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Depending on how shallow the hip socket is and other factors, the affected hip might be dislocated (sitting completely out of socket), subluxable (able shift in and out) or stable but shallow.

The treatments depend on that age at diagnosis and the severity of the dysplasia. It usually involves a brace rather than an operation. It is important to seek the opinion of a specialist paediatric hip surgeon if you are concerned.

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Developmental dysplasia of the hip (DDH) is a common condition in which the acetabulum (hip socket) is shallower than it should be. 

Depending on how shallow the hip socket is and other factors, the affected hip might be dislocated (sitting completely out of socket), subluxable (able shift in and out) or stable but shallow.

The exact cause is unknown; however, it is thought to be a combination of genetics and positioning in-utero.

Several well-established risk factors include:

  • Breech (foot first) positioning in the uterus
  • Family history
  • Being first born
  • Being female
  • Oligohydramnios (reduced amniotic fluid volume surrounding the foetus)

All newborn babies are assessed for hip stability before they are discharged from hospital, usually by a paediatric doctor or nurse. This is part of the routine ‘baby check’.

Signs of an unstable hip at that point might be a clunk with backward pressure on the thigh, asymmetric skin creases, a clicking sound, or asymmetric movement of the two hips. That said, asymmetric skin creases and clicks are quite common in normal hips.

Hip dysplasia is not usually painful in babies and young children, so they might be completely asymptomatic and their dysplasia only detected on an x-ray performed for another reason.

Late diagnosis of hip dysplasia is uncommon, but may happen due to a difference in leg lengths or limp noted after walking age.

An ultrasound is the best way to look at babies’ bones as much of the bone around the hip is still actually cartilage and doesn’t show up on x-ray. Most babies are diagnosed based on an ultrasound scan, or due to abnormal examination findings, followed by a scan.

In Australia, selective ultrasound screening is often performed for babies with increased risk factors as it can help with early detection. An ultrasound should also be performed if there are concerns during the baby check, or later health checks by community nurses or GPs.

Early diagnosis is important as it increases the success rate of treatment.

After 6 months of age, developmental hip dysplasia is best diagnosed or monitored with x-rays as the bones have had time to mature.

Hip dysplasia treatments depend on the age at diagnosis and the dysplasia’s severity. Treatment is usually non-operative, using a brace to change hip’ position and shape.

You may have seen babies of friends or relatives in braces for a period of time when they were little. These harnesses bring the thighs up and out so that the top of the thigh bone points more directly at the hip socket, encouraging it to mature and develop stability.

In true dislocation cases, the hip joint needs to be reduced. Depending on the age at diagnosis, this may be done using a brace or in an operating room under anaesthetic. In younger babies, the hip can often be relocated without surgery. A dye is often injected into the joint which shows up on x-ray and helps confirm the reduction, and a special cast is applied to maintain the hip’s position. Often one of the tight adductor tendons on the inside of the hip is released to reduce pressure – this can be done through a tiny incision in the groin.

If a hip can’t be manipulated back into position, surgery may be required. The goal of surgery is to open the joint, release soft tissues that are tight or blocking the ball’s passage back into the socket, and reduce the hip. A special cast then holds the hip in position.

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