Developmental Dysplasia of the Hip (DDH) is the most common hip disease in infants. About 1.5 cases will happen in every 1,000 babies. In the long term, the disease could result in unequal leg lengths, asymmetric movements, and limping gait. The treatment becomes more difficult with poor results if the diagnosis is conducted later in life. Hence, early detection and early intervention are very important.

Risk Factors

Girl babies, pregnant mothers with medical history of oligohydramnios, babies born on breech position, families with medical history of hip disease, and patients with medical history of torticollis or inversion of foot.

Clinical Symptoms

Most babies do not show significant symptoms initially, or feel pain or discomfort. Sometimes, the babies can be seen with asymmetry of skin folds over bilateral thighs or their legs are limited during abduction. Sometimes when the parents change their baby's diapers, they could occasionally feel a hip "click" when moving the infant's thigh outward. As the babies grow older, they could have unequal leg length and limitation of movements between the two legs.

Diagnosis

1. Physical examination: The doctor will conduct a physical examination during routine checkups. In particular, the appearance and activity of the hip, symmetry of skin folds, movement of legs, and range of motion of hip joints.
2. Ultrasound: The scan can be done on babies up to about 6 months of age. It can evaluate the structure and stability of the hips through ultrasound. The advantage is no radiation exposure and could be used for disease screening.
3. X-ray: The main diagnosis instrument for babies aged after 4~6 month old. The X -ray shows the part with ossification femur and relative position of the acetabulum. Due to traces of radiation, it is not suitable for screening.

Prevention

Avoid bundling the baby with over-tight scarf so to provide sufficient space for the babies to bend the legs below, and stretch the legs freely, to avoid limiting the hip movement. When using the scarf, not the lower extremities of the babies appeal in “M” shape and the hip joint is located on the correct position.

Treatment

1. Before 4~6 month old: Pavlik's harness is the most common initial treatment for DDH in infants. (as shown in the graphic).
2. After 6 months old: Surgery may be needed if your baby is after 6 months old, or if the Pavlik harness has not helped. The most common surgery is called reduction. This involves placing the femoral head back into the hip socket.