Common Hip Injuries

Developmental Dislocation (Dysplasia) of the Hip (DDH)
Developmental dysplasia (dislocation) of the hip (DDH) is an abnormal formation of the hip joint in which the ball on top of the thighbone (femur) is not held firmly in the socket. In some instances, the ligaments of the hip joint may be loose and stretched.

The degree of hip instability varies in DDH. In some children, the thighbone is simply loose in the socket at birth. In other children, the bone is completely out of the socket. In still other children, the looseness worsens as the child grows and becomes more active.

Pediatricians screen for DDH at a newborn's first examination and at every well-baby checkup thereafter. When the condition is detected at birth, it can usually be corrected. But if the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated and uncertain.

Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or a "duck-like" gait and decreased agility. If treated successfully (and the earlier the better), children regain normal hip joint function. However, even with appropriate treatment, especially in children 2 years or older, hip deformity and osteoarthritis may develop later in life.

Symptoms:  Some babies born with a dislocated hip will show no outward signs.

Contact a pediatrician if your baby has:

• Legs of different lengths
• Uneven skin folds on the thigh
• Less mobility or flexibility on one side
• Limping, toe walking, or a waddling, duck-like gait

Nonsurgical Treatment Treatment methods depend on the child's age:

Newborns
Newborns are placed in a Pavlik harness for 1 to 2 months to treat DDH
Newborns are placed in a Pavlik harness for 1 to 2 months to treat DDH. The baby is placed in a soft positioning device, a Pavlik harness, for 1 to 2 months to keep the thighbone in the socket. This will help tighten the ligaments around the hip joint and promote normal hip socket formation.

1 to 6 months
The baby's thighbone is repositioned in the socket using a harness or similar device. The method is usually successful. But if it is not, the doctor may have to anesthetize the baby and move the thighbone into proper position, and then put the baby into a body cast (spica).

Surgical Treatment:

6 months to 2 years
The child is placed under anesthesia, and the thigh bone is manipulated into the proper position in the socket. Open surgery is sometimes necessary. Afterwards, the child is placed into a body cast (spica) to maintain the hip position.

Older than 2 years
Deformities may worsen, making open surgery necessary to realign the hip. Afterwards, the child is placed into a body cast (spica) to maintain the hip in the socket. In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. X-rays and other regular follow-up monitoring are needed after DDH treatment until the child's growth is complete.