For parents, a diagnosis of Developmental Dysplasia of the Hip (DDH) brings a wide range of emotions and responses. Parents want to understand not only the condition, but what the future holds for their child after diagnosis. As an orthopedic specialist, sharing a diagnosis with parents sparks many questions. Luckily, we can offer answers.
What is DDH?
DDH is a health problem that occurs when a child’s hip joint hasn’t formed normally. Similar to a car’s tires wearing out faster when they are out of alignment, DDH prevents the hip joint from functioning properly causing the joint to wear out faster than normal.
In a normal hip joint, the head of the femur fits snugly into the hip socket. For a child with DDH, the hip socket is shallow, allowing the head to slip in and out, moving partly or completely out of socket.
What causes DDH? Is my child at risk?
Each year, approximately one in six newborns will have some type of hip instability and two to three out of every 1,000 infants will require treatment. Several mechanical, hormonal, genetic and environmental factors can lead to DDH. Firstborn females carry the highest risk for DDH as the uterus is typically smaller with firstborns, resulting in limited room for movement. A breech delivery or a baby’s response to the mother’s hormones during pregnancy may play a role in DDH. After birth, DDH can occur if an infant is held with extended and adducted hips while swaddled.
Present at birth, DDH is more common in girls than boys. While this condition is often detected early on, as a child grows, hip pain may not be felt until later stages of development.
What are the symptoms of DDH?
Symptoms present differently from child to child. However, common symptoms of DDH include the leg on the side of the dislocated hip appearing shorter or turning outward, uneven folds in the skin of the thigh or buttocks and the space between the legs seeming wider than normal.
Many symptoms of DDH are symptoms similar to other hip problems. Always consult with your child’s physician for proper diagnosis.
How is it diagnosed?
For many children, DDH is detected by routine history and physical examination during the neonatal period. Newborns are screened for hip problems before going home, but sometimes DDH is not discovered until later.
Clinical screening is crucial for diagnosis with hip exams carried out at birth and subsequent visits throughout childhood. During exams, your child’s pediatrician will ask questions regarding risk factors such as birth history and family history of DDH. In addition, several tests many be administered like the Ortolani test, Barlow maneuver-rays and ultrasounds.
If my child is diagnosed, what does the future hold?
If DDH is detected, your child will be referred to a pediatric orthopedist for treatment. As DDH presents differently for every child, treatment looks different as well. Stable hips that become normal do not need treatment. However, close follow-up and routine exams are required through the child’s development. If unstable, your orthopedist can offer treatment options with the goal of putting and keeping the head of the femur back into the hip socket so that the hip can develop. Treatment may include a special device or Pavlik harness to the hold the hip in place or casting. Some babies may need surgery to realign the hip.
Why screening is important?
Early diagnosis and treatment for DDH is crucial to a child’s development down the road. Many children treated within the first six months recover and develop normally with no long-term problems. However, the older the child or less successful the repositioning, the greater the possibility is for future problems including early onset degenerative hip disease, arthritis and pain in older patients if treatment is foregone.
To learn more about the Hip Program at Nationwide Children's Hospital, click here.