What is developmental dysplasia of the hip (DDH)?
Developmental dysplasia of the hip (DDH or hip dysplasia) is a relatively common condition in the developing hip joint. It occurs once in every 1,000 live births. The hip joint is made up of a ball (femur) and socket (acetabulum) joint. In DDH, this joint may be unstable with the ball slipping in and out of the socket.
In addition, the socket is often shallow which can increase a person’s risk of developing arthritis and joint pain later in life. Hip dysplasia has wide spectrum of severity ranging from a mildly shallow hip socket to a completely dislocated hip.
The greatest incidence of DDH occurs in first-born females with a history of a close relative with the condition and/or history of breech position in utero.
Why Choose Us?
The Hip Disorders Program at Children's Hospital of Philadelphia specializes in diagnosis, treatment, and long-term follow-up for infants, children, teens and young adults with congenital, developmental and post-traumatic hip disorders.
Treatment for developmental dysplasia of the hip
Specific treatment for DDH will be determined by your baby's physician based on:
- Your baby's gestational age, overall health, and medical history
- The severity of the condition
- Your baby's tolerance for specific medications, procedures or therapies
- Your opinion or preference
The goal of treatment is to put the femoral head back into the socket of the hip and to deepen the socket so that the hip can develop normally. Treatment options vary for babies and may include:
The Pavlik harness is used on babies up to 6 months of age to guide the hip into place, while allowing the legs to move a little. The harness is put on by your baby's physician and is usually worn full time for several weeks, then part time for an additional number of weeks.
Your baby is seen frequently during this time so that the harness may be checked for proper fit and to examine the hip. During the course of treatment, ultrasound (or X-ray) will be used to check hip placement and the development of the socket.
Most hips in infants can be successfully treated with the Pavlik harness, but sometimes, they may continue to be partially or completely dislocated.
If the hip continues to be partially or completely dislocated, the second line of treatment is an abduction brace, which is more rigid and can be used beyond 6 months of age in older and bigger infants.
These braces generally allow less motion than a Pavlik harness, but can be quite successful for those infants in whom the Pavlik does not work.
Body casting (spica casting)
If the harness and/or brace are not successful, a procedure under anesthesia may be required to put the hip back into place manually, also known as a closed reduction. If successful, a custom molded body cast (called a spica cast) is put on the baby to hold the hip in place. The hip spica cast is usually applied from the chest down to the ankle of the affected side and usually includes part of the opposite leg as well.
The spica cast is worn for approximately three to six months. The cast is changed from time to time to accommodate the baby's growth and for hygiene reasons. Following casting, a brace and/or physical therapy may be necessary to promote deepening of the hip socket and strengthen the muscles.
If a closed reduction is not successful, the next line of treatment is surgery in the form of an open reduction, to reposition the ball within the socket.
This involves an incision, opening of the hip joint itself, and directly visualizing the ball and socket. After open reduction, infants will require a spica cast but generally for less time than after a closed reduction.