Developmental dysplasia of the hip (DDH) 

Developmental dysplasia of the hip, also known as congenital hip dislocation or hip dysplasia, is a condition in babies and young children in which the ball-and-socket joint of the hip doesn’t form properly.

The result is that the socket of the hip is too shallow to hold the top of the leg bone (the femoral head) properly, resulting in a loose hip joint. In some cases this can lead to dislocation of the hip.

It affects roughly one in every 1,000 babies, although many are born with a mild form which gets better on its own in the first weeks of life.

During your consultation, we’ll talk to you about your baby’s health. The condition is more common following breech births, and where there’s a family history of DDH.

Next, we’ll carry out a full screening. There are certain signs we’ll look for – for instance a clicking noise during sideways movement of the hip, or whether one leg is noticeably shorter than the other.

We may also arrange for an ultrasound scan at The Portland Hospital’s imaging department. This will help us to make an accurate assessment of your baby’s condition.

The established method of treatment for newborns is the Pavlik harness – a fabric splint that keeps your baby’s hips in a strong position.

By keeping the hips in a strong position, the harness promotes natural movement and helps to strengthen your baby’s ligaments around the hip joint, which allows the hip socket to mature.

Your baby will need to wear the harness constantly for between one to three months. During this time, you’ll have additional appointments with us, at which we can adjust the position of the harness as necessary. We may also arrange for another ultrasound scan to monitor your child’s hip development.

We’ll talk you through all aspects of this treatment to make sure you’re completely comfortable with it. We’ll also be able to offer advice and support when it comes to caring for your baby during this time. This includes, but isn’t limited to:

• Changing clothes and nappies
• Cleaning the harness
• Helping with your baby’s rehabilitation
• How to avoid skin irritation
• Recommended sleeping position

Once treatment is completed, your baby should begin to move more freely. You can help by encouraging activities such as swimming.

We recommend regular check-ups over the next few years to monitor hip development as your child grows and learns to walk.

In some very rare cases, a child can continue to experience problems. If that is the case, a reduction procedure is another option, and one we’ll talk through with you fully at the time if necessary.

In a small number of patients, Pavlik harness therapy isn’t sufficient to correct the hip position. In this case, there are alternative techniques we can try.

Often, when your child is around six months old, a procedure called a closed reduction can help. This is carried out under general anaesthetic, and involves placing the hip in a good position and holding it in place with a special cast called a hip spica.

In addition, there’s a very small procedure we can use to release a tight muscle, which can also help with hip positioning.

If your child is a little older, around 12 months old, an operation to open the hip joint via a small groin incision, allows the ball to be placed correctly in the socket directly. Again, a hip spica cast is used to hold things in place.

We’ll make sure you’re fully involved – and informed – with all aspects of your child’s care. We’ll answer all your questions and give you a detailed explanation of the hip development process, information about any procedures necessary, as well as tips on hip spica care and car seat adjustments.

You’ll have the full support, not just of your surgeon, but of the wider team at The Portland Hospital, including our specialist nurses and physiotherapy team.

Reduction and hip reconstruction surgery involves placing the ball of the thigh bone back into the hip socket. Although considered safe, it’s major surgery, and is carried out under general anaesthetic.

During the open reduction and hip reconstruction procedure, we’ll make a cut in the groin to open up the hip joint. Then, we’ll remove the damaged tissue before aligning the thigh bone and hip socket.

After the procedure, we’ll place your child into a spica cast. This is a special cast that keeps their hip in its newly aligned position. Your child will need to wear the cast for anywhere between three and six months and we’ll need to change it every six weeks.

Sometimes, patients need additional support once the spica cast is removed. If that’s the case, we’ll give your child a hip abduction brace. A few weeks is usually all it takes.

We’ll help you with advice and support on how to manage your child’s recovery, and how you can help them get back to their usual routine. Typically, it will take a year for most children to fully recover from their surgery.