Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) can develop during a child’s first year of life in addition to being present at birth. The hip joint is a “ball and socket” joint. The “ball” is the top end of the femur, which is called the head of the femur. The “socket” is the acetabulum, which is part of the pelvis. The head of the femur (ball) should fit firmly in the acetabulum (socket). In DDH, the socket is shallow and the ball cannot fit tightly into the socket. Because the ball cannot fit tightly, the hip can be described as loose or having instability. The amount of looseness can vary.

There are three types of developmental dysplasia of the hip:

Subluxatable. This is when the head of the femur (ball) is loose in the socket. The ball can be moved within the socket during a physical exam but will not dislocate.
Dislocatable. This is when the head of the femur is in the socket but will dislocate out of the socket during a physical exam.
Dislocated. This is a severe form of DDH in which the head of the femur is out of the socket.

Certain factors may increase a child's risk of developmental dysplasia of the hip, including:

Being female
Being a first-born child
Being born in the breech position
Having a family history of DDH
Having low levels of amniotic fluid (the fluid that surrounds a fetus in the womb)

Diagnosis of Developmental Dysplasia of the Hip

A doctor can diagnose DDH by doing a physical exam. Doctors at Riley at IU Health look for:

One leg that is longer than the other
Uneven skin folds of the thigh (in babies)
Less motion of the hip joint on one side
Waddling, toe walking or limping

The doctor will also move both hips in different directions to see if he or she can feel the ball move in or out of the socket. If your child is younger than 3 or 4 months old, an ultrasound may be recommended to see the position of the ball within the socket. If your child is older than 3 or 4 months old, X-ray may be used.

Treatments

Your child's doctor may use a Pavlik harness to treat developmental dysplasia of the hip, depending on your baby’s age at the time of diagnosis. A Pavlik harness is a special brace that is made out of soft materials. The purpose of the harness is to keep the ball in the socket and help with hip socket formation. The Pavlik harness has a unique design: It allows for diaper changes without having to take the entire harness off.

Instructions for using a Pavlik harness include:

Your baby should wear the harness 23 hours a day. The harness should be worn at all times except during bath time and diaper changes.
The shoulder and leg straps are marked to put the hips in proper placement. Trace over the markings if they become hard to see.
If the harness becomes soiled, wash it by hand in gentle detergent or spot clean it using a stain-removal cloth or pen. Allow the harness to air dry.
Please do not swaddle your baby. The harness works when the hips are kept away from the body (abduction).
If you are nursing, make sure you keep your baby’s hips away from the body. Use pillows to help you. Try the “football” position.
It is OK for your baby to do “tummy time” in the harness.
Make sure your baby is moving his or her legs (straightening out at the knees) when out of the harness for bath time. Call your child's doctor if your baby is not straightening out his or her legs.

Sometimes Pavlik harness treatment is not effective, or the child is too old for Pavlik harness treatment. If this is true for your child, the doctor will talk to you about other treatment options.

Key Points to Remember

Developmental dysplasia of the hip (DDH) can develop during a child’s first year of life in addition to being present at birth.
There are three types of DDH: subluxatable, dislocatable and dislocated.
Certain factors may increase a child's risk of DDH, including being female, being a first-born child, being born in the breech position, having a family history of DDH and having low levels of amniotic fluid in the womb.
Your child's doctor may use a Pavlik harness to treat the condition. A Pavlik harness is a special brace that keeps the ball in the socket and helps with hip socket formation.

Support Services & Resources

Visit the trusted websites below to learn more about developmental dysplasia of the hip.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

OrthoInfo

The American Academy of Orthopaedic Surgeons provides in-depth information about DDH on its educational website, OrthoInfo.org.

Departments Treating This Condition

Orthopedics & Sports Medicine