by Robert Bernstein

Created on: February 08, 2007   Last Updated: April 09, 2007

Developmental Dysplasia of the Hip in Children

Developmental dysplasia of the hip (DDH) is a fairly common problem in the newborn, occurring in about 1:1000 live births. DDH includes hips that are dislocated (completely out of the joint) as well as those hips that are subluxated (partially out) and those that are in but can be pushed almost out (subluxatable). If identified early and treated appropriately, the child should have normal function of the hip throughout their lifetime. The four major risk factors are: Breech position in the uterus, female, first child, and family history of DDH.

Breech presentation (in which the unborn child's bottom is facing down instead of up) may cause DDH since it increases the flexion of the hip and allows the muscles in front of the hip to be tighter. At birth, when the legs are straightened, the muscles act like a tether, forcing the hip out the back of the joint. About 30% of children that were breech will have some form of DDH. It is believed that females are more at risk because they likely have more receptors for Relaxin, the hormone secreted by the mother to loosen the ligaments in her pelvis to let the baby come out. First children are at risk because the uterus is tighter (hasn't been stretched out) and finally, there is clearly some genetic factors that increase the likelihood since DDH can run in families.

Early signs include a shortened leg (called Galleazi's sign), asymmetric thigh folds, and a "clunk" in those hips that can be pushed in or out (Ortoloni and Barlow maneuvers). The dislocated hip or subluxated hip is not painful to the newborn child and children with untreated hip dysplasia will walk, although with a limp. Over time, the hip can become arthritic and painful, and thus early identification and treatment are important.

The pediatrician will check the infant's hips multiple times after birth and in the first year of life for this problem. If he or she suspects a problem, they may order an ultrasound of the hip to document its position (x-rays generally aren't useful before 6 months of age because the hip is mostly cartilage which doesn't show up on an x-ray). If that ultrasound is positive, they should refer you to a pediatric orthopaedic surgeon for treatment.

Early treatment is generally with the Pavlik Harness, a cloth device that keeps the child's hips flexed and allows the femoral head (ball)to slip back into the acetabulum (socket). Sometimes, other braces such as the Ilfeld splint will be used. If

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