Hip Dysplasia (Developmental Dysplasia of the Hip)

Also known as: Developmental dysplasia of the hip, DDH (developmental dysplasia of the hip), Hip dysplasia, Congenital hip dysplasia, Congenital dislocation of the hip, Developmental hip dislocation, Shallow hip socket (acetabular dysplasia)

Last updated: December 18, 2024

Hip dysplasia (developmental dysplasia of the hip) is abnormal hip joint development where the acetabulum (socket) does not adequately cover the femoral head (ball), causing instability and altered mechanics that can lead to pain, early joint degeneration, and arthritis. It is often found in infancy but may be missed until adolescence or adulthood. Symptoms can include gradual hip or groin pain and pain with prolonged walking, standing, or activity. Treatment may involve a Pavlik harness in infants, and early treatment in infancy often leads to normal hip development.

Key Facts

  • •Hip dysplasia refers to abnormal development of the hip joint in which the acetabulum (hip socket) does not adequately cover the femoral head (ball of the hip)
  • •Hip or groin pain, gradual in onset
  • •Diagnosed through history, physical exam, and imaging
  • •First-line treatment includes exercise, weight management, and activity modification

What It Is

Hip dysplasia refers to abnormal development of the hip joint in which the acetabulum (hip socket) does not adequately cover the femoral head (ball of the hip). This instability and altered mechanics can lead to pain, early joint degeneration, and arthritis. While often identified in infancy, some cases are not detected until adolescence or adulthood.

Affected Anatomy

This condition affects several structures in and around the joint:

  • •Acetabulum (hip socket, typically shallow or abnormally oriented)
  • •Femoral head (ball of the hip joint)
  • •Acetabular labrum (often stressed due to undercoverage)
  • •Articular cartilage of the hip
  • •Hip joint capsule and ligaments
  • •Surrounding hip musculature

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

  • •Hip or groin pain, often gradual in onset
  • •Pain with prolonged walking, standing, or physical activity
  • •Catching, clicking, or locking sensation in the hip
  • •Feeling of hip instability
  • •Limping or altered gait pattern
  • •Stiffness or reduced range of motion
  • •Pain that may worsen with activity and improve with rest
  • •Some individuals may be asymptomatic until significant cartilage damage occurs

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

  • •Abnormal positioning in utero or limited fetal movement
  • •Genetic factors contributing to acetabular development
  • •Laxity of the hip joint capsule and ligaments
  • •Swaddling practices that force hips into extension and adduction
  • •Breech presentation during pregnancy
  • •First-born status (associated with decreased uterine space)

Risk Factors

  • •Female sex (more common in females)
  • •Family history of hip dysplasia
  • •Breech presentation during pregnancy
  • •First-born children
  • •Oligohydramnios (low amniotic fluid)
  • •History of hip instability or clicking in infancy
  • •Certain swaddling practices
  • •Associated conditions including torticollis or metatarsus adductus

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

  • •Physical examination in infants using Ortolani and Barlow maneuvers
  • •Ultrasound is the primary imaging modality for infants under 6 months
  • •X-rays are used in older infants, children, and adults to assess acetabular coverage
  • •Measurement of acetabular index, center-edge angle, and other radiographic parameters
  • •MRI may be used to assess labral pathology and cartilage status in adolescents and adults
  • •CT scan may help with surgical planning in complex cases
  • •Clinical assessment of gait, hip range of motion, and leg length

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

  • •Pavlik harness or other bracing for infants to promote proper hip development
  • •Closed reduction and casting if bracing is unsuccessful or if diagnosed later
  • •Activity modification to reduce joint stress

Physical Therapy and Exercise

  • •Physical therapy focusing on hip strength and stability

Surgery

  • •Open reduction surgery if closed methods fail
  • •Periacetabular osteotomy (PAO) to reposition the acetabulum in adolescents and young adults
  • •Femoral osteotomy may be needed if femoral abnormalities contribute
  • •Total hip arthroplasty for end-stage arthritis in severe cases

Prognosis and Recovery

The course of this condition varies between individuals:

  • •Early detection and treatment in infancy generally leads to normal hip development
  • •Delayed diagnosis may result in residual dysplasia and increased risk of early arthritis
  • •Joint-preserving osteotomy can provide good outcomes if performed before significant cartilage damage
  • •Untreated dysplasia often leads to premature hip osteoarthritis
  • •Long-term follow-up is important to monitor for degenerative changes

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Frequently Asked Questions

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