Developmental Dysplasia of the Hip

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KEY POINTS

• Developmental dysplasia of the hip (DDH) is a problem with the development of a baby's hip joint. It can cause the hip to dislocate. Sometimes a baby is born with a dislocated hip.
• Your newborn may be put in a splint for 2 to 4 months to hold the hips in the right place and tighten the ligaments.
• Follow your child’s healthcare provider's instructions. Ask your provider how long it will take for your child to recover and how to take care of your child at home.

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What is developmental dysplasia of the hip?

Developmental dysplasia of the hip (DDH) is a problem with the development of a baby's hip joint. It can cause the hip to dislocate. A hip is dislocated when the top of the upper leg bone (the ball of the hip joint) slips out of the hip socket. Sometimes a baby is born with a dislocated hip.

If DDH is not treated, it can lead to pain and arthritis in early adulthood. If a hip dislocation is found and treated early, children usually have normal hip joints and movement.

What is the cause?

The exact cause of DDH is not known. It can happen in one or both hips. Strong bands of tissue called ligaments connect bones at the hip joint. If the ligaments of the hip joint are loose or stretched, the thighbone may not fit securely in the hip socket. When this happens, the hip socket does not form normally.

DDH tends to run in families and is seen more often in first-born babies or babies born breech (bottom or feet first instead of head first). Because of the way most babies are positioned inside the mother's womb during pregnancy, the left hip is affected more often than the right hip.

What are the symptoms?

All babies are checked at birth for this problem, but it may not show up at birth. Later, as the baby gets older, symptoms may include:

• The leg on the side of the hip with DDH may turn out more than the other leg.
• Your baby may have less movement of the leg on the side with the problem, or the leg may be shorter than the other leg.
• Your baby may seem to have pain when crawling or walking.
• Your baby may walk with a limp or on his or her toes, or waddle with a duck-like walk

How is it diagnosed?

When your baby is born, your child’s healthcare provider will examine your baby's hips. Your provider will push and pull the thighbones to see if they are loose in the socket. If your child's provider thinks there may be a problem, your baby may have an X-ray or ultrasound scan. An ultrasound uses sound waves to show pictures of the hip joint. Your child's provider may recommend that you see a bone specialist called an orthopedist.

Your child’s healthcare provider will keep checking your baby's legs and hips during well-child visits.

How is it treated?

Treatment is usually easier and more effective in a newborn with DDH than in an older child. Treatment is not always needed. Many times the problem will go away on its own in 2 to 6 weeks.

Your newborn may be put in a splint for 2 to 4 months. The splint holds the hips in the right place and helps tighten the ligaments so the hip joint can form normally. Your baby will wear the brace day and night.

Between the ages of 6 months and 2 years, your healthcare provider may treat the problem by trying to move the hip back into position without surgery. This procedure is usually done under anesthesia so your baby will not feel any pain. Your baby is then put in a body cast called a hip spica cast to hold the hip in place. If the problem is severe, or your child is older than 18 months, surgery may be needed to correct it.

After treatment with a splint, cast, or surgery, your child will have physical therapy to help develop movement and strength of the legs and hips.

How can I take care of my child?

Your child’s provider will give you instructions for bathing your baby, cleaning the splint, and putting the splint back on your child if you are allowed to take it off. It’s important to have the splint placed with just the right amount of tightness. If it’s too tight or too loose, it can cause problems.

Follow your child’s healthcare provider's instructions. Ask your provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup.