Developmental Dysplasia of the Hip (DDH)
What is DDH?
Developmental dysplasia of the hip is a congenital (present at birth) condition of the hip joint. It happens once in every 1,000 live births. The hip joint is created as a ball and socket joint. In DDH, the hip socket may be shallow, letting the "ball" of the long leg bone, also known as the femoral head, slip in and out of the socket. The "ball" may move partially or completely out of the hip socket.
The greatest incidence of DDH happens in first-born females with a history of a close relative with the condition.
What causes DDH?
Hip dysplasia is considered a "multifactorial trait." Multifactorial inheritance means that many factors are involved in causing a birth defect. The factors are usually both genetic and environmental.
Often, one gender (either male or female) is affected more often than the other in multifactorial traits. There appears to be a different "threshold of expression," which means that one gender is more likely to show the problem than the other gender. For example, hip dysplasia is more common in females than males.
One of the environmental influences thought to contribute to hip dysplasia is the baby's response to the mother's hormones during pregnancy. A tight uterus that prevents fetal movement or a breech delivery may also cause hip dysplasia. The left hip is involved more often than the right due to intrauterine positioning.
What are the risk factors for DDH?
First-born babies are at higher risk since the uterus is small and there is limited room for the baby to move, therefore affecting the development of the hip. Other risk factors may include the following:
Family history of developmental dysplasia of the hip, or very flexible ligaments
Position of the baby in the uterus, especially with breech presentations
Associations with other orthopedic problems that include metatarsus adductus, clubfoot deformity, congenital conditions, and other syndromes
What are the symptoms of DDH?
The following are the most common symptoms of DDH. However, each baby may experience symptoms differently. Symptoms may include:
The leg may appear shorter on the side of the dislocated hip
The leg on the side of the dislocated hip may turn outward
The folds in the skin of the thigh or buttocks may appear uneven
The space between the legs may look wider than normal
A baby with developmental dysplasia of the hip may have a hip that is partially or completely dislocated, meaning the ball of the femur slips partially or completely out of the hip socket. The symptoms of DDH may resemble other medical conditions of the hip. Always talk with your baby's healthcare provider for a diagnosis.
How is DDH diagnosed?
Developmental dysplasia of the hip is sometimes noted at birth. The pediatrician or newborn specialist screens newborn babies in the hospital for this hip problem before they go home. However, DDH may not be discovered until later evaluations. Your baby's healthcare provider makes the diagnosis of developmental dysplasia of the hip with a clinical exam. During the exam, the healthcare provider obtains a complete prenatal and birth history of the baby and asks if other family members are known to have DDH.
Diagnostic procedures may include:
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
Treatment for DDH
Specific treatment for DDH will be determined by your baby's healthcare provider based on:
Your baby's gestational age, overall health, and medical history
The extent of the condition
Your baby's tolerance for specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
The goal of treatment is to put the femoral head back into the socket of the hip so that the hip can develop normally.
Treatment choices vary for babies and may include:
Nonsurgical positioning device or placement of a Pavlik harness. The Pavlik harness is used on babies up to 6 months of age to hold the hip in place, while allowing the legs to move a little. The harness is put on by your baby's healthcare provider and is usually worn 1 to 2 months. Your baby is seen often during this time so that the harness may be checked for proper fit and to examine the hip. At the end of this treatment, X-rays (or an ultrasound) are used to check hip placement. The hip may be successfully treated with the Pavlik harness, but sometimes, it may continue to be partially or completely dislocated.
Casting. If the hip continues to be partially or completely dislocated, casting, or surgery may be required.
Surgery. If the other methods are not successful, or if DDH is diagnosed at age 6 months to 2 years, surgery may be needed to put the hip back into place manually, also known as a "closed reduction." Children older than 2 years may need an "open surgery" to realign the hip, followed by spica cast. If successful, a special cast (called a spica cast) is put on the baby to hold the hip in place. The spica cast is worn for approximately 3 to 6 months. The cast is changed from time to time to accommodate the baby's growth. Also to make sure that the cast stays rigid, as it may soften with daily wear.
The cast remains on the hip until the hip returns to normal placement. Following casting, a special brace and/or physical therapy exercises may be necessary to make the muscles around the hip and in the legs stronger.
What is a short leg hip spica cast?
A short leg hip spica cast is applied from the chest to the thighs or knees. This type of cast is used to hold the hip in place after surgery to allow healing.
Cast care instructions
Recommendations for taking care of the cast include the following:
Keep the cast clean and dry.
Check for cracks or breaks in the cast.
Rough edges can be padded to protect the skin from scratches.
Do not scratch the skin under the cast by inserting objects inside the cast.
Use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
Do not put powders or lotion inside the cast.
Cover the cast during feedings to prevent spills from entering the cast.
Prevent small toys or objects from being put inside the cast.
Elevate the cast above the level of the heart to decrease swelling.
Do not use the abduction bar on the cast to lift or carry the baby.
When to call your baby's healthcare provider
Contact your baby's healthcare provider if your baby develops one or more of the following symptoms:
Fever or chills
Increased swelling above or below the cast
Drainage or foul odor from the cast
Cool or cold toes
Long-term outlook for a baby with DDH
While newborn screening for DDH allows for early detection of this hip condition, starting treatment immediately after birth may be successful. Many babies respond to the Pavlik harness, and/or casting. Additional surgeries may be necessary since the hip dislocation can happen again as the child grows and develops. If left untreated, differences in leg length or a duck-like gait, and a decrease in agility may happen. In children 2 years or older with DDH, deformity of the hip and osteoarthritis may develop later in life. DDH can also lead to pain and osteoarthritis by early adulthood.