Topic Overview
What is developmental dysplasia of the hip (DDH)?
Developmental dysplasia of the hip (DDH) is the name for a range of conditions
of a child's hip. It can affect one or both hip joints.
- In mild cases, the
ligaments and other soft tissues around the hip joint
are not tight, and they allow the thighbone (femur) to move around more than
normal in the hip socket.
- In more severe cases, the joint is loose
enough to let the ball at the top of the thighbone (femoral head) come partway
out of the hip socket. This is called subluxation.
- Dislocation is
the most severe form of DDH. The ball at the top of the thighbone fully slips
out of the hip socket (dislocates).
With subluxation or dislocation, the hip socket is often too
shallow, more like a saucer than the deep cup that it should be.
See pictures of
normal hip anatomy in a child and a
dislocated hip.
What causes DDH?
The exact cause of DDH is not
known. A number of risk factors can raise your child's chances of having
DDH, including a
family history of DDH and your baby's position in the
womb and at birth.
What are the symptoms?
Having DDH does not cause
pain. A baby with DDH may have:
- A hip joint that feels loose or slips out of
place when examined.
- One leg that seems shorter than the
other.
- Extra folds of skin on the inside of the
thigh(s).
- A hip joint that moves differently than the other.
A child who is walking may:
- Walk on the toes of one foot with the heel up
off the floor.
- Walk with a limp (or waddling gait if both hips are
affected).
How is DDH diagnosed?
Usually, DDH is diagnosed
during your newborn's physical exam. If your baby is older, DDH may be
diagnosed during a well-baby checkup. But it may be harder to diagnose
the condition in a baby older than 1 to 3 months, because the only outward sign
may be less mobility or flexibility in the movement of the affected hip
joint(s).
If the results of a physical exam are unclear, an
imaging test such as an
ultrasound or
X-rays may be used to evaluate your child's hip
joints.
How is it treated?
Most children born with looseness (laxity) of the hips won't have problems and won't need treatment. If treatment is needed, the doctor will move
your baby's upper thighbone into the hip socket and keep it in place while
the hip joint grows. A splint, called a
Pavlik harness, is most often used to keep the joint in place in babies younger
than 6 months. A hard cast, known as a
spica cast, is used for older babies. Other forms of treatment, such as
surgery or a brace, also may be needed.
It's important to treat
DDH early. Children with untreated DDH may develop lasting hip problems.
Don't try to treat DDH on your own, such as by diapering a baby with 3 or 4
diapers at a time or by trying to put your baby's legs in certain positions.
These methods don't work well and may cause the joint to develop
abnormally.
Frequently Asked Questions
Learning about developmental dysplasia of the hip (DDH): | |
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Symptoms
The signs of
developmental dysplasia of the hip (DDH) vary
depending on whether one or both hips are affected.
Having DDH
does not cause pain. A newborn or infant with DDH may have:
- No obvious signs of a defect.
- Extra
folds of skin on the inside of the thigh(s). But a newborn without this
condition also may have these extra folds.
- Less mobility or
flexibility in the movement of the hip joint(s).
- One leg that seems
shorter than the other.
- Other physical deformities, especially of
the feet.
In rare cases, DDH develops in the first few weeks or
months after birth and signs may not be seen until your child starts to walk.
Then your child may:
- Stand with one hip raised higher than the other
because of a shorter leg on the affected
side. It seems shorter if the upper end of the thighbone has slipped up above
its normal position in the hip socket.
- Walk on the toes of one foot
with the heel up off the floor, attempting to make up for the difference in leg
length.
- Walk with a limp (or a waddling gait if both hips are
affected).
- Stand with a greater-than-normal inward curve (lordosis) of the lower back if both hips
are affected.
Children with untreated DDH may develop lasting
deformities in their hips. Untreated DDH can also lead to hip joint
degeneration, which is a sort of early "wearing out" of the socket. When the
degeneration occurs in the
cartilage that protects and cushions joints, it is
known as
osteoarthritis. Eventually the bones, which had been
separated by the cartilage, rub against each other. This rubbing damages tissue
and bone, and it causes pain.
Exams and Tests
Developmental dysplasia of the hip (DDH) is usually diagnosed by a
physical exam. A
medical history and other tests also may be useful in
diagnosing DDH.
All babies are examined for DDH at birth.
Newborns who have
risk factors for DDH, such as having foot, knee, or leg deformities, are
examined very closely for the condition.
Your child's hips are
also examined during regular
well-child checkups. But a baby with DDH who is older
than 1 to 3 months may have fewer visible signs, making it more difficult to
detect. These babies may have only slightly less mobility or flexibility of the
affected hip joint(s).
An
orthopedic surgeon or a pediatric orthopedist usually
confirms a diagnosis of and provides treatment for DDH. Your doctor will refer
you to one of these specialists if he or she suspects your child has DDH.
Imaging tests
Tests that show
images of the hip joint are often done to help diagnose DDH if results from
physical exams are unclear. These tests are also used to monitor treatments for
DDH.
