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Developmental dysplasia of the hip (DDH) describes a range of conditions of the hip.

The hip should be a ball and socket joint. The condition ranges from a shallow, poorly developed hip to a hip which is dislocated (out of joint).

In the UK, approximately 1 in 1,000 children may require surgery for dislocation of the hip. Other children may not require surgery but will be treated in a brace/splint over the first few weeks of life. Although the majority of children may develop an abnormal hip for no particular reason, some hips may be more “at risk” than others. Some of the risk factors are:

  • Breech presentation: most important risk factor
  • Strong family history: most important risk factor
  • Some foot abnormalities
  • Some neck abnormalities

Girls are more commonly affected than boys (80% female). All children are checked for hip problems at birth (usually within 48hrs). If there are any concerns about the hip, the child will usually be sent to an Orthopaedic Surgeon for a further hip check.

As well as a hip check, an Orthopaedic Surgeon or other specialist may check the hip using an ultrasound scan (usually within 2 weeks). The ultrasound scan is helpful as it will check if the hip is normal, shallow or dislocating and it is more helpful than the hip check alone.

Children in “at risk” groups are usually checked by an ultrasound scan at a later date, usually between four and six weeks of age.

If the child’s hip has a problem, the hip is usually treated with a Pavlik brace/harness (you will be shown a picture of a baby wearing a brace). This is a loose harness for the treatment of poorly developed or dislocated hips. This has been used successfully in Blackburn for over 30 years. The brace was developed to keep the head of the hip in the socket of the joint. In the majority of children, this is successful in treating the hip problem without surgery.

The brace should be used twenty-four hours a day (day & night). It should not be removed. The brace is usually used for six weeks. Loose clothes should be worn over the brace in order to keep the hip in the correct position. The hip is usually checked with an ultrasound scan at three and six weeks to check that the hip is developing satisfactorily.

The position of the brace/ harness is important, and the ideal position of the hips will be discussed with you by the consultant doctor and nurse. The hip should be flexed between 90-100 degrees and abducted by 30-60 degrees (this position will be explained to you during the consultation). This is called the “safe position”. Complications are rare if the brace/ harness is used correctly and these are usually minor and short-term.

What is a hip spica?

It may be necessary for your child to have a hip spica cast applied. This is usually applied in theatre by a specialist team and your child’s consultant. The hip spica cast is used to immobilise the hips. The material used is plaster of Paris and takes up to 48 hours to dry out. The plaster cast extends from your child’s waist down the full length of the affected leg and down to just above the knee on the unaffected side.

An area is left open for toileting purposes, so a nappy can still be worn. Usually the day after your child’s surgery you and your child will go to the plaster room so that any adjustments and trimming of the cast can be made. The cast will be reinforced at this stage with a lightweight material.

All the edges of the cast are covered with felt padding to provide a soft edge. You will be encouraged to do this at home and be provided with a supply. The staff in the plaster room are highly skilled individuals who are there to support you and your child.

Some useful advice:

It is important that the plaster cast is kept dry at all times. Any wetness can be a potential problem to your child’s skin underneath the cast causing redness or broken sores.

If the cast becomes wet it will soften and disintegrate, therefore losing its integrity and not holding the child’s hip in the correct position.

Change your child’s nappy more frequently and use a nappy pad/sanitary towel gently tucked into the opening of the plaster cast and then put the nappy over this. Whilst you are doing this it’s a good time to make sure the plaster cast is not rubbing on any edges.

Obviously you need to dress your child, so it is advisable that you use loose clothing or make adjustments to clothing. Depending on the age of your child a beanbag can be used for meal times and playtime purposes. Your child will adjust to the plaster cast very quickly as will you.

The plaster room staff are there to support you and your child, if you have any concerns or worries do not feel that you have to wait until your next appointment contact the plaster room.

Contact numbers:

A Pavlik brace is a loose harness for the treatment of poorly developed or dislocated hips in babies (DDH/CDH). This has been used successfully in Blackburn for over ten years.

Diagnosis:

Following a hip check an ultra-sound scan of the hip (or occasionally an x-ray) will confirm if the hip is abnormal (coming out of joint or shallow). The brace is a treatment to allow the hip to improve or become normal. 80-90% of DDH cases will be successfully treated by this method.

Safe Position/fitting:

The brace will be fitted in the clinic by the doctor/nurses. The safe position of the brace will be shown and discussed. The brace position is important. Complications are rare if the splint is used in the proper way. This brace should be used all the time for twenty-four hours. It should not be taken off at all. It is usually used for a total of six weeks.

Loose clothing should be used over the brace to allow the correct position of the brace to be maintained. This will be discussed in the clinic.

Review:

The child is usually reviewed on a weekly basis to check that the position of the brace has been maintained and in order that any problems or concerns with the brace can be discussed in the clinic. The hip is usually checked with an ultra-sound scan at between three and six weeks to check if the hip is improving.

If there are any problems or concerns with the brace please contact the clinic on the following numbers:

Additional information:

STEPS is a children’s charity which is dedicated to helping children with abnormalities of the lower limbs.

This is a rare condition where the blood supply to the hip joint is temporarily interrupted resulting in pain, a limp and stiffness.

This is more common in boys than girls. The cause is not known. It is not catching. There may be a family history in about 10% of people.

Various cases have been looked at including diet and activity,
but no definite causes have been confirmed. It occurs between the ages of 3 to 12 years of age (most commonly between 5 to 7 years of age). 90% of children should do well. Only some may develop hip arthritis as an adult. This would be due to the hip joint becoming misshapen in the worst cases. The best results are usually in children under the age of six. “Bad hips” in girls may do worse than in boys.

Surgical treatment:

Surgery is used for the worst cases. Varus/valgus osteotomy of the femur (an operation to change the shape of the hip joint).

In this uncommon operation the upper thigh bone is divided to
improve the position of the hip in its socket. This may improve
the shape of the hip and help the pain and the long-term result.

  1. A plate and screws on the thigh bone are used. The plate and screws are usually removed at a second operation some months later.
  2. Shelf procedure. In the worst cases, an operation is done on the pelvic bone in order to make a “shelf” over the hip head. This is very rarely needed.

If surgery is required either on the thigh bone or the pelvis,
the child is usually in the hospital for several days and after the operation may need a wheelchair and / or crutches for several weeks.

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