AKT · Child health/Growth, GI & MSK

Developmental dysplasia of the hip

Abnormal hip development (acetabular dysplasia/instability)

Overview

A spectrum from acetabular dysplasia to frank dislocation, detected by newborn screening (Barlow/Ortolani) and selective USS. Risk factors: breech, female, family history, firstborn, oligohydramnios.

Recognise

Newborn: positive Barlow (dislocatable) / Ortolani (relocatable) on screening
Later: asymmetric skin/thigh creases, limited hip abduction, leg-length discrepancy
Walking age: painless limp / waddling gait

Red flags

Late presentation; bilateral disease (subtle); irreducible dislocation

Differentials & how to tell them apart

Transient synovitisacute painful limp after viral illness, not congenital instability

Septic arthritisunwell, febrile, refuses to weight-bear — emergency

Perthes / SUFEolder children; different age groups

Investigations

Newborn exam (Barlow/Ortolani). USS hip <6 months (selective: breech, FH, abnormal exam). X-ray after ~4–6 months once ossified.

Management

Pavlik harness (if detected <6 months)

1Detected early (<6 months): Pavlik harness to hold the hip reduced.Gate: Failed harness or later presentation → closed/open reduction and hip spica cast
2Selective USS screening for risk factors (breech, FH); examine all newborns.

Pavlik harness — <6 months, holds hips flexed/abducted

Closed/open reduction + spica — if harness fails or later presentation

Key points

Breech presentation and a positive family history trigger selective USS even with a normal exam. Late DDH causes a painless limp.

Monitor & prognosis

Serial USS/X-ray; hip development.

Excellent if treated early; late disease → osteoarthritis.

Source: NICE; newborn screening (NIPE)