Developmental dysplasia of the hip (DDH) is a condition where a baby’s hip joint does not develop normally. The hip joint may be loose, unstable, partially dislocated, or completely dislocated.
Many babies with DDH appear healthy and comfortable, with no obvious symptoms. This is why routine newborn hip examinations and appropriate screening are important. Early detection allows treatment to begin promptly and can help support normal hip development.
The hip is a ball-and-socket joint. During normal development, the rounded top of the thigh bone fits securely inside the hip socket, allowing the joint to grow and move properly.
In babies with DDH, the ball and socket do not fit together as they should. The hip may be slightly loose, unstable, partially out of place, or fully dislocated.
DDH exists on a spectrum. Some babies have mild hip instability, while others have more significant hip displacement. Early diagnosis and treatment help the hip joint develop in a stable position and reduce the risk of walking problems, hip pain, or early joint damage later in life.
Many babies with DDH have no obvious signs, especially in the early stages. This is why newborn hip checks are important even when a baby appears healthy.
When DDH signs are present, they may include:
Uneven skin folds on the thighs, buttocks, or legs
One leg appearing shorter than the other
Limited movement in one hip
A hip “click” or feeling of instability during examination
Difficulty spreading the baby’s thighs during nappy changes
Limping in older infants or toddlers
Delayed walking
A hip click does not always mean a baby has DDH. Some hip clicks are harmless. However, if a doctor detects hip instability or if other risk factors are present, further assessment may be recommended.
Certain babies have a higher risk of developmental dysplasia of the hip. Recognised risk factors include:
Breech position during late pregnancy or at birth
Family history of DDH
Female babies
First-born babies
Low amniotic fluid during pregnancy, which may restrict movement in the womb
However, DDH can also occur in babies with no known risk factors. For this reason, routine newborn hip examinations remain important for all babies
Newborn hip examinations help detect DDH as early as possible, including in babies who do not show visible symptoms.
During the examination, the doctor gently moves the baby’s hips to assess whether the joints are stable. This may include two simple checks known as the Barlow and Ortolani manoeuvres.
These tests help assess whether the hip can be gently moved out of position or guided back into the socket. They are routinely performed as part of the newborn examination and are not intended to cause pain.
If the hip feels unstable, or if the baby has risk factors for DDH, further screening such as a hip ultrasound may be recommended.
A hip ultrasound may be recommended when a baby has abnormal findings during a physical hip examination or has recognised risk factors for DDH.
A hip ultrasound provides a detailed view of the baby’s hip joint and helps doctors assess how well the ball and socket are developing.
A baby may need a hip ultrasound if:
The newborn hip examination is abnormal
The baby was in a breech position
There is a family history of DDH
The doctor detects hip instability
Further assessment is needed after birth
Not every newborn requires a hip ultrasound. The need for screening depends on the baby’s examination findings, risk factors, and doctor’s assessment.
Treatment for DDH depends on the baby’s age, the severity of hip instability, and whether the hip is loose, partially dislocated, or completely dislocated.
The goal of treatment is to keep the hip joint in the correct position so the socket and thigh bone can develop normally.
In younger babies, DDH is often treated with a soft brace called a Pavlik harness. The harness gently holds the baby’s hips in a stable position while still allowing movement. This helps guide normal hip development and is commonly used when DDH is detected early.
For older babies, or if the hip does not respond to a harness, other treatments may be needed. These may include a procedure to reposition the hip and a cast to keep it stable while it develops.
In more severe cases, or when DDH is diagnosed later, surgery may be required to correct the hip position and support proper joint development.
Your paediatric orthopaedic specialist will recommend the most appropriate treatment based on your baby’s age, hip stability, and imaging results.
In younger babies, treatment with a Pavlik harness or other bracing method may help the hip develop normally without surgery. However, if DDH is diagnosed later, is more severe, or does not improve with bracing, additional procedures or surgery may be needed. Therefore, early diagnosis is important to improve the chance of simpler treatment and better long-term hip development.
If DDH is not diagnosed and treated, the hip joint may not develop properly. This can lead to long-term problems as the child grows.
Possible complications include:
Limping
Uneven leg length
Difficulty walking
Reduced hip movement
Hip pain
Early joint wear and tear
Increased risk of osteoarthritis later in life
These complications are less likely when DDH is identified and treated early. Regular follow-up is important to monitor hip development and ensure the joint continues to grow properly.
Many babies with DDH who are diagnosed and treated early go on to develop good hip function, normal mobility, and the ability to participate in usual childhood activities.
Outcomes depend on several factors, including:
Severity of DDH
Age at diagnosis
Type of treatment required
How well the hip responds to treatment
Consistency of follow-up care
Regular follow-up appointments allow doctors to monitor hip development and address any concerns early as the child grows.
Parents should consider seeing a paediatric orthopaedic specialist if they are concerned about their baby’s hip development or if their baby has been advised to undergo further assessment for DDH.
Medical review is especially important if:
A newborn hip check is abnormal
A hip click or instability is detected
The baby was born breech
There is a family history of DDH
One leg appears shorter
Hip movement seems limited
The baby develops a limp or delayed walking
At Prince Court Medical Centre, our paediatric orthopaedic specialists provide comprehensive assessment, screening, diagnosis, and treatment for developmental dysplasia of the hip in babies and children.
Book an appointment with our specialists for a personalised assessment and treatment plan for your child.
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