Developmental Dysplasia of the Hip (DDH)

Developmental Dysplasia of the Hip (DDH)

DDH is a spectrum of disorders in the hip of infants ranging from slight displacement to dislocation. Newborns are often screened for this during baby checks but it is not always easy to establish when the baby is very young. Infants who are deemed to have unstable hips are referred to the paediatric orthopaedic surgeon where, after a history and examination, an ultrasound scan may be requested to ensure the hip is in the normal place. If the hip is deemed to be abnormal then treatment is initiated in a Pavlik harness which is worn 24 hours a day until the hip is stable (typically 4 to 6 weeks).

Developmental Dysplasia of the Hip (DDH) Image courtesy of Texas Children’s Hospital

A different kind of brace, a rhino cruiser, is then used first for 23 hours a day and then weaned to nap and night times until the hips are normal (serial X-rays will be taken).

Rhino cruiser brace

Rhino cruiser brace Image courtesy of The Mighty

The child is then followed up until skeletal maturity to ensure normal hip development. If picked up late, a cast (hip spica) is required to keep the hip in joint. If the hip dysplasia is noticed after 6 months of age, an operation often has to be performed to remove soft tissue obstacles to concentric hip reduction, and then the hip is kept in a cast. In some cases, the child has been walking on a dislocated hip for a long time and in these cases more extensive surgery is required to shorten the thigh bone so that the hip can fit back in the socket. With this an operation to improve the shape of the socket is normally undertaken at the same time. Failure to ensure good hip function in childhood often leads to hip wear and tear in middle age or sooner.