Developmental dysplasia of the hip (DDH) is a condition where the hip joint doesn’t develop normally. Early diagnosis and prompt treatment are crucial for the best outcomes. When a healthcare provider suspects DDH, referral to a pediatric orthopedist is the standard next step.
For newborns to 6-month-olds, the standard of care for diagnosis starts with physical examinations. Doctors routinely perform the Barlow and Ortolani tests to assess hip stability. An immature hip that is stable (Barlow negative) and resolves on its own typically needs no treatment, only close observation with routine physical exams and a follow-up ultrasound to confirm normal hip development. If the hip is Barlow positive at birth but becomes stable within the first few weeks, a similar approach of monitoring and later ultrasound is recommended.
However, an unstable hip that is Ortolani positive requires early intervention. In these cases, the standard of care shifts to immediate treatment to facilitate proper hip joint development. The Pavlik harness is the most common initial treatment for infants in this age group. This dynamic brace positions the baby’s legs in flexion and mild abduction, which encourages the hip to reduce into the joint and remain there. Infants fitted with a Pavlik harness need bi-weekly adjustments to the straps. Ultrasound evaluations are regularly used to monitor progress and confirm hip reduction throughout the Pavlik treatment, which usually lasts for about 2-3 months until ultrasound parameters are normal and the hip is stable on examination. Long-term follow-up until skeletal maturity is essential to ensure continued healthy hip development.
For children diagnosed between 6 months and 1-2 years old, or for those who don’t stabilize with Pavlik harness treatment, the standard of care involves general anesthesia for either closed or open hip reduction followed by spica casting.
In children older than 2 years at diagnosis, achieving hip reduction becomes more complex. The standard of care for this age group often necessitates extensive open surgical procedures, potentially including femoral and pelvic osteotomies to reshape and realign the bones. A spica cast is then applied after surgery.
The success of hip dysplasia treatment is significantly influenced by the child’s age at diagnosis and the effectiveness of hip repositioning. Infants treated within the first 6 months of life using the Pavlik harness often achieve full recovery and normal hip development without long-term issues. However, with increasing age at treatment and less successful initial reductions, the likelihood of needing further surgeries or developing hip arthritis later in life increases. Therefore, adhering to the standard of care for diagnosis and initiating prompt, age-appropriate treatment are paramount in managing hip dysplasia and ensuring the best possible outcomes.
