Developmental hip dysplasia (DDH) affectsaround 3-5 per 1,000 births in Saudi Arabia. If diagnosed and treated withinthe first 6 months, most children have no long-term complications. (1)

What is Developmental Hip Dysplasia (DDH)?

DDH is a condition in which the hip joint isunstable or misaligned, meaning the top of the thigh bone (femoral head) doesnot fit properly into the hip socket.

The dislocation can be partial or complete,and may affect one or both hips. (2)

Updated Terminology

Although DDH is most often present at birth,it can also develop during a child's first few months of life. That’s why theterm "Developmental Hip Dysplasia" is more accurate than"Congenital Hip Dislocation."  (2)

Incorrect swaddling practices, such as tightlywrapping the baby’s legs straight and together, can raise the risk, whereasproper swaddling allows natural hip and leg movement. (3)

Causes of DDH

The exact causes of DDH are not fully known,but several factors increase the likelihood of developing this condition,including: (4)(5)

• Being a first-born child,especially if female.
• Family history of hip dislocation(e.g., parent or sibling with DDH).
• Breech position at birth.
• Multiple births.
• Females are 4-5 times more proneto DDH compared to males.
• Low amniotic fluid duringpregnancy.
• Certain congenital abnormalities,such as cerebral palsy or spina bifida. 

Signs and Symptoms of DDH

DDH canbe difficult to spot, but possible signs (which maynot apply to every child) include: (4)

• One leg turning outward more thanusual.
• Asymmetry in skin folds on thethigh or buttocks.
• Limited movement in one leg (oftennoticed during diaper changes).
• A leg that appears shorter on theaffected side.

Screening for DDH

Routine hip exams for newborns help identifyDDH early. All newborns undergo aninitial physical examination immediately after birth, and another one at 6-8weeks to assess hip motion and any visible signs of dislocation. (6)

A doctor may also recommend an ultrasound of the pelvis within thefirst 4 months of life to get a clearer view of hip alignment. Especially if: (7)

• The physical exam results areconcerning or unclear.
• There are possible signs of hipdislocation.
• The child has DDH risk factors,such as breech position and family history.

After four months, an X-ray can be used ifneeded, as the bones have developed sufficiently to be well visualized by anX-ray image. (7)

Importance of Early Detection

DetectingDDH early makes treatment easier and more effective,while delayed treatment can lead to walking difficulties or long-termcomplications, including: (6)

• Limping and uneven leg lengths.
• Joint pain, especially later inlife.
• Increased risk of arthritis inadulthood.

Treatment for DDH

The treatment approach depends on the child’sage. If detected within the first 6 months, a special brace called “Pavlikharness” is typically used. This device stabilizes the hips by holding themin place using straps around the shoulders and chest. (5)

If detected later, treatment for DDH variesdepending on the severity, and most cases require surgical intervention. (5)

1-Pavlik Harness:

The Pavlik harness is a brace that helps thehip joint stay in place until it fully develops. The device is generally wornfor 6-12 weeks and has a success rate of over 85%, allowing normal hipjoint development. (5)

2-Surgery:

Surgery is usually necessary for children diagnosed after 6 months of age. Thejoint is repositioned under anesthesia followed by casting to stabilize thehip. (5)

Inchildren over 1–2 years, treatment becomes more complex and may require manually realigning the joint through open surgery. Inmany cases, bone trimming (osteotomy) is also necessary to correct thealignment of the hip joint. (2)

At Dr.Soliman Fakeeh Hospital, our pediatricorthopedic team treatsthousands of children with congenital hip dysplasia, using both surgical andnon-surgical methods

Frequently Asked Questions

Does Double Diapering Help with DDH?

Most studies don't support double diapering asan effective treatment for DDH, though it has shown some limited benefits inmild cases. Consulting a doctor for accurate guidance is essential. (8)(9)

What Are the Degrees of DDH?

DDH is classified into 3 grades based on the extent of the hip instability, these are: (2)

• Subluxatable (Mild): The femoral head is slightly loose but remains in the hip socket.
• Dislocatable (Partial): The femoral head is in place but can slip in and out of the socket with movement.
• Dislocated (Complete): The femoral head is fully dislocated from the socket. 

References

1. SpringerLink - Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review
2. OrthoInfo - Developmental Dislocation (Dysplasia) of the Hip (DDH)
3. International Hip Dysplasia Institute - Hip-Healthy Swaddling
4. MedlinePlus - Developmental dysplasia of the hip
5. Betterhealth - Developmental dysplasia of the hip (DDH)
6. NHS - Developmental dysplasia of the hip
7. International Hip Dysplasia Institute - Infant Diagnosis
8. NIH NLM - Double diapering facilitates hip maturation in newborns
9. NIH NLM - Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips