Guide to What Do You Need Know About Developmental Dysplasia Hip Ddh Congenital
Learn about developmental dysplasia of the hip (DDH) in children—its signs, risk factors, diagnosis, and treatment options.
Written by Dr. Dhankecha Mayank Dineshbhai
Reviewed by Dr. Shaik Abdul Kalam MD (Physician)
Last updated on 24th Sep, 2025
.webp?tr=q-80,f-webp,w-350,dpr-2,c-at_max 700w)
Introduction
Discovering that your child has a potential health concern can be overwhelming. If you've heard the term "developmental dysplasia of the hip" or DDH, you likely have many questions. Simply put, developmental dysplasia of the hip is a condition where a baby's hip joint doesn't form properly. The ball (the top of the thigh bone) isn't held firmly in the socket, making the joint unstable. This guide is designed to walk you through everything you need to know—from recognising the subtle signs to understanding treatment options and long-term outcomes. We'll demystify the medical jargon, explain the diagnostic process, and outline the journey to a healthy, functional hip. Remember, early detection is key, and with modern medicine, the prognosis for children with DDH is excellent.
What Exactly is Developmental Dysplasia of the Hip?
Developmental dysplasia of the hip is not a single problem but a spectrum of disorders. It can range from a hip that is slightly loose (subluxated) to one that is completely dislocated, where the ball is entirely outside the socket. The "developmental" aspect is crucial; it means the issue can develop before birth, during infancy, or even after birth, which is why screening continues beyond the newborn period.
From "Congenital Dislocation" to DDH: Understanding the Terminology
You might hear the older term "congenital dislocation of the hip" (CDH). While related, DDH is the preferred term today because it more accurately reflects that the hip instability can develop after birth, not just be present at birth. This highlights the importance of ongoing monitoring.
The Hip Joint: A Quick Anatomy Lesson
Think of the hip as a ball-and-socket joint. The "ball" is the head of the femur (thigh bone), and the "socket" is the acetabulum, part of the pelvis. In a healthy hip, the ball fits snugly into the socket, allowing for smooth movement. In DDH, the socket may be too shallow, or the ligaments around the hip may be too loose, allowing the ball to slip in and out or remain dislocated.
Consult a Paediatrician for the best advice
Recognising the Signs: Symptoms of DDH by Age
DDH can be tricky because it often presents with no pain in a baby. Knowing what to look for is your first line of defense.
Signs in Babies and Newborns
- Asymmetrical Skin Folds: Extra or uneven skin folds on the thigh or buttocks.
- Limited Range of Motion: One hip may not open as widely as the other during diaper changes.
- A "Clicking" or "Clunking" Sound: A distinct sound, different from a common joint pop, may be heard when the hip is moved. It's important to note that many innocent clicks are harmless, but any concerning sound should be evaluated by a doctor.
- Instability: The hip may feel like it slips in and out of place.
Signs in Toddlers and Older Children
Once a child starts walking, the signs become more apparent:
- Limping when walking.
- Walking on toes on one side.
- A waddling gait (like a duck).
- Lumbar Lordosis: An exaggerated curve in the lower spine.
- Leg Length Discrepancy: One leg may appear shorter than the other.
Unique Insight: Many parents worry about swaddling. While tight, straight-leg swaddling can increase the risk of DDH, hip-healthy swaddling—which allows the legs to bend and move freely—is safe and recommended.
What Causes DDH? Unraveling the Risk Factors
The exact cause of developmental dysplasia of the hip is often unknown, but it's likely a combination of genetic and environmental factors.
Common Risk Factors You Should Know
- Breech Position: Babies in the breech position (feet first) in the last trimester have increased pressure on their hips.
- Family History: DDH is more common in families with a history of the condition.
- Gender: Girls are 4-5 times more likely to have DDH due to increased ligament laxity from maternal hormones.
- First-Born Status: The uterus of a first-time mother can be tighter, potentially limiting fetal movement.
- Oligohydramnios: Low levels of amniotic fluid can restrict fetal movement.
Getting a Diagnosis: How Doctors Check for DDH
Early diagnosis is critical for successful non-surgical treatment. Screening happens in two main ways.
1. The Newborn Physical Exam: The Ortolani and Barlow Maneuvers
Shortly after birth, your paediatrician will perform a gentle physical exam. The Ortolani test involves moving the hip to see if a dislocated hip can be guided back into the socket. The Barlow test checks if a stable hip can be gently manipulated out of the socket. These tests are skill-dependent, which is why follow-up is important.
2. Imaging Tests: Ultrasound vs. X-Ray
- Ultrasound: This is the gold standard for diagnosing hip dysplasia in infants under 6 months old because it visualises the soft cartilage of the hip before bones have fully ossified. It's painless and radiation-free.
- X-Ray: After about 4-6 months, when more bone has formed, an X-ray becomes the preferred imaging method to get a clear picture of the hip joint's position and development.
If your paediatrician has any concerns during a well-baby check, it's crucial to follow up. You can consult a paediatric orthopedist online with Apollo24|7 for a second opinion or to book a physical visit for further evaluation.
Treatment Options for DDH: A Roadmap to a Healthy Hip
The goal of all DDH treatment is to center the hip ball in the socket so that it can develop normally. The method depends almost entirely on the child's age at diagnosis.
Treatment for Newborns to 6 Months: The Pavlik Harness
The Pavlik harness is the most common treatment for babies under 6 months. This soft brace holds the baby's hips in a flexed and abducted (frog-like) position, which encourages the ball to settle into the socket. It is typically worn full-time for several weeks to months, with regular adjustments and ultrasounds to monitor progress. Success rates are very high (over 90%) when used correctly.
Treatment for 6 Months to 2 Years: Casting and Surgery
If the harness is unsuccessful or the child is older, a procedure under anaesthesia called a closed reduction is performed. The doctor gently maneuvers the hip into place, and then a spica cast is applied to hold it there. This cast covers the waist down to the ankles on one or both legs. If soft tissue is blocking the hip from going into place, an open reduction surgery is needed to clear the obstruction before casting.
Treatment for Older Children and Adults: Advanced Surgical Procedures
For children diagnosed after toddlerhood or adults with untreated DDH, more complex surgeries are required. These may involve reshaping the socket (pelvic osteotomy) or the thigh bone (femoral osteotomy) to achieve better alignment. Hip arthroscopy may also be used to address related issues like labral tears.
Life After DDH: Long-Term Outlook and Follow-Up Care
With early and appropriate treatment, most children with DDH go on to lead completely normal, active lives. However, the hip will need to be monitored periodically with X-rays until the child reaches skeletal maturity to ensure it continues to develop correctly. The long-term goal is to prevent early-onset osteoarthritis in adulthood, which is a common consequence of untreated DDH.
Can DDH Be Prevented? Proactive Steps for Parents
While you can't change genetic risk factors, you can practice hip-healthy baby wearing and swaddling. Always ensure your baby’s legs can bend up and out at the hips. Avoid tight swaddles that press the legs together straight down. Using carriers that support the thighs (in an "M" position) rather than dangling the legs is also recommended.
Conclusion: Empowerment Through Early Action
Navigating a developmental dysplasia of the hip diagnosis can feel like a daunting journey, but knowledge is power. Understanding the signs, risk factors, and treatment pathways empowers you to be an active participant in your child's care. The most important message is that DDH is highly treatable when caught early. Trust your instincts as a parent—if you notice any potential signs, don't hesitate to bring them up with your paediatrician. Timely intervention is the single greatest factor in ensuring your child has a strong, stable foundation for a lifetime of activity. If you have any concerns about your child's hip development, consulting a paediatric orthopedist is the best next step. You can easily book a physical visit to a specialist with Apollo24|7 to get the expert care your child deserves.
Consult a Paediatrician for the best advice
Consult a Paediatrician for the best advice
Dr. Saheli Dasgupta
Paediatrician
10 Years • MBBS, MD (Paediatrics), Indian Diploma of Paediatric Critical Care Medicine
Kolkata
Sristi Polyclinic, Kolkata
Dr. Guruprasad N
Paediatrician
7 Years • MBBS, MD Peadiatrics, DNB pediatrics
Bangalore
Apollo Clinic Bellandur, Bangalore
Dr. Sushil Kumar
Paediatrician
30 Years • MBBS, MD - Pediatrics
Bilaspur
Apollo Hospitals Seepat Road, Bilaspur
(25+ Patients)
Dr Sharvari Kulkarni
Paediatrician
5 Years • MBBS, MD PEDIATRICS
Pune
Apollo Clinic, Viman Nagar, Pune
Dr. J N V. Bhuvaneswararao
Paediatrician
24 Years • MBBS,Diploma in Child Health
Vijayawada
SRI SRINIVASA CHILDRENS HOSPITAL, Vijayawada
Consult a Paediatrician for the best advice
Dr. Saheli Dasgupta
Paediatrician
10 Years • MBBS, MD (Paediatrics), Indian Diploma of Paediatric Critical Care Medicine
Kolkata
Sristi Polyclinic, Kolkata
Dr. Guruprasad N
Paediatrician
7 Years • MBBS, MD Peadiatrics, DNB pediatrics
Bangalore
Apollo Clinic Bellandur, Bangalore
Dr. Sushil Kumar
Paediatrician
30 Years • MBBS, MD - Pediatrics
Bilaspur
Apollo Hospitals Seepat Road, Bilaspur
(25+ Patients)
Dr Sharvari Kulkarni
Paediatrician
5 Years • MBBS, MD PEDIATRICS
Pune
Apollo Clinic, Viman Nagar, Pune
Dr. J N V. Bhuvaneswararao
Paediatrician
24 Years • MBBS,Diploma in Child Health
Vijayawada
SRI SRINIVASA CHILDRENS HOSPITAL, Vijayawada
More articles from Hip dysplasia
.webp)
Frequently Asked Questions
1. Can DDH correct itself?
In some very mild cases of instability in newborns, the hip may stabilise on its own within the first few weeks of life. However, any diagnosed DDH requires close monitoring by a doctor to ensure it resolves and does not worsen.
2. What happens if developmental dysplasia of the hip is left untreated?
Untreated DDH can lead to a permanent limp, leg length discrepancy, chronic pain, and damage to the hip joint. In adulthood, it almost inevitably leads to severe osteoarthritis, often requiring a total hip replacement at a young age.
3. How long does a baby need to wear a Pavlik harness?
The duration varies, but it's typically worn full-time for 6-12 weeks, followed by a part-time wearing period. The orthopaedist will adjust the harness regularly and use ultrasounds to determine the exact timeline for your baby.
4. Are there any exercises for developmental dysplasia of the hip?
For babies, the treatment is bracing or casting, not exercises. However, after treatment, physical therapy may be recommended to help strengthen the muscles around the hip and improve range of motion. Your doctor will provide specific guidance.
5. Is hip dysplasia in newborns always present at birth?
No. The 'developmental' nature of DDH means it can develop after birth. This is why paediatricians check the hips at every well-baby visit during the first year, not just at the initial newborn exam.