Developmental Dysplasia of the Hip (DDH)

What is developmental dysplasia of the hip?

Developmental dysplasia of the hip — DDH — describes a spectrum of conditions where the hip joint hasn't formed normally. At one end, the socket is shallow but the hip is in place; at the other, the hip is fully dislocated.

DDH is more common in girls, in firstborn babies, in babies who were breech, and where there's a family history. Routine baby checks include hip examination because catching DDH early dramatically improves outcomes.

Treatment depends heavily on age at diagnosis. Identified in the first few months, DDH is often managed simply and well. Identified later, particularly after walking age, treatment becomes more involved.

What does it feel like?

Babies with DDH don't usually appear in pain — it's something detected on examination or noticed by parents:

• Asymmetric thigh creases

• One leg appearing shorter than the other

• A clunk or click on hip examination

• Reduced ability to spread one leg outward

• In older children, a limp or a waddling gait when walking begins

Bilateral DDH (both hips affected) can be harder to spot because the asymmetry isn't there — which is why structured screening matters.

How is it diagnosed?

In babies under six months, ultrasound is the imaging of choice — it gives a clear view of the still-cartilaginous hip and allows precise assessment of the socket and the position of the hip.

After about six months, when the hip becomes more bony, X-rays take over as the main imaging tool.

Examination is essential at every age. The clinical findings, combined with the right imaging, give a clear picture and guide the management plan.

What are the treatment options?

In young babies, a Pavlik harness or similar device is the mainstay of treatment. It holds the hip in a position that encourages the socket to develop normally. The success rate when DDH is caught early is very high.

In older babies and children, treatment may involve closed reduction (manipulating the hip back into place under anaesthetic and applying a cast) or, in some cases, open surgery to address the soft-tissue and bony components. The right approach depends on age, severity and what's been tried already. Nev will work through this with you at your consultation.

When should you get it checked?

Seek a specialist assessment if:

• A baby check has flagged a possible hip problem

• There's a family history of hip dysplasia and you want screening

• Your baby has risk factors (breech presentation, firstborn girl) and hasn't had a clear assessment

• There's asymmetry of the legs or thigh creases

• An older child is walking with a limp or unusual gait

DDH is one of those conditions where early identification matters enormously. The earlier the right plan is started, the simpler and more successful the management tends to be.