One of the most important aspects of well child physical exam screening in infants involves evaluating your baby’s musculoskeletal system. Among these screenings, checking for Developmental Dysplasia of the Hip (DDH) is a top priority. While the name may sound complex, understanding what it is and why we check for it can help ease any concerns you may have during your child’s early months.  Developmental dysplasia of the hip is the most common musculoskeletal condition in infants.  It occurs in approximately 4–23 per 1,000 live births, though complete dislocation is rarer at roughly 1 per 1,000. 

What is Developmental Dysplasia of the Hip (DDH)?

Developmental Dysplasia of the Hip (DDH) is a condition where the “ball and socket” joint of the hip does not form properly. In a healthy hip, the head of the femur (thigh bone) fits snugly into the acetabulum (hip socket). In cases of DDH, the socket may be too shallow, or the ligaments holding the joint together may be too loose, allowing the ball to slide partially or completely out of place.

What Causes Developmental Dysplasia of the Hip?

DDH results from improper alignment or abnormal growth of the femoral head and acetabulum, influenced by both genetic and environmental factors. 

 Significant risk factors include:

• Breech presentation in the third trimester (may be the single most important risk factor, with DDH reported in 2–27% of breech-presenting infants) 
• Female sex (more common in girls)
• First-degree family history of DDH
• Other associations: firstborn status, oligohydramnios, torticollis, and foot deformities 

Signs and Symptoms to Watch for at Home

In many cases, DDH does not cause pain in infants, which is why clinical screening is so vital. However, parents may occasionally notice the following signs:

• Uneven Skin Folds: The folds of skin under the buttocks or on the thighs may appear asymmetrical.
• Limited Range of Motion: You might notice that one leg doesn’t turn outward as far as the other during diaper changes.
• Leg Length Discrepancy: One leg may appear shorter than the other.
• Clicking or Clunking: During a physical exam, a pediatrician may feel or hear a “clunk” as the hip moves in or out of the socket.

How is Developmental Dysplasia of the Hip Diagnosed?

• Physical Exam

• • Ortolani maneuver (birth to 3 months): detects a dislocated hip by gently abducting the flexed hip while applying anterior pressure on the greater trochanter — a positive result is a palpable “clunk” as the femoral head reduces into the acetabulum.
  • Barlow maneuver (birth to 3 months): detects an unstable/dislocatable hip by applying posterior pressure. Together, these maneuvers have a sensitivity of 46–66% and specificity of 99%. 
  • Limited hip abduction and leg length discrepancy become more useful signs after 3 months of age. 
• Imaging

• • Ultrasonography is the preferred modality for infants younger than 4–6 months (the femoral head is not yet ossified). 
  • Plain radiography is preferred after 4 months of age once ossification allows visualization. 

How is Developmental Dysplasia of the Hip Treated?

If your primary care provider diagnoses developmental dysplasia of the hip, your child will be referred to a pediatric orthopedic physician.  The treatment depends on your child’s age at the time of diagnosis and also on the severity of they dysplasia: 

• Under 6 months: Abduction bracing (most commonly the Pavlik harness) is first-line, with success rates of approximately 90% when treatment begins before 3 months of age. Risks of the Pavlik harness include avascular necrosis of the femoral head, femoral nerve palsy, and inferior dislocation; treatment should be discontinued after 3 weeks if the hip does not reduce. 

• 6–18 months: Closed reduction under anesthesia with spica casting may be required if bracing fails or diagnosis is delayed. 

• Older children: Open reduction with possible femoral and/or pelvic osteotomies may be necessary. 

Long-Term Significance

Delayed diagnosis carries significant consequences. Developmental dysplasia of the hip is the most common cause of hip arthritis in women younger than 40 years and accounts for approximately 10% of all hip replacements and up to 33% of hip replacements in patients younger than 60. 

Children with DDH may require follow-up until skeletal maturity to detect residual dysplasia that could predispose to early degenerative joint disease.

Moving Forward

Receiving a diagnosis of DDH can be overwhelming, but it is important to remember that with early intervention, the vast majority of children go on to have normal hip function and lead active, healthy lives.  If you are concerned that your child has developmental dysplasia of the hip, please contact your primary care physician or the physicians at Show-Me State Pediatrics.

Questions

1. Have you ever noticed anything about your baby’s hips or leg movement that made you pause or wonder if it was normal? What did you do next?
2. If your pediatrician mentioned a hip check or screening, what questions came to mind right away?
3. For parents who’ve been through this—what advice would you share with someone hearing about hip dysplasia for the first time?

Medical Disclaimer

This blog is for informational purposes only and is not professional medical advice, diagnosis, treatment, or care, nor is it intended to be a substitute, therefore. Always seek the advice of your physician or other qualified health provider properly licensed to practice medicine or general healthcare in your jurisdiction concerning any questions you may have regarding any information obtained from this website and any medical condition you believe may be relevant to you or to someone else. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Information obtained on the website is not exhaustive and does not cover all diseases, ailments, physical conditions, or their treatment.