Developmental Dysplasia Of The Hip
Developmental dysplasia of the hip (DDH), sometimes referred to as congenital dislocation of the hip, is a condition that affects many newborn babies, and refers to the fact that the hip may be dislocated completely, or otherwise prone to dislocation.
The hip joint is a ball and socket joint, where the rounded end or ‘ball’ of the femur sits deeply within the acetabulum or ‘socket’ of the pelvis. In most of us, this joint is very secure and held together strongly by ligaments, but in approximately 1 in 600 girls, and 1 in 3000 boys, the socket is too shallow to enclose the head of the femur, or the ligaments are too loose to hold the joint together. This results in either a completely dislocated hip, or a hip that can very easily be dislocated with movement. DDH may affect 1 or both hips.
DDH has many acknowledged causes, that may be the result of genetic predisposition or external/environmental factors:
- Family history of DDH
- Female babies
- Breech delivery, due to prolonged periods of extreme hip positioning
- First-born babies, due to longer labours and potential compromised uterine positioning
- Multiple births, due to uterine crowding
- Other congenital disorders eg spina bifida, cerebral palsy
DDH can go unnoticed, or it may be obvious from birth, which is why it is routinely tested at birth, and with subsequent paediatric and maternal and child health appointments. Symptoms include:
- A stiff or immobile hip joint
- Uneven leg lengths
- Uneven skin folds around the groin or buttocks
- Audible clunking when the hips are moved gently
- An out-turned leg
- Leaning to one side when standing (older babies and children)
- Waddling gait or tiptoe walking (older children)
Testing for DDH involves manual movement of the hip to check for both range and clunking or clicking, which indicates dislocation or relocation of the joint. To assess the severity of the dislocation or laxity, x-rays, CT or MRI scans may be performed.
Treatment of DDH is essential to ensure that as the baby grows and develops they are able to sit, crawl, walk etc without restriction or pain. If detected early, treatment can be very effective, and greatly reduces the risk of complications such as arthritis in later life.
The most common form of treatment is the use of a splint or harness, that a baby is required to wear for 6-12 weeks, often for 24 hours a day. The harness is designed to hold the hip in the optimal position as the skeleton grows and the ligaments strengthen.
If the harness is unsuccessful, or if DDH is only detected later on, repositioning and casting may be advised. In some cases, surgical intervention to repair the ligaments may be required to reposition the hip joint.
If you are concerned about your baby’s hip development, or are unsure if their hips have been assessed, it is important to seek medical advice. In most cases, routine checks are well performed and DDH is picked up early, which results in the best outcomes. And whilst the treatment methods such as harnesses may seem unpleasant or arduous for families to adhere to, they do not seem to cause any distress to the baby, and they are quickly forgotten!