Developmental Dysplasia of the Hip

Treatment Overview

Treatment for developmental dysplasia of the hip (DDH) focuses on moving your child's upper thigh bone (femur) into its normal position and keeping it in place while the joint grows. The hip socket will not form and grow properly if the ball at the top of the thigh bone (femoral head) does not fit snugly in the joint.

• Sometimes in babies with signs of DDH the thigh bone and hip socket start to grow as they normally would, without treatment. But it is hard to predict whether this will happen.
• Hips that are fully dislocated or that can be dislocated easily by certain movements are usually treated as soon as they are detected.

Treatment for DDH usually includes one of the following:

• Pavlik harness. This device usually is tried first if your baby is younger than 6 months. The harness has fabric straps and fasteners that fit around your baby's chest, shoulders, and legs. The harness holds the baby's legs in a spread position, with the hips bent so that the thighs are out to the sides. Your doctor monitors the harness's effectiveness through regular examinations and imaging tests. The Pavlik harness successfully makes the hip normal about 90% of the time. But if your doctor doesn't see improvement in the hip after about 3 to 4 weeks, the harness is removed and other treatment options are explored.¹ See a picture of a Pavlik harness.
• Spica cast. This cast is made of plaster or fibreglass to form a hard covering over the waist, hips, and legs. To make it stronger, the cast may have a bar between the legs. See a picture of a spica cast with a bar and a photograph of a spica cast without a bar.

Other forms of treatment

• Braces and splints. Your child may wear a brace or splint as a first treatment for DDH instead of a Pavlik harness or spica cast. In some cases, a brace or splint follows another type of initial treatment, such as surgery. In these cases, the device is used to help support the hips and legs as they heal. In particular, children with DDH who also have other problems with their feet or knees may benefit from wearing a brace.
• Surgery. An osteotomy is surgery to correct a deformed thigh bone or hip socket. This procedure repositions the thigh bone, usually after cleaning the socket of fat deposits. If needed, surgery may include reshaping the socket or thigh bone. After surgery, your child probably will need to wear a spica cast to position the hip joint until it completely heals.
• Physiotherapy. An older child may need physiotherapy exercises to restore movement of the legs and strengthen muscles after being in a spica cast.
• Traction. A very rarely used treatment for DDH, traction involves weights, pulleys, and ropes to gradually stretch and loosen the hip joint's muscles and tissues while holding the bones in their correct position. This allows doctors to place the ball at the top of the thigh bone (femoral head) back into the hip socket. Traction may also help prevent problems with the blood supply to the joint. Typically, traction takes about 2 to 4 weeks. The treatment can be set up in a hospital or at home. Afterward, your child will probably wear a spica cast.

What to think about

If your child has had successful treatment for DDH, he or she will likely not have any further hip problems. But have your child examined regularly to make sure his or her hips continue to grow and develop normally.

The longer an unstable, dislocatable, or dislocated hip persists, the more likely it is to cause long-term problems that are difficult to treat. For this reason, it is important to diagnose and treat DDH early.

Follow-up medical checkups are very important for monitoring the effectiveness of treatment and preventing complications. For example, damage sometimes occurs to the blood supply of the femoral head from treatment. If not detected and treated early, this damage can lead to the destruction of bone cells (avascular osteonecrosis). The bone may then grow abnormally, become deformed, and later develop osteoarthritis.

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Author:	Shannon Erstad, MBA/MPH Carrie Henley	Last Updated: July 23, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas S. Renshaw, MD - Orthopedics Andrew Swan, MD, CCFP, FCFP - Family Medicine
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