Developmental Dysplasia of the Hip (DDH)

Developmental Dysplasia of the Hip (DDH) is a common condition within pediatric orthopedics.  Other synonyms include 'congenital dislocation of the hip' (CDH) and hip dysplasia.

The hip joint is a ball and socket joint.  Normally, the femoral head (ball) sits within the acetabulum (socket). However, for various reasons, the socket can often be under-developed.

Some of the time, babies can have immature hips with maternal hormones still their system.  This can result in laxity in the hips that resolves on its own in the first few weeks of life, without treatment.  Other babies have true hip dysplasia, which if left untreated can go on to a dislocated hip. Risk factors with hip dysplasia include: Female baby, first born child, twin births, breech, family history of hip dysplasia or other packaging problems during pregnancy. We use hip ultrasound during the first six months of life to assess for hip dysplasia.  After six months, there is too much bone present for ultrasound to be useful and so at that point we use X-ray as the choice imaging test.

In Canada we are blessed with an excellent system for screening babies and thus there are not nearly as many late presentations for dislocated hips as compared to other countries. However, it is still possible for this diagnosis to be delayed.  There can be a range of severity, from mild cases to true dislocations.

For children who have instability on physical exam, bracing is required for early treatment to get the ball in the socket, thereby encouraging remodelling and growth. Most hips respond to bracing however some hips that are very severe require surgical treatment, even if detected early.  Our goal is to get the hips in-joint as soon as possible, with the least number of complications.  We are hoping to prevent pain and early-onset arthritis in these patients.  

 

Helpful Resources

Royal Childrens Hospital Developmental Dysplasia Hip Parent Information Video

Royal Childrens Hospital - How to wrap/swaddle your infant while avoiding hip dysplasia Video

Royal Childrens Hospital DDH 

Hip Spica 

Hip Spica care at home Royal Childrens

Note that there are multiple closed Facebook groups that you can join that support families with this diagnosis.

 Both hips dislocated in a toddler who presented at age 2.5 years   

Both hips dislocated in a toddler who presented at age 2.5 years