What Is Developmental Dysplasia of the Hip?
Developmental dysplasia of the hip (DDH) is an abnormal hip socket formation that predisposes the ball of the thighbone to slip in and out of the socket. It occurs at birth or early childhood, but it can persist through adolescence (adolescent hip dysplasia) if the diagnosis is not treated or if the child's symptoms go unnoticed.
DDH is a condition with a wide spectrum, from a hip socket that appears to be abnormal without the ball slipping out to a hip socket where the ball of the thighbone is dislocated. It's important to treat DDH early to prevent hip problems later in life.
What Causes DDH?
The cause of DDH is unknown, but it is commonly seen in first-born babies, especially Caucasian or Native American girls who are born breech, or feet first.
How Is DDH Found?
The condition can be found by checking a baby's hips and, if suspected, performing an ultrasound of the hip. Your baby's doctor should look for:
A hip click or clunk
Limited hip movement
A difference in leg lengths
Increased skin folds on thighs
How Is DDH Treated?
DDH treatment depends on the child's age and results of the hip exam and ultrasound or X-ray. Observation may be needed, and treatment options may include harnessing, traction and/or surgery.
Observation: The doctor may want to watch the child's hips closely. Sometimes babies' hips are loose at birth, and they may tighten on their own after a few weeks.
Harnessing: For babies less than 6 months old, the doctor may recommend a soft, fabric brace called a Pavlik harness. The Pavlik harness keeps the hips in a “frog-leg” position, holding the ball of the thighbone in the socket. The harness is usually worn for 23 to 24 hours per day for a few weeks. The doctor will then determine how often
it needs to be worn for the next 6 to12 weeks. No further treatment is needed in
95 percent of babies treated with a Pavlik harness.
Closed Reduction Under Anesthesia: If the Pavlik harness is not keeping the baby's hips in place, the doctor may place the baby in light traction to loosen the muscles around the hip joint before surgery. Bryant's traction uses soft wraps around the legs attached to weights. The baby will stay in traction for two to three weeks before surgery. Following this, the doctor attempts to place the hip into the socket while the child is under anesthesia. If successful, the baby is placed in a hip spica cast for up to three months.
Surgery: Surgery may be necessary if closed reduction doesn't completely correct the problem or if the child is significantly older (adolescent hip dysplasia.) The baby may need surgery to place the ball of the thighbone into the socket. After surgery, the baby will be placed in a spica cast for about eight weeks. Your nurse will teach you how to take care of your baby while he or she is in a cast.