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Developmental Dysplasia of the Hip (DDH)
As one of the nation’s Best Children’s Hospitals in pediatric orthopedics, Gillette Children’s Specialty Healthcare has one of the country’s largest groups of pediatric orthopedic specialists. We provide comprehensive diagnoses and treatments for developmental dysplasia of the hip (DDH) in infants and children. Our in-depth knowledge, offered in a family-centered environment, helps patients attain full use of their hips.
Why Choose Gillette?
- Gillette is one of the nation’s Best Children’s Hospitals in pediatric orthopedics.
- Our skilled surgeons and nurse practitioners are experts in diagnosing and treating DDH.
- Our coordinated approach often lets patients see a team of specialists during a single visit at one location.
- Our goal is to help patients resolve their hip issues early—and, when possible, without surgery—so they can participate in a full, active life.
- We believe that clinical research and outcomes-based medicine promote the highest standards of care.
Definition and Types
Developmental dysplasia of the hip (DDH) occurs when the hip is out of joint (dislocated) or isn’t stable in the joint at birth. The hip might be misshapen at the top of the femur (upper leg bone) or in the hip socket (part of the pelvis). The malformed hip typically doesn’t work properly, and it will worsen without correction.
There are four types of hip dysplasia:
- Acetabular dysplasia: The ball remains in the socket, but the socket is too shallow to keep the ball in place.
- Subluxable: The ball is located normally in the socket, but in certain positions (when pushing on the hip), the ball can be pushed partially out of the socket.
- Subluxed: In resting position, the ball is not located normally in the socket. Instead, it rests partway out of the socket.
- Dislocatable: The hip rests in the normal position, but it can be dislocated easily.
- Dislocated: The hip is completely out of the socket when the child is at rest.
Causes and Risk Factors
The hip is a ball and socket joint. If the ball isn’t in the socket, the hip doesn’t develop normally. DDH seems to run in families. In addition, being in the breech position in utero sometimes puts stress on the baby’s hip and thigh muscles, causing a hip to move out of joint.
DDH occurs in approximately one in 1,000 births. Risk factors include:
- A family history of DDH
- Being female
- Being in a breech position during pregnancy
- Being part of a multiple gestation pregnancy (twins, triplets)
- Being the firstborn child
- Environmental factors, such as poor nutrition and certain positioning (some forms of swaddling)
Symptoms and Effects
The earlier providers discover and treat DDH, the greater are the child’s chances for a successful correction. DDH might prevent or delay milestones, such as sitting and crawling. If left untreated, DDH can lead to gait (walking) abnormalities, a limb-length difference, early arthritis or hip pain.
Although health care providers might have difficulty detecting DDH, especially in newborn babies, they will continue looking for signs of DDH during a baby’s routine medical checkups. If they detect possible DDH, they’ll perform one of these imaging tests on the child’s hips:
- Ultrasound (for children younger than 6 months)
- X-ray (for children older than 6 months)
Our orthopedic team uses several types of treatments to correct DDH. The most common involve a harness, traction, surgery, casts or braces. If children have a more complicated condition, we might suggest other treatments.
We evaluate the hip using ultrasound to determine progress during the first two months of treatment. In addition, we use periodic X-rays.
- Harness: For babies who cannot yet walk, we often prescribe a special harness that holds the hip in place until the baby’s muscles and ligaments can do so. Initially, the baby wears the harness full-time. Once the hip becomes more stable, the baby might gradually spend less time in the harness. Older children use a Hewson abduction orthosis to hold the hip in place.
- Traction: We sometimes use traction for babies when a harness has not been successful. Toddlers and older children also might need traction. Traction moves the leg in line with the hip socket.
- Closed Reduction Procedure: In a closed reduction, an orthopedist moves the hip back into place by hand; there’s no need for surgery on the child’s hip bone. The child wears a cast after the procedure to hold the hip in place. Some children require traction or tendon surgery before a closed reduction. The orthopedist might do the procedure under general anesthesia.
- Open Reduction: In some cases, a pediatric orthopedic surgeon must perform open reduction surgery to return a dislocated joint to its proper place. We most often use the procedure on older children or on children whose hips don’t move back using a closed reduction.
- Tenotomy: Sometimes children require surgery to release a tight tendon. That operation is called a tenotomy. When needed, we usually do a tenotomy before a closed reduction or before fitting a harness on a baby.
- Osteotomy: Sometimes, we need to cut or realign the thigh or pelvic bone. That procedure is called an osteotomy.
- Casts and braces: Children who have closed or open reductions might need to wear a cast after the hip returns to its socket. While wearing a cast, children might need to be carried or use a wheelchair. Later, we replace the cast with a brace to prevent the hip from dislocating again. Children generally use the brace for six months to a year. Sometimes, a soft pillow improves positioning while the child is sitting or sleeping.
Gillette’s team approach to care helps us identify DDH early and manage it properly. Because we offer access to a variety of experts, we make it easier for patients, families and providers to select the best treatments for each situation.
Gillette employs specialists in many fields. Specialties and services most often involved in DDH include:
Gillette patients also can receive services for conditions associated with DDH, such as clubfoot, gait abnormalities, a limb length difference, early arthritis or hip pain. Our goal is to help our patients achieve their highest possible levels of health, independence and happiness.
For more of our comprehensive services at Gillette, search Conditions and Care.