Developmental Dysplasia of the Hip in Infants and Children
Developmental dysplasia of the hip, or DDH, is a relatively common condition that occurs in the hip joint as it develops. If left untreated, DDH can cause arthritis and other joint problems. The pediatric orthopedic surgeons at University Hospitals Rainbow Babies & Children’s are experts at treating hip dysplasia in infants, children and adolescents.
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What is Hip Dysplasia?
The hip joint is made up of a ball (femoral head) and a socket (acetabulum). With DDH, the joint develops a shallow socket that does not adequately contain the ball of the hip. Severity of the condition can range from a shallow socket alone to complete dislocation of the hip. Hip dysplasia can affect one or both hip joints.
If left untreated, DDH may lead to joint pain and hip arthritis early on in life. Hip dysplasia is the most common reason for a total hip replacement in patients under the age of 50. That is why the pediatric orthopedic specialists at UH Rainbow Babies & Children’s recommend close monitoring and early intervention to prevent DDH from affecting quality of life during childhood, adolescence and beyond.
What Causes Hip Dysplasia?
The exact cause of hip dysplasia is unknown, but multiple factors are thought to contribute to the development of DDH, including genetics, hormones and mechanical components. Risk factors of DDH include:
- First-born children: Due to smaller, tighter conditions in the uterus.
- Females: Girls have much higher rates of DDH than boys.
- Breech position in utero: The feet or buttocks are pointed downward instead of the head.
- Genetics: A family history of DDH can increase the DDH risk.
- Tight swaddling: Improper swaddling techniques in which the hips are constricted can put a child at risk for DDH. Cultures that encourage tight swaddling often have higher rates of DDH. While DDH can’t be 100 percent prevented, learning safe swaddling techniques in which the hip joints can move freely can help decrease the risk.
What Are the Symptoms of Developmental Hip Dysplasia?
Early symptoms of DDH may be very subtle. Parents may notice some of the following signs of hip dysplasia in their child:
- Hip makes clunking, popping or clicking sound during diaper changes.
- Difficulty rotating the child’s hip all the way out to the side.
- Asymmetric hip range of motion or uneven skin creases in the thighs.
- Walking with a limp or waddling gait.
- Leg length discrepancy or toe walking on one side.
Even if the hip is dislocated, DDH typically does not cause pain until adolescence or early adulthood.
How Is Hip Dysplasia Diagnosed?
Hip dysplasia is typically diagnosed based on physical examination and imaging tests such as:
- Ultrasound: This is the preferred testing method in the first 6 months of life.
- X-Ray: Used to diagnose DDH after 6 months of age.
- Magnetic resonance imaging (MRI)
- Computed tomography (CT) scans
Patients with specific risk factors such as hip instability on examination, breech presentation during the third trimester, and a family history of hip dysplasia in a first-degree relative should obtain a screening ultrasound at 6 weeks of age.
How Is Hip Dysplasia Treated?
Treatment for hip dysplasia depends on the age of the patient and severity of the condition. In the first 6 months of life, most cases of DDH can be successfully treated with a brace. After 6 months of age, mild cases may be treated with a brace, but hips that are dislocated often require surgery to reduce and stabilize the hip.
After walking age, additional procedures, such as a femoral osteotomy and/or a pelvic osteotomy, may be needed to further stabilize the hip and encourage normal hip development.
Follow-Up Care
Children with hip dysplasia will be checked by their pediatric orthopedic specialist regularly until they are done growing to make sure that the hip is continuing to develop properly. If the socket remains shallow, additional procedures may be needed to improve coverage of the ball by the socket to minimize the risk of arthritis as an adult.
This follow-up care is important because your child’s doctor will be able to identify any other problems that develop sooner, so they are able to treat the problem quickly before it gets worse.
Related Content and Resources
Early Diagnosis of Girl’s Hip Dysplasia Is Key to Treatment Success
Should You Swaddle Your Newborn?
Hip Dysplasia in Adolescents and Adults
