not typically beneficial.  If DDH is diagnosed or if signs and symptoms continue, your doctor will most likely also want to follow the progress of the hip(s) with future ultrasounds or x-rays.

Four months of age and older: After 4 months of age, bone has formed in the hip joint.  At this age an x-ray of the hip(s) along with an ultrasound (up to 6 months) can be used to diagnose DDH.

What to expect from hip dysplasia tests

X-rays are taken in the office during your doctor visit.  Ultrasounds are typically scheduled an hour before your appointment and occur in the radiology department on the first floor of the hospital.

How do providers at Children’s Hospital Colorado make a diagnosis?

Our doctors are able to diagnosis DDH based on your child’s birth history, physical examination and ultrasound. A physical evaluation plays an important role in diagnosis. Ultrasound is equally as important and can also help to determine the severity of the hip dysplasia.


How is developmental dysplasia of the hip treated?

Treatment for developmental dysplasia of the hip (DDH) is based on the severity of the dysplasia and the age of the child.  There are surgical and non-surgical ways of treating DDH.

Bracing

Another option for treatment of hip dysplasia is the use of an abduction brace.  This is a ridged plastic brace that is worn under a thin layer of clothes.  In most cases it is worn 23 hours per day and is removed for bathing and diaper changes. The severity of the dysplasia will determine how long (how many weeks) the brace is needed. 

Surgery

A surgical procedure can be performed if treatment of the hip dysplasia is not successful using bracing, if the child is diagnosed at a later age and the hip is not reducible during a physician’s examination, or if the dysplasia is too severe to correct with bracing. 

Surgical options include closed reduction and casting and open reduction and casting with or without bone procedures. Surgery options can be discussed with your child’s orthopedic hip specialist at Children’s Hospital Colorado.

Why choose Children’s Hospital Colorado for your child’s DDH?

By working together as a team, we are able to develop a comprehensive approach to patient diagnosis and individualized treatment plans. Specialists from our Hip Program offer a broad spectrum of options for our patients and include experts in the fields of rehabilitation, physical therapy, rheumatology, anesthesiology, and pain.

With a sole focus on hip disease in young patients, our pediatric Hip Program is nationally recognized for excellence in hip surgeries, and our doctors educate healthcare providers around the nation on hip diseases and surgery.

Our goal is to provide our patients with options for pain control, function improvement and preservation of the hip joint.




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