Developmental Dysplasia of the Hip

What is developmental dysplasia of the hip?

Developmental dysplasia of the hip (DDH) is the name for a wide variety of problems in the formation of children’s hips. Some of these problems are present at birth (congenital). Others develop as your child grows.

In general, DDH makes it more likely that your child’s leg bones can come out of the hip joint (dislocation).

DDH can range from mild to serious. In some cases, DDH means the child has shallow hip sockets that make dislocation more likely. Other children are born with leg bones that are already out of the socket.

While we can treat most children who have DDH successfully, it is important to find the problem and start treatment quickly. Children who do not get help can develop a limp and a serious case of arthritis as adults.

Developmental dysplasia of the hip in children

About 1 in every 1,000 children in the United States has some form of developmental dysplasia of the hip. The great majority of them are girls. Babies who are born bottom first (breech) are more likely to have DDH.

Children with family members who have DDH are more likely to have the problem.

Developmental Dysplasia of the Hip at Seattle Children’s

Our doctors are known nationally for their skill in treating developmental dysplasia of the hip. We have an experienced ultrasound unit that produces high-quality images to help your child’s doctor choose the right treatment.

We have years of experience making custom braces and splints to help correct hip problems. Read about braces and splints and our other orthotics and prosthetics services.

  • To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like physical therapy and braces), recommending surgery only when we believe it will give your child the best results. Many of our pediatric orthopedic surgeons have expanded fellowship training.

    We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

  • We see your child as a whole person. Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. Here, your child’s team has special training in the medical, surgical, emotional and social needs of young people.

Symptoms of Developmental Dysplasia of the Hip

You usually see no symptoms of developmental dysplasia of the hips in your baby. But some that can show up include: 

  • Legs held in positions that don’t match
  • Uneven folds of fat on the thighs
  • Less movement on the side affected by DDH
  • After about 3 months of age, 1 leg is shorter than the other

Diagnosing Developmental Dysplasia of the Hip

When your baby is born, the doctor will examine both hips to make sure they are stable. The doctor will gently move your baby’s legs to look for signs that the bones can come out of the sockets.

Babies change as they grow, so doctors will examine your child several times as they get older, often at regular well-baby exams.

If your child’s doctor thinks your baby might be inclined to have DDH and your baby is younger than 4 months, we may ask for an ultrasound image to be taken of the hips. If your child is older than 4 months, we may take X-rays.

Treating Developmental Dysplasia of the Hip

It is important to find developmental dysplasia of the hip early to treat it successfully. In the first few months of life, babies often can wear a type of harness to fix the problem. But babies older than 6 months often need surgery, and those who are older than 1 year almost always need surgery.

Treatment depends on how old your child is when DDH is found. All types of treatment have 1 goal: putting the hip joint back in place and keeping it there. This kind of treatment is called reduction, and there are several methods.

  • The youngest babies may wear a Pavlik harness. This is a soft harness that flexes and pulls the baby’s legs away from their middle while allowing the baby to move their legs. The harness keeps the ball (femoral head) at the top of the thighbone positioned deeply in the socket.

    This is the simplest form of reduction treatment and works 80% of the time. It allows the baby to exercise their legs while redirecting the thighbone into the hip socket.

    If a Pavlik harness is not successful, after a month or so we may transition to try a different type of brace. Fixed abduction braces like the Rhino Cruiser or Ilfeld brace are more rigid, and hold the hips in a safe position that directs the top of the thighbone into the socket.

  • If the Pavlik harness is unsuccessful or if a child is older than 6 months, they may need a hip spica body cast or a special brace to hold the thighbone in the hip socket.

    Doctors either manipulate your child’s joint with a cast or brace (closed reduction) or operate to put the thighbone in the socket (open reduction).

    Open reduction is necessary when a closed reduction is not successful. During the procedure, the doctor opens the hip and puts the ball directly into the hip socket, releasing soft tissues that are blocking the hip from going on.

    In some children, the hip tendon (adductor tendon) also is tight and must be released. Doctors do this by making a small cut through the skin to release the tendon.

  • Older children usually need surgery to redirect or reshape the bones of the hip, the pelvis or the thighbone so their hips will stay in proper alignment.

    After surgery, your child will wear a special body cast, called a spica cast (PDF), on their hips and legs. The length of time in the cast is variable, but generally ranges from 6-12 weeks. In some circumstances, the surgeon may recommend changing the cast to allow for growth and reassess the position of the hip.

    After the doctor removes the cast, your child will wear a brace to hold the hips in place until X-rays show that the hip socket is developing normally.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

Providers, see how to refer a patient or read the infant hip dysplasia algorithm (PDF).