Developmental Dysplasia of the Hip
(DDH; Congenital Dysplasia/Dislocation of the Hip [CDH]; Congenital Dysplasia of the Hip; Congenital Dislocation of the Hip; Congenital Subluxability of the Hip; Congenital Hip Dysplasia; Congenital Hip Dislocation; Congenital Hip Subluxability; Dysplasia of the Hip, Developmental)
Developmental dysplasia of the hip (DDH) is a problem with how a child's thigh bone fits into the cup-shaped area on the pelvis. Problems may include:
- The ball of the thigh is loose inside the cup of the pelvis, making the hip unstable
- The ball moves easily out of the cup, causing the hip to dislocate
- The ball and cup do not meet
- The cup is not shaped correctly
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DDH is caused by how the baby is positioned in the womb.
This problem is more common in newborns. It is also more common in girls. Things that may raise the risk are:
- Breech birth (feet first)
- Low levels of amniotic fluid during pregnancy
- Using incorrect swaddling positions
- A family history of DDH
DDH can make the hip unstable and loose. The problem is more common in the left hip, but both hip joints can also be affected. Symptoms may depend on the age of the child. Problems may be:
- Uneven folds in a newborn's thigh or hip
- Problems with motion and flexibility around the time a baby learns to crawl
- One leg that is shorter than the other
- Limping, lurching, walking on toes, or other unevenness when a child walks
DDH may be found when a baby is born or during a physical exam. The exam will focus on the child's hips.
Pictures of the hips may be taken. This can be done with:
The goal of treatment is for the hip to be in the correct position. How it is done depends on the child's age. Options are:
- Watchful waiting of newborns to see if the problem gets better
- A harness to keep a newborn or baby's hip in place
- Adjusting the hip bones and applying a lower body cast
- Hip surgery and a lower body cast
Avoiding tight swaddling positions may lower the risk in some children.
- Bittersohl B, Hosalkar HS, et al. Surgical treatment of hip dysplasia in children and adolescents. Orthop Clin North Am. 2012 Jul;43(3):301-315.
- de Witte PB, van Bergen CJA, et al. Treatment of decentered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 2, EFORT Open Reviews 2022; 7(8):542-553.
- Developmental dysplasia of the hip. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/developmental-dysplasia-of-the-hip.
- Developmental dysplasia of the hip. Ortho Info—American Academy of Orthopedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/developmental-dislocation-dysplasia-of-the-hip-ddh.
- Pavone V, de Cristo C, et al. Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review. Children. 2021; 8(2):104. https://doi.org/10.3390/children8020104.
- van Bergen CJA, de Witte PB, et al. Treatment of centered developmental dysplasia of the hip under the age of 1 year: an evidence-based clinical practice guideline - Part 1, EFORT Open Reviews 2022; 7(7): 498-505.
- Laura Lei-Rivera, PT, DPT
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