Developmental dysplasia of the hip

Royal Childrens Hospital, 2011Royal Childrens Hospital

Developmental dysplasia of the hip (DDH) occurs in babies and young children. It results in abnormal development of the hip, as the femur head and hip socket are not correctly aligned (the hip socket can be shallow, resulting in the head being unstable). Consequently, patients with developmental dysplasia of the hip are at higher risk of hip dislocation. Developmental dysplasia of the hip is not a painful condition; however, early diagnosis is best as later diagnosis has a higher likelihood of requiring surgical management, and increases the chance of ongoing hip problems (eg early hip osteoarthritis). Common risk factors are female gender, a family history of developmental dysplasia of the hip, a first or twin pregnancy, and a breech presentation.

Developmental dysplasia of the hip is difficult to diagnose as signs can be subtle; they include uneven position of the legs, one leg appearing shorter than the other, stiffness of the hip, and uneven thigh or buttock creases.

Clinicians should be alert to the signs of developmental dysplasia of the hip at birth and look for them in young children. If developmental dysplasia of the hip is suspected, a hip ultrasound is recommended if the child is under 6 months old. Hip X-ray is recommended in children after 6 months of age. For further advice on screening and referral, see The Royal Children’s Hospital Guideline on Developmental dysplasia of the hip.

Management of developmental dysplasia of the hip depends on the age of the child and the severity of the condition. Abduction braces are a common treatment in young babies; they hold the legs apart, which helps the hip socket to deepen, increasing stability with growth.