Developmental dysplasia of the hip in babies

What is developmental dysplasia of the hip (DDH)?

Developmental dysplasia of the hip (DDH) is when the ball-shaped part of the end of the thighbone and the socket do not fit correctly together. There are varying levels of hip dysplasia, from mild to severe.

If the ball (femoral head) is not held correctly in place, the socket may be more shallow than usual. Sometimes this makes the joint less stable and the ball may slide in and out of the socket. This is called a dislocatable or ‘subluxatable’ hip. If the ball loses contact with the socket and stays outside the joint, it is called a dislocated hip. One or both hips may be affected.

How common is it?

Around 1 or 2 in every 1000 babies have developmental dysplasia of the hip that needs treatment. It may affect one or both hips but is most common in the left hip. It is also more common in girls.

Why does it happen?

Developmental dysplasia of the hip can happen to any baby, but some factors make the condition more likely.

The most common risk factors are:

• a baby born breech or who was in the breech position in the last 3 months of pregnancy
• a close family history of developmental dysplasia of the hip or hip problems that came on in early childhood
• increased risk with twins or multiples births

Sometimes there is no identified risk factor and the cause is unknown. A possible factor that could hinder normal hip development is tight swaddling. Anything that pulls the hips straight or restricts their natural movement should be avoided.

How is this diagnosed?

Your baby may be referred to our orthopaedic department due to the above risk factors.

Your baby may have had an examination as a newborn and at 6 to 8 weeks old, where the examining clinician may have felt a clicking or clunking at the hip which can indicate instability. An ultrasound scan of the hips is performed to check their positioning and will confirm a diagnosis. If your child is over 6 months old an X-ray will be performed to confirm a diagnosis.

How is this treated?

Babies diagnosed with developmental dysplasia of the hip early in life will be placed into a fabric splint called a Pavlik harness.

The harness holds both the hips in a stable position and allows them to develop normally. The harness will be fitted in clinic by the orthotist. The Pavlik harness needs to be worn 24 hours a day for several weeks and should only be removed by a health professional.

You will have regular follow ups with further ultrasound scans to follow your baby’s progress and the harness may be adjusted. As the treatment progresses your baby may be allowed short periods of time out of the harness before it can be permanently removed. This will be discussed at follow up appointments. The length of time spent in the harness is variable depending on the severity of your baby’s hip condition.

Everyday activities in a Pavlik harness

It will take some time to get used to your baby being in the Pavlik harness but your baby will adapt very quickly.

Feeding

If you are breastfeeding your baby you can continue to do this. We can put you in contact with the infant feeding team to go through positioning and attachment if this becomes an issue.

Bathing

While your baby is in the Pavlik harness 24 hours a day they cannot go in the bath. However, you can sponge bath your baby.

If the harness becomes soiled do not remove it if your baby is in it for 24 hours day. Clean as best you can and if you think needs replacing please get in contact with us.

Clothing

You may need larger (size up), loose fitting clothes. Although not always necessary. Marks and Spencers, and Next sell a hip dysplasia range of clothes if you are wanting to buy new. Alternatively, social media groups are useful for second hand.

Equipment

You will not need any special equipment whilst your baby is in the harness. They will still be able to fit in a normal car seat, pram and cot.

What if the Pavlik harness does not work?

Your consultant will discuss your baby’s progress at each appointment with you. If the harness is not working then it will be discontinued and further options will be discussed at this stage.