Developmental hip dysplasia (DDH) is a condition where the hip joint, which is a ball and socket joint, develops abnormally. This condition was previously known as congenital hip dysplasia or congenital hip dislocation (CDH).
What is developmental dysplasia of the hip? DDH is a condition that is most often discovered whilst babies are still quite young. However, in some cases, it can develop after this time. Thus why it is known as developmental hip dysplasia.
In DDH the femoral head (ball on top of the thigh bone) is not stable within the acetabulum of the pelvis (the socket). This may be caused by the ligaments and joint capsule around the hip being loose. The good news is that DDH does not typically cause pain in babies.
DDH is a condition that is screened for very well in Australia. Your baby’s hips would have been checked in the hospital and by the maternal child health nurses at your baby’s postpartum appointments.
What are the signs of hip dysplasia in babies?
There are a number of factors that are looked at in regards to the likelihood of a baby needing further examinations for DDH. They include:
- Family history of hip dysplasia
- The baby is a twin or multiple
- The baby was in a breech position at birth
- Asymmetry of hip/thigh creases
- Restricted hip motion and asymmetry between hips. This can be picked up with a physical examination or parents may report feeling a difference in one leg’s movement when trying to change a nappy
- Presence of a click in the hips with a physical examination
- Female babies have a higher incidence of hip dysplasia
If there are any concerns about the existence of hip dysplasia, a referral for a hip ultrasound will be given. An ultrasound allows us to look at the coverage of the hip joint. If your baby is over 4-6 months of age, an x-ray will be performed.
In addition, there is a potential link with neck restriction (torticollis)  or fixed foot deformity and hip dysplasia . This may be as a result of the position the baby was in whilst in the uterus.
Hip dysplasia treatment
As hip dysplasia is well screened for, it means it is usually picked up and treated early. As a result, management and long term outcomes are relatively good. The goal of treatment is to ensure the correct positioning of the hip joint to allow for optimal stability.
The choice of treatment for DDH varies depending on the severity of the case. Treatment may include the use of a brace (such as a Pavlik harness or Denis Browne brace), a plaster cast (hip spica), or surgical intervention in more serious cases.
Tips for parents
- Aim to encourage optimal hip position as much as possible. Optimal hip position resembles a ‘frog leg’ or ‘M position’. This means that the hips are able to be in an up and out position. We want to avoid the legs being extended, completely straight, and stuck next to each other.
- With swaddling, ensure your baby has ample space around the hip and leg region. We want the baby to be able to bend the hips up and out. We do not want the hips to be swaddled tightly with the legs stuck next to each other.
- If ‘babywearing’ using a carrier or a sling, you must ensure the hips and legs are in an ‘M position’. The legs should be wrapped around the parent’s torso, with the knees flexed and slightly higher than the hip joint. We also need to ensure the thighs are supported by the carrier.
- Avoid baby seats, baby jumpers, or walkers that have narrow-based seats and don’t support the legs and hips.
The International Hip Dysplasia Institute is a brilliant resource for information regarding hip dysplasia. If you have any concerns regarding your baby’s hips please consult a health professional.
This blog post is an educational tool only. It is not a replacement for medical advice from a registered and qualified doctor or health professional.
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