Developmental Dysplasia of the Hip, commonly known as DDH, is a condition in which a baby’s hip joint does not develop normally.

The hip is a ball-and-socket joint. Normally, the rounded head of the thigh bone, called the femoral head, fits securely inside the cup-shaped socket of the pelvis, called the acetabulum.

In DDH, the socket may be too shallow, or the hip joint may be unstable. In milder cases, the hip may simply be loose. In more severe cases, the femoral head may partially or completely come out of the socket.

The important thing for parents to know is that DDH can often be treated successfully when detected early. However, because babies usually do not experience pain or obvious symptoms, the condition can be easy to miss without proper screening and follow-up.

What is Developmental Dysplasia of the Hip?

DDH is not a single condition but a spectrum of abnormalities involving the development and stability of the hip joint.

• Mildly unstable
• Partially displaced from the socket
• Completely dislocated
• Associated with an underdeveloped or shallow hip socket

The term “developmental” is important because the problem may not always be obvious at birth and can develop or become more apparent as the baby grows.

Why Does DDH Matter?

A hip that remains unstable or improperly positioned while the child grows can affect the normal development of the joint.

If DDH is not detected and treated appropriately, it may eventually contribute to problems such as:

• Limping or an abnormal walking pattern
• Difference in leg length
• Restricted hip movement
• Hip pain later in life
• Early degenerative changes or arthritis

The earlier a significant hip abnormality is identified, the more straightforward treatment generally tends to be.

Why Can DDH Be Difficult to Detect?

One of the biggest challenges with DDH is that a baby may look completely normal.

There may be no pain, swelling or obvious deformity. A baby who has not yet started walking cannot show parents an abnormal walking pattern either.

That is why physical examination during newborn and routine infant health visits is so important.

A normal first examination also does not guarantee that the hip will remain normal throughout infancy. Periodic hip examinations are therefore recommended as the child grows.

Who Is at Higher Risk of DDH?

DDH can occur in babies without any obvious risk factors, which is why all babies should have their hips examined.

Breech Presentation

Babies who were positioned breech during pregnancy or at birth have a higher risk of DDH.

Family History

A family history of DDH is another important risk factor.

Female Babies

DDH is more commonly seen in girls.

Other Factors

The way an infant’s legs are positioned or tightly swaddled may also affect hip development. Swaddling should allow the baby’s hips and legs to move freely rather than holding the legs tightly straight and together.

Importantly, the absence of risk factors does not rule out DDH. Many babies diagnosed with DDH do not have an obvious risk factor.

How Is DDH Diagnosed?

1. Physical Examination

The first and most important step is a careful physical examination.

During the examination, a paediatrician or paediatric orthopaedic specialist gently assesses the baby’s hip stability.

Two well-known clinical manoeuvres are the Barlow and Ortolani tests.

These involve carefully moving the baby’s hips to assess whether the femoral head is stable within the socket or whether the hip can move out of or back into the socket.

These tests must be performed gently by a trained healthcare professional.

As the baby gets older, the usefulness of these particular manoeuvres changes. Other findings, such as limited or asymmetric hip movement, may become more important.

2. Ultrasound of the Hip

When imaging is required in a young infant, ultrasound can provide detailed information about the developing hip because much of the baby’s hip joint is still made of cartilage.

Ultrasound can help the specialist assess:

• The shape and development of the hip socket
• How well the femoral head is covered
• The stability of the hip
• The relationship between the ball and socket

Ultrasound is particularly useful in young infants when performed and interpreted by experienced professionals. Current guidance generally recommends selective rather than universal ultrasound screening, depending on clinical findings and risk factors.

3. X-Ray

As the child grows and more bone develops, an X-ray of the pelvis becomes increasingly useful for evaluating the hip.

Current guidance supports the use of an anteroposterior pelvis X-ray after approximately 4–6 months, depending on the clinical situation.

Your child’s doctor will decide which imaging study is appropriate based on the child’s age, examination findings and risk factors.

How Is DDH Treated?

Treatment depends on several factors, particularly:

• The child’s age
• How unstable or displaced the hip is
• The development of the hip socket
• Whether the hip can be positioned properly without surgery
• How the hip responds to initial treatment

The general principle is simple:

The earlier significant DDH is identified, the more likely treatment can be achieved with simpler and less invasive methods.

Treatment in Young Babies: Pavlik Harness

For appropriate infants, particularly those diagnosed in the first months of life, a Pavlik harness may be used.

This is a soft harness designed to keep the baby’s hips in a position that allows the femoral head to remain properly positioned within the socket.

The aim is to encourage the hip joint to develop normally while maintaining a safe position.

The harness is generally worn for a period determined by the treating paediatric orthopaedic specialist, with regular follow-up to monitor the hip’s development.

For many appropriately selected young infants, bracing can successfully treat the condition without surgery.

Treatment When the Baby Is Older

If DDH is diagnosed later, or if the hip does not respond adequately to bracing, additional treatment may be required.

One option may be a closed reduction.

In this procedure, the surgeon gently guides the femoral head back into the socket under anaesthesia without making a surgical incision.

The hip is then maintained in the correct position using a special cast, commonly called a spica cast.

Treatment in Older Children or More Severe Cases

If the hip is more rigidly dislocated or the child is older at the time of diagnosis, an open reduction may be required.

Open reduction involves surgery to reposition the femoral head into the socket.

Depending on the child’s age and the anatomy of the hip, additional procedures may sometimes be required to improve the shape or alignment of the socket or femur.

The exact treatment plan is individualised for every child.

Why Early Detection Matters

DDH is one of those conditions where timing can make a significant difference.

A young baby’s developing hip has considerable potential for normal growth when the femoral head is properly positioned within the socket.

As the child grows, a persistently dislocated or poorly developing hip can become more difficult to correct and may require more complex treatment.

This is why regular infant examinations and appropriate follow-up are so important.

A Message for Parents

DDH can understandably sound frightening when parents first hear words such as “hip dysplasia” or “dislocation.”

But there is an important positive message:

DDH is treatable, and early detection can make treatment considerably simpler.

Your baby does not need to be in pain for DDH to be present. There may be no obvious signs at home.

So, make sure your baby attends routine newborn and infant health examinations. If your paediatrician identifies a concern, particularly if your baby was breech or has a family history of DDH, don’t ignore it.

A timely assessment by a paediatric orthopaedic specialist can help determine whether further observation, imaging or treatment is needed.

The Takeaway

Developmental Dysplasia of the Hip is a condition affecting the developing hip joint in babies and young children.

It can range from mild instability to complete dislocation. Because it can be silent in infancy, regular clinical examination is an important part of early detection.

When DDH is identified early, treatment may often be achieved with non-surgical methods such as bracing. If the condition is diagnosed later or is more severe, procedures such as closed or open reduction may be necessary.

The key message for every parent is simple: don’t wait for your child to start walking before paying attention to hip health. Early screening, appropriate follow-up and timely treatment can make a meaningful difference.

About Dr. Sandeep Vaidya

Dr. Sandeep Vaidya is a Paediatric Orthopaedic Surgeon specialising in the diagnosis and treatment of orthopaedic conditions affecting children.

If you have concerns about your baby’s hip development, discuss them with your paediatrician or consult a paediatric orthopaedic specialist for an appropriate evaluation.

Medical Disclaimer: This blog is intended for general patient education and does not replace an individual medical consultation. Every child’s condition is different, and treatment should be decided by the treating doctor after clinical evaluation and appropriate investigations.