Imaging tests used to diagnose and monitor DDH
include:
- Ultrasound of
the hip. This test provides the clearest images in babies younger than 5 months
when the hip joints are still made of
cartilage. Ultrasound can provide images to help a
doctor see the subtle signs of DDH that often aren't detected during a physical
exam.
- Hip
X-rays. These tests are most useful after a child is 4
to 6 months old. Before this age, a baby's bones are too soft to show up well
on an X-ray.
- CT scans. The doctor may use these tests to help see how well treatment is working.
Treatment Overview
Treatment for
developmental dysplasia of the hip (DDH) focuses on
moving your child's upper thighbone (femur) into its normal position and
keeping it in place while the
joint grows. The hip socket will not form and grow
properly if the ball at the top of the thighbone (femoral head) does not fit
snugly in the joint.
- Sometimes in babies with signs of DDH, the
thighbone and hip socket start to grow as they normally would, without
treatment. But it is hard to predict whether this will happen.
- Hips
that are fully dislocated or that can be dislocated easily by certain movements
are usually treated as soon as they are detected.
Treatment for DDH usually includes one of the
following:
- Pavlik harness. This device usually is
tried first if your baby is younger than 6 months. The harness has fabric
straps and fasteners that fit around your baby's chest, shoulders, and legs.
The harness holds the baby's legs in a spread position, with the hips bent so
that the thighs are out to the sides. Your doctor monitors the harness's
effectiveness through regular exams and imaging tests. The Pavlik harness
successfully makes the hip normal most of the time. But if your doctor
doesn't see improvement in the hip after about 3 to 4 weeks, the harness is
removed and other treatment options are explored.
- Spica cast. This body cast is made of
plaster or fiberglass to form a hard covering over the waist, hips, and legs.
To make it stronger, the cast may have a bar between the legs. Or the cast may not have a bar. Your child needs general anesthesia when this cast is put on him or her.
Other forms of treatment
- Braces and splints. Your child may wear a brace
or splint as a first treatment for DDH instead of a Pavlik harness or spica
cast. In some cases a brace or splint follows another type of treatment, such as surgery. In these cases, the device is used to help support
the hips and legs as they heal. In particular, children with DDH who also have
other problems with their feet or knees may benefit from wearing a
brace.
- Surgery. Few children need osteotomy
surgery to correct a deformed thighbone or hip socket. This procedure
repositions the thighbone, usually after cleaning the socket of fat deposits.
If needed, surgery may include reshaping the socket or thighbone. After
surgery, your child probably will need to wear a spica cast to position the hip
joint until it completely heals.
- Physical therapy. An older child may need
to do physical therapy exercises to restore movement of the
legs and strengthen muscles after being in a spica cast.
- Traction. A very rarely used treatment for DDH,
traction involves weights, pulleys, and ropes to gradually stretch and loosen
the hip joint's muscles and tissues while holding the bones in their correct
position. This allows doctors to place the ball at the top of the thighbone
(femoral head) back into the hip socket. Traction may also help prevent
problems with the blood supply to the joint. Typically, traction takes about 2
to 4 weeks. The treatment can be set up in a hospital or at home. Afterward,
your child will probably wear a spica cast.
What to think about
If your child has had
successful treatment for DDH, he or she will likely not have any further hip
problems. But have your child examined regularly to make sure his or her hips
continue to grow and develop normally.
The longer an unstable,
dislocatable, or dislocated hip persists, the more likely it is to cause
long-term problems that are hard to treat. For this reason, it is
important to diagnose and treat DDH early.
Follow-up medical
checkups are very important for monitoring the effectiveness of treatment and
preventing complications. For example, damage sometimes occurs to the blood
supply of the femoral head from treatment. If not detected and treated early,
this damage can lead to the destruction of bone cells (avascular
osteonecrosis). The bone may then grow abnormally, become deformed, and later
develop
osteoarthritis.
Home Treatment
Basic home treatment for
developmental dysplasia of the hip (DDH) focuses on
interacting with your child and keeping him or her comfortable.
If your baby or child is wearing a harness, brace, or cast:
- Talk to your doctor about how to care for the
device.
- Check your child's skin around the edges of the device for
red areas or blisters. If you find any, contact your doctor for treatment.
- Don't put anything inside the device that might scratch or
irritate your child's skin. Infection could occur. Also, don't apply
ointments or creams to your child's skin without checking with your doctor
first.
- Play with and hold your child as usual. In most cases, you
should be able to interact with your child normally. You will have to adjust
some activities, but keeping him or her stimulated and engaged is important.
Simple measures, such as moving your child around to different places in your
home throughout the day, can help. Also, keep a variety of toys within his or
her reach.
- Take your child for short trips outside the home. He or
she can still be safely placed in a carrier, stroller, or car seat. Depending
on your child's leg positions, he or she may need a specially designed car
seat. Ask your doctor about where to buy or rent one. Usually they are
available through hospitals or medical supply stores.
Other home treatment depends on the precise medical
intervention used.
Pavlik harness care
Do not remove the
harness and do not adjust the straps for the first 3
to 4 weeks of treatment unless your doctor tells you to. The harness holds the
joint in the correct position for normal development. Removing the harness may
cause the thighbone to move out of position.
Give your child a
sponge bath while he or she is in the harness. Later in your child's treatment,
the harness may be removed for short periods of time, such as for bathing or
for cleaning the harness.
You can put your child's clothing on
under the straps to prevent skin irritation. You can also pad the shoulder
straps if needed.
Spica cast care
If your child's cast is made of
plaster, it may need time to dry after it is first put on. Your child will
likely be in a semi-sitting position and may need you to help him or her move.
Turn your child at least every 2 hours for the first 24 to 48 hours to prevent
uneven drying of the cast. You can use a fan to help the cast dry more quickly,
but don't use heat. When you tap the cast and hear a hollow sound, it is
dry.
While your child is in a
spica cast:
- Tuck your child's diaper inside the cast
beginning at the child's rear and moving toward the front. Use a smaller size
than you normally would, and use only disposable diapers. Cut the adhesive tabs
off the diaper so that they won't irritate your child's skin. Change the diaper
as soon as possible after your child urinates or has a bowel movement. At
night, add an extra smaller diaper, sanitary napkin, or adult incontinence pad
inside the diaper.
- Place your child's clothing over the cast to
prevent food or small toys from getting inside the cast.
- Don't move
or lift your child by the bar between the legs.
- Give your child a daily sponge bath. Take care not to get the
cast wet.
Traction care
- Make sure the weights are hanging
freely.
- Check underneath your child for small toys or bits of food.
These can irritate his or her skin.
- Bathe your child once a
day.
- Find activities your child can safely do. For example, read to
your child or play games if your child is old enough. If your child is still a
baby, you can help keep him or her calm and distracted during traction. Try
talking, reading, and singing to keep the baby's attention. Touching and
stroking your baby will also help.
Parental feelings and concerns
DDH is a growth and development problem that is beyond your control. Remind yourself that you
did not do anything to cause this condition. Know that it takes time to manage
the frequently shifting emotions that are common when your child is diagnosed
with DDH. Find a doctor with whom you feel comfortable talking about any
concerns you may have.
Caring for a child who has DDH can be
stressful. Take time to care for yourself to reduce stress and to stay healthy.
When you have the energy to function well, you are able to provide the best
care for your child. For more information, see the topic
Stress Management.
Other Places To Get Help
Organizations
|
HealthyChildren.org |
| 141 Northwest Point Boulevard |
| Elk Grove Village, IL 60007 |
| Phone: |
(847) 434-4000 |
| Web Address: | www.healthychildren.org |
| |
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more. |
|
| American Academy of Family
Physicians |
| P.O. Box 11210 |
| Shawnee Mission, KS 66207-1210 |
| Web Address: | www.familydoctor.org |
| |
The American Academy of Family Physicians offers information on adult and child health conditions and healthy living. Its Web site has topics on medicines, doctor visits, physical and mental health issues, parenting, and more. |
|
| American Academy of Orthopaedic Surgeons
(AAOS) |
| 6300 North River Road |
| Rosemont, IL 60018-4262 |
| Phone: | 1-800-346-AAOS (1-800-346-2267)
(847) 823-7186 |
| Fax: | (847) 823-8125 |
| Email: | orthoinfo@aaos.org |
| Web Address: | www.orthoinfo.aaos.org |
| |
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise. |
|
| KidsHealth for Parents, Children, and
Teens |
| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Fax: | (904) 697-4220 |
| Web Address: | www.kidshealth.org |
| |
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest. |
|
References
Other Works Consulted
- American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Developmental dysplasia of the hip. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 1050–1055. Rosemont, IL: American Academy of Orthopaedic Surgeons.
- Delahay JN, Lauerman WC (2010). Children’s orthopedics. In SM Wiesel, JN Delahay, eds., Essentials of Orthopedic Surgery, 4th ed., pp. 173–251. New York: Springer.
- Podeszwa DA (2011). Developmental dysplasia of the hip. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 852–856. New York: McGraw-Hill.
- Polousky JD (2011). Developmental dysplasia of the hip joint section of Orthopedics. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 779–780. New York: McGraw-Hill.
- Sankar WN, et al. (2011). The hip. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2355–2365. Philadelphia: Saunders.
- Shah SA, Stankovits LM (2006). Developmental dysplasia
of the hip section of The hip. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1018–1021. Philadelphia: Saunders
Elsevier.
- U.S. Preventive Services Task Force (2006). Screening for developmental dysplasia of the hip. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspshipd.htm.
- White KK, Goldberg MJ (2012). Common neonatal orthopedic ailments. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 1351–1361. Philadelphia: Elsevier Saunders.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Susan C. Kim, MD - Pediatrics |
|---|
| Specialist Medical Reviewer | John Pope, MD - Pediatrics |
|---|
| Last Revised | March 12, 2012 |
|---|