DDH

• Baby Hip Clinic

  • Is a regional service
  • Children from birth to two years
  • Referrals from any practitioner qualified to complete NIPE
  • Approximately 3500 referrals a year to Musgrave Park
  • Regionally, ¼ of infants born are screened
• Incidence of DDH


  • Approximately 5 in 1000 infants
  • Approximately 300 babies treated per year
  • 8 of 10 cases are females
  • Surgeries greatly reduced in the past decade
  • More babies treated for dysplasia
  • Movement from Population Surveillance towards Screening in future?
• Developmental Dysplasia of the Hip

  • NORMAL
  • DYSPLASTIC
  • DISLOCATED
• Risk Factors

  • Family history
  • Breech
  • Female and first born
  • Fixed foot deformities
  • Torticollis
• Cephalic v Breech presentation, note the infants' hip joints.
• Clinical Examination

  • Infants aged under 4 months
  • Barlow and Ortolani tests
  • Leg lengths- Galeazzi test
  • Range of hip abduction
  • Skin creases only in conjunction with other signs
• Barlow Test

  To detect a dislocatable hip
• Barlow Positive infant; hip is dislocatable
• Ortolani Test


  • To detect dislocated hip
  • "O" is for "OUT"
• Positive Ortolani test- dislocated hip reduces
• Clinical Examination

  • Children aged over 4 months
  • Range of hip abduction
  • Leg lengths- Galeazzi Test
  • In the walking child may cause limp or Trendelenburg gait
  • Uneven skin creases in conjunction with other signs
• Normal infant with good abduction, equal bilaterally
• Do not test leg lengths by pulling a young infant's legs 'straight' you must bend at the knees to see leg length accurately.
• • Hip clicks
  • Examiner needs to determine that it is an innocent click that is elicited and there is no instability or abnormal movement in the joint
• • Asymmetrical skin folds
  • are there any other abnormal signs?
• Basic Hip Care

  • Incidence varies globally and how babies are handled may improve or exacerbate DDH:
  • Supervised tummy time
  • 'Baby-Wearing' – carrying infants across a parents body with legs wide
  • Swaddling
  • Allowing an infant to lie tilted to the same side often – encourage or support baby to lie straight
• Radiograph Vs Ultrasound Scan

  • Age of infant determines medical imaging:
  • 0-6months Ultrasound scan
  • 6months+ Plain Radiograph (X-ray)
  • Hip joint is not well visualised by x-ray until 6 months old as the articulating joint surfaces are cartilage
  • Imaging is safer and treatment more effective for younger infants
• Early Treatment

  • High success rate
  • Less invasive for the child and family
  • Painless
  • Avoids Gait problems developing
  • Avoids pain and surgery in adult life
  • Is much cheaper!
• Pavlik Harness


  • Is the 1st-line, conservative treatment for DDH
  • Only effective for infants 0-6months old
  • Very high success rates for infants 0-4months
• Ring Splints

  Can be effective for older infants 6-12months with mild DDH (i.e. socket is slightly shallow or dysplastic)
• Treatment for irreducible hips and older children

  Often requires surgery and Hip Spica casting
• • Late Diagnosis:
  • Often requires surgery
  • Often outcomes are good from surgery
  • Is stressful for families
  • Is invasive
  • Is expensive
• Complications


  • Avascular Necrosis
  • Interference to the blood supply to the head of the femur
  • Femoral Nerve Palsy
  • Pressure/Damage to the femoral nerve
• Main Risk Factors


  • breech presentation
  • a family history of the condition
• Clinical signs


  • Ortolani and Barlow in younger infants
  • restricted range of movement
  • leg length discrepancies in any infant
  • Limp and gait difficulties in walking children
• Pavlik Harness is the treatment of choice. It is safe, effective, non-invasive and not painful for infants.
• Any H.V. can refer, contact us at the clinic if you are unsure.