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Developmental Dysplasia of Hip

Developmental Dysplasia of Hip

The hip is a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.

Although DDH is most often present at birth, it may also develop during a child’s first year of life. Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. As swaddling becomes increasingly popular, it is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH.

Description

In all cases of DDH, the socket (acetabulum) is shallow, meaning that the ball of the thighbone (femur) cannot firmly fit into the socket. Sometimes, the ligaments that help to hold the joint in place are stretched. The degree of hip looseness, or instability, varies among children with DDH.

  • Dislocated. In the most severe cases of DDH, the head of the femur is completely out of the socket.
  • Dislocatable. In these cases, the head of the femur lies within the acetabulum, but can easily be pushed out of the socket during a physical examination.
  • Subluxatable. In mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.
 
Illustrations of a normal hip and a dislocated hip

(Left) In a normal hip, the head of the femur fits firmly inside the hip socket. (Right) In severe cases of DDH, the thighbone is completely out of the hip socket (dislocated).

In the United States, approximately 1 to 2 babies per 1,000 are born with DDH. Pediatricians screen for DDH at a newborn’s first examination and at every well-baby checkup thereafter.

Cause

DDH tends to run in families. It can be present in either hip and in any individual. It usually affects the left hip and is predominant in:

  • Girls
  • Firstborn children
  • Babies born in the breech position (especially with feet up by the shoulders). The American Academy of Pediatrics now recommends ultrasound DDH screening of all female breech babies.
  • Family history of DDH (parents or siblings)
  • Oligohydramnios (low levels of amniotic fluid)

Symptoms

Some babies born with a dislocated hip will show no outward signs.

Contact your pediatrician if your baby has:

  • Legs of different lengths
  • Uneven skin folds on the thigh
  • Less mobility or flexibility on one side
  • Limping, toe walking, or a waddling gait

Doctor Examination

Physical Examination

In addition to visual clues, your doctor will perform a careful physical examination to check for DDH, such as listening and feeling for “clunks” as the hip is put in different positions. Your doctor will use specific maneuvers to determine if the hip can be dislocated and/or put back into proper position.

 
DDH examination

During the exam, your doctor will maneuver your baby’s legs and hips in certain ways to detect hip instability.

Reproduced and adapted from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed. 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Newborns identified as at higher risk for DDH are often tested using ultrasound, which can create images of the hip bones. For older infants and children, x-rays of the hip may be taken to provide detailed pictures of the hip joint

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