Hip Dysplasia

Around 11 children a day are diagnosed with hip dysplasia in Australia. In South Australia, 10 to 15 per year are diagnosed after 6 months of age. Some children are diagnosed at preschool age and some may not be diagnosed until teenage or adulthood.

DDH stands for developmental dysplasia of the hip, it is also called hip dysplasia. It's a condition where the ball and socket of the hip joint don't form properly.

Often there are no symptoms at all so we screen for it as part of the examinations performed on newborns and young children. Nurses, doctors and other professionals check the hip movements to see if the ball can be displaced from the socket. Unfortunately these tests can be tricky to perform and aren't positive in every child with hip dysplasia. Some children develop signs later on. Signs in an older infant are being unable to spread their legs apart equally when changing nappies. In a child who has started walking, they may tiptoe on one side.

If it's picked up early, there is a good chance that it can be treated successfully with a splint. Older children are more likely to need surgery and a cast for a number of months. This is called a spica cast and it covers the tummy and legs and holds the hip in place.

A big risk factor that is preventable is swaddling or wrapping newborn babies with their legs forced together. It's important to allow young babies' hips to flex up and spread apart naturally. Babywearing and carriers that allow the legs to spread apart in the "M" position may help prevent hip dysplasia.

““Initially we found the diagnosis quite confronting: we were told our seemingly perfect baby had something wrong with her.””

The first reason I have been interested in researching DDH is that in South Australia for many years, the vast majority of children with DDH were diagnosed under 3 months of age. Over the last 20 years, we are seeing many more children diagnosed at an older age, with many already walking when diagnosed. Our research team at the Women's and Children's Hospital has identified some risk factors for late diagnosis such as being born in a rural hospital and also, having few of the recognised traditional risk factors for DDH. Breech presentation and being the first born child are strong risk factors for DDH overall but are actually associated with a decreased rotten risk of a late diagnosis.

We also need to research DDH because there are still so many things we don't know about what causes it, how we can diagnosis it better, what is the best type of splint and what is the right treatment time and follow-up? At WCH we ask the families of children with DDH whether they are happy for their child to be enrolled in the International Hip Dysplasia Registry. Adelaide WCH has been collaborating with researchers around the world to answer some of the unknown questions. This research has already identified groups of children for whom the common types of splints don't work reliably. DDH is a spectrum from severe dislocations to subtle changes in shape of the ball and socket and every child is different. With research we hope to discover the best way to detect the condition as early as possible in every child and to be able to recommend treatment that is individualised to each child and had the best possible chance of success.

Courtesy Associate Professor Nicole Williams, Head of Orthopaedic Surgery, Women’s and Children’s Hospital, Adelaide

The Patient

At what age was your daughter diagnosed with DDH? When did you realise something was wrong?

Gisele was born by elective c-section - due in part to being in a breech position. When the attending paediatrician examined her he mentioned the possibility of hip dysphasia; however, as it seemed subtle he recommended we wait to see if it had resolved by the age of six weeks. Unfortunately,  at Gisele’s six week check-up her hips were still noted to be ‘clicky.’ We were referred to Dr Cundy (orthopaedic surgeon) and following a scan he confirmed the diagnosis of hip dysphasia. 


Can you briefly detail the process that lead to her recovery? What was the hardest part for you and your family? 

Following the scan of Gisele’s hips she was referred to a physiotherapist who fitted a brace known as a Pavlik Harness which had to be worn 24/7 for ten weeks. We re-visited the physiotherapist every couple of weeks to have the brace adjusted and had follow-up visits with Dr Cundy to monitor Gisele’s progress. 

Unfortunately, following the completion of ten weeks in the Pavlik Harness, an x-ray revealed Gisele’s right hip issue still wasn’t resolved and she had to wear another brace until the age of fifteen months. 

Initially we found the diagnosis quite confronting: we were told our seemingly perfect baby had something wrong with her. It was hard to see our baby girl having to come to terms with what looked like a pretty brutal and uncomfortable contraption from the Dark Ages and our whole routine had to change by way of managing new positions to feed her, we couldn’t bath her, she couldn’t fit into her newborn capsule or bassinet and most of the little outfits she had she could no longer wear. Every time Gisele saw the physiotherapist and her brace was adjusted, we had a sleepless night as she was obviously uncomfortable. 

How is your daughter’s health following her treatment?

At the age of fifteen months Gisele’s Dr discharged her as he was confident her hips were within expected norms.

Although it was confronting at the time, we were and are very thankful that it was a condition that could be fixed non-surgically and in the bigger picture, in a non-evasive way.  We are also very grateful for the medical care we received right from the onset of Gisele’s diagnosis. Because she was identified and subsequently treated it’s anticipated that she won’t suffer from any life-long complications - we are very fortunate to be living in a country where screening is routine and we have access to such competent care. 

Whilst she struggles with strength, she loves ballet, gymnastics and swimming and is an active six year old.