Overview

Developmental Dysplasia of the Hip (DDH) is a condition in which a baby's hip joint does not develop normally. The hip socket may be shallow, allowing the thigh bone to move partially or completely out of its normal position. DDH can affect one or both hips and may be present at birth or become noticeable as the child grows. Early diagnosis is important because the hip joint is still developing during infancy, making timely treatment particularly beneficial.

Developmental dysplasia of the hip treatment depends on the child's age, the severity of the condition and the stability of the hip joint. Many babies can be treated without surgery using a specialised brace, such as a Pavlik harness. Children diagnosed later may require procedures to reposition the hip and support normal joint development. At Sarvodaya Hospital, parents can seek guidance on appropriate assessment and treatment options for DDH, depending on the services available at the treating location.

Symptoms of Developmental Dysplasia of the Hip

• Uneven skin folds around the thighs or buttocks.
• One leg appearing shorter than the other.
• Limited movement of one hip, particularly when spreading the legs apart.
• A clicking or clunking sensation during hip movement.
• Difficulty spreading the thighs during nappy changes.
• Uneven leg positioning or movement.
• Limping or an unusual walking pattern in older children.
• Walking on the toes on one side or developing a noticeable difference in leg length in some cases.

Causes of Developmental Dysplasia of the Hip

Abnormal Hip Joint Development

Ligament Laxity

Foetal Positioning

Family History

Restricted Hip Positioning After Birth.

Diagnosis of Developmental Dysplasia of the Hip

Accurate DDH diagnosis helps determine whether the hip joint is stable, partially displaced or completely dislocated.

• Clinical Hip Examination: A doctor checks hip movement, stability, leg positioning and the range of movement during routine newborn and infant examinations.
• Hip Ultrasound: Ultrasound is commonly used in young infants because the hip joint contains substantial cartilage.
• Pelvic X-ray: X-rays become more useful as the baby grows and the bones develop. They help assess the position of the hip joint and the development of the socket, particularly in older infants and children.
• Follow-up Imaging: Repeat ultrasound or X-rays may be recommended to monitor hip development during and after treatment.
• Specialist Assessment: A paediatric orthopaedic specialist reviews the examination and imaging findings to determine the severity of the condition and recommend the most suitable treatment.

Benefits of Early DDH Treatment

• Support normal hip joint development
• Maintain proper positioning of the thigh bone within the hip socket
• Reduce the need for surgery in suitable cases
• Improve hip stability and alignment
• Support normal standing, walking and mobility
• Reduce the risk of long-term hip complications
• Monitor hip development and guide further treatment
• Support healthy growth and joint function

Prevention & Lifestyle Modifications

• Attend Routine Newborn Examinations: Ensure that your baby receives recommended hip examinations after birth and during routine health visits.
• Follow Screening Advice: Babies with breech presentation, a family history of DDH or an abnormal hip examination may need additional ultrasound or other imaging.
• Practise Hip-Safe Swaddling: If you swaddle your baby, allow the hips and knees to bend and move freely. Avoid wrapping the legs tightly in a straight, extended position.
• Follow Brace Instructions: If your baby is prescribed a Pavlik harness or another brace, follow the specialist's instructions regarding use, adjustments and follow-up appointments. Do not alter the harness yourself.

When Should You See a Doctor?

• Uneven thigh or buttock skin folds alongside other hip concerns.
• Limited movement when spreading the legs apart.
• One leg that appears shorter than the other.
• An abnormal hip examination during a routine check-up.
• A history of breech presentation or a family history of DDH.
• An unusual walking pattern, limp or difference in leg length as they grow.
• Persistent hip movement concerns or abnormal follow-up imaging.

Pre- and Post-Treatment Care

Pre-Treatment

• Consultation with a paediatric orthopaedic specialist.
• Detailed review of the baby's birth history and DDH risk factors.
• Clinical examination of hip movement and stability.
• Hip ultrasound or pelvic X-ray, depending on age and clinical findings.
• Assessment of the severity of hip dysplasia or dislocation.
• Discussion of bracing, closed reduction or surgical options when indicated.
• Individualised treatment planning based on the baby's age and hip development.
• Guidance for parents on safe positioning and treatment expectations.

Post-Treatment

• Attend all recommended clinical and imaging follow-ups.
• Use the prescribed harness, brace or cast according to the specialist's instructions.
• Do not adjust or remove prescribed devices without medical guidance.
• Keep the skin clean and monitor for pressure areas or irritation around the harness or cast.
• Follow instructions for bathing, clothing, handling and positioning.
• Seek medical advice if the baby's legs appear unusually swollen, cold or discoloured, or if movement changes significantly.
• Continue monitoring hip development after the brace or cast is discontinued.
• Follow rehabilitation or activity recommendations after surgery.
• Attend longer-term follow-up appointments to assess hip growth and joint alignment.