Developmental Dysplasia of the Hip (DHH)
DDH describes a spectrum of conditions related to the development of the hip in infants and young children. It encompasses abnormal development of the acetabulum and proximal femur, and mechanical instability of the hip joint.
Action: Key Assessment points
- Lower limb symmetry; check leg length and skin/gluteal creases
- Barlows/Ortolani test
- Restricted or asymmetrical hip abduction (should be > 80 degrees and equal right and left)
- Check for Waddling gait/limp (when walking age)
Action: Referral not indicated
- Child has full hip range of motion, no instability or asymmetry
- Baby has had a normal hip USS
Action: Refer for a Hip Ultrasound scan if:
Baby is under 10 months of age and has:
- A positive Barlow or Ortolani indicating a clinically unstable hip, obvious asymmetry or reduced hip abduction
- A risk factor for hip screening including family history (1st Degree: Siblings or parents), breech presentation (from 36 weeks gestation), oligohydramnios , intrauterine moulding (torticollis / SMT / windswept / calcaneovalgus feet / metatarsus adductus)
- A risk factor that has been identified in a twin/ multiple pregnancy – all babies should be scanned
NB: if baby is less than 12 weeks old, US referral should be urgent, as conservative treatment (Pavlik harness) cannot be commenced over this age.
Action: Refer for Pelvis X-ray if:
Baby is over 10 months of age and has:
- Leg length asymmetry and skin / gluteal crease asymmetry
- Restricted or asymmetrical hip abduction (over 80 degrees, and symmetrical)
- A waddling gait or mobilises with a limp
Action: Refer to Paediatric Orthopaedics
USS or XR is abnormal and baby falls outside of window of treatment for Pavlik harness application (usually over 12 weeks)
Action: Information leaflets
STEPS charity leaflet ‘Baby Hip Health’. StepsCharity.org
International Hip Dysplasia Institute What is Hip Dysplasia? - International Hip Dysplasia Institute
