DDH (Developmental dysplasia of the hip)

What is DDH?

DDH is when the baby's hip joints do not form well. In this condition, the ball part of the hip joint is partly or completely out of the socket. In some cases, it may slide in and out occasionally due to a shallow socket (acetabulum). If this is not treated on time, it can result in serious issues like hip arthritis and back pain at a very young age (particularly if it is on one side).

The condition can begin as early as when the baby is unborn or can develop after birth as your child grows. In children, it affects one or both hips.

Causes of DDH

DDH can affect any individual or any hip. However, certain babies are more prone to the condition, like:

• Girl child
• Firstborn babies
• Babies born in a breech position
• Babies with parents or siblings with DDH
• Babies whose mothers have low amniotic fluid during pregnancy

Types of DDH

The degree of DDH varies among children, but these are the two types of DDH that are commonly found: 

• Subluxation: It is a mild case of DDH, where the head of the femur bone lies loosely in the socket but does not come out completely.
• Dislocation: It is a more severe case of DDH, where the head of the femur usually lies completely out of the socket. Sometimes, it may lie within the socket (acetabulum), but it can be easily pushed out of the socket.

Symptoms of DDH

Since DDH does not cause pain to babies, recognising it can be hard for parents. Generally, doctors check the hips of all newborns and babies to check for signs of DDH. Yet, there are some symptoms that you should not ignore:

• A popping or clicking sound from the hips
• Limping when a child starts walking
• Different lengths of the baby's leg
• A hip or leg that doesn't move like the other
• Uneven skin folds on thighs and buttock

Treatment at Maruti Clinic for Children Orthopaedics

If your child shows any of the visible symptoms of DDH, we will perform a physical examination of the child to check for signs of DDH. We will place the baby's legs and hips in certain positions and listen for clunking sounds. 

If your child is a newborn or between 0-6 months old, we perform an ultrasound to create images of the hip bone. This helps us understand the position of the head of the femur and plan treatment accordingly. For older babies and infants, we prefer X-rays as they provide a detailed picture of the hip bone because as your child gets older, their bone shows up better on X-rays.

Based on our assessment, severity of the condition, and age of your child, we recommend the following treatment options: 

Non-Surgical Treatment:

If DDH is detected at birth, we correct it using a harness or brace. There are two options available for the same:

• Pavlik Harness: It is a very simple appliance made of soft cloth fiber so that it does not hurt the newborn. The harness must be worn throughout the day initially, as it aligns the newborn's hips with the acetabulum.
• Abduction Brace: It also acts like the Pavlik Harness but is made out of plastic

Surgical Treatment

In severe cases of DDH or when the child has come late for treatment, surgical options are explored. 

For babies, closed hip reduction is preferred, if possible. In the case of older children and teenagers, open reduction with osteotomy is performed. 

It is advisable to come for a timely check-up at Maruti Clinic so that we can detect DDH early and provide prompt and precise treatment for your precious child.