Developmental Dysplasia of the Hip (DDH)
Developmental dysplasia of the hip is a failure of the normal relationship between the socket and the head of the thigh bone to develop from birth. It covers a wide range, from a mildly shallow socket to complete dislocation. When recognised early, treatment is far simpler; screening examination is therefore important.
Why Does It Matter?
The hip socket and the head of the thigh bone shape one another as they develop. If the head does not sit properly in the socket, the socket does not deepen adequately and the joint surfaces remain mismatched over time. In cases that go unrecognised, pain, limping and early hip osteoarthritis can develop in later life.
By contrast, in cases identified during infancy simple methods can allow the hip to develop in the correct position. That is what makes early diagnosis valuable.
Risk Factors
- Breech presentation at birth — among the strongest factors
- A family history of hip dysplasia
- More common in girls
- Being a first baby, and situations where movement in the womb is limited (low fluid, twin pregnancy)
- Tight swaddling with the legs held straight and together
Because it also occurs in babies with no risk factors, screening examination is recommended for all infants.
How Is It Noticed?
In infancy
- Restriction on one side when the legs are opened (the hips not spreading symmetrically)
- Asymmetry of the thigh and buttock skin creases
- The legs appearing different in length
- A “click” felt while changing a nappy
None of these findings makes the diagnosis on its own; they all indicate the need for assessment. Crease asymmetry is also common in healthy babies.
In the walking years
- Limping, or a waddling gait
- Toe walking, or one leg appearing shorter
- In two-sided cases the signs being more subtle (they can be missed because there is no side to compare with)
Diagnosis
- Physical examination: specific tests assessing hip stability are performed in the newborn period.
- Hip ultrasound: the most suitable method in the early months, because a baby’s hip is largely cartilage.
- X-ray: preferred once ossification has progressed, in older babies and children.
The timing of screening and imaging is determined by the baby’s age and risk profile; this is planned by the physician following your child.
Treatment
The approach varies markedly with the age at diagnosis and the degree of dysplasia. The general principle is: the earlier, the simpler the method.
Early infancy
Soft devices that hold the hip in a suitable position (for example Pavlik-type harness systems) aim to seat the hip in the socket and allow the socket to develop. Treatment at this stage is generally well tolerated. Adherence to the wearing regime directly affects the outcome.
Later months and the walking years
Where diagnosis is delayed, closed or open methods of placing the hip in the socket and protection in a cast may be needed. In older children, surgical procedures to correct the socket or the thigh bone may be considered.
The process requires regular follow-up; the development of the hip is monitored throughout growth. Outcomes vary from child to child and no guarantee of a specific result is given for any treatment.
Advice for Families
- Do not swaddle tightly. The baby’s hips should be able to bend and open freely; wrapping the legs straight and together increases the risk
- Prefer “hip-friendly” swaddling and carrying methods that leave the hips free
- Do not skip your baby’s hip examination; keep to the recommended schedule of checks
- Always tell your physician if there is a family history of hip dysplasia or a breech presentation
- If a treatment device is being used, follow the wearing regime exactly
When Should You Seek Assessment?
- If your baby’s legs do not open equally
- If the thigh creases are markedly asymmetrical
- If the legs appear different in length
- If your child limps or has a waddling gait
- If there is a family history of hip dysplasia (even without findings)
When to Seek Medical Help Without Delay
- Redness, swelling and fever at the hip with the baby not moving the leg at all (suspected joint infection)
- Inability to bear weight on the leg after a fall or injury
- Colour change, coldness or marked distress in the leg while a treatment device is being used
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
Does swaddling cause hip dislocation?
Tight swaddling with the legs held straight and together is a practice that increases the risk of hip dysplasia. Wrapping methods that allow the hips to bend and open freely are recommended.
My baby’s hip “clicks” — is it dislocated?
Some sounds heard in babies are harmless. However, a sensation of the hip jumping while changing a nappy requires assessment. Sound alone does not make the diagnosis; examination and, if needed, ultrasound clarify it.
When should an ultrasound be done?
Timing is determined by the baby’s age and risk profile; ultrasound is preferred in the early months and X-ray once ossification has progressed. The physician following your child plans the appropriate time.
Can I take the treatment device off?
The wearing regime directly affects the outcome; do not remove it on your own decision. Your physician will explain in detail what to do for skin care or bathing.
What happens if it is found late?
Late diagnosis may require more extensive treatment and the process may take longer. In cases that go unrecognised, pain, limping and early hip osteoarthritis can develop in later life. This is why screening matters.
Will my child be able to do sport later?
This depends on the age at diagnosis, the degree of dysplasia and the course of treatment. Many children can maintain daily activities and sport; individual assessment is made at follow-up examinations.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of paediatric orthopaedics and hip surgery and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Paediatric Orthopaedics
- Hip Osteoarthritis (Coxarthrosis)
- Knee and Hip Problems
- Hip Arthroscopy
- Joint Replacement Surgery (Knee, Hip and Shoulder Arthroplasty)
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.