Reviewed by Wudbhav (Woody) N. Sankar, MD
Reviewed on 06/05/2026
What is developmental dysplasia of the hip (DDH) in babies?
Developmental dysplasia of the hip (DDH or hip dysplasia) is a common condition, occurring once every 1,000 live births. The hip joint is made up of a ball (femur) and socket (acetabulum) joint. In DDH, this joint may be unstable with the ball slipping in and out of the socket.
In addition, the socket is often shallow, which can increase a person’s risk of developing arthritis and joint pain later in life. Hip dysplasia has a wide spectrum of severity ranging from a mildly shallow hip socket to a completely dislocated hip.
The greatest incidence of DDH occurs in first-born females with a history of a close relative with the condition and/or history of breech position in utero.
What causes developmental hip dysplasia?
The exact cause of hip dysplasia in babies is unknown. It is likely that many factors play a role, including:
- The baby’s response to the mother’s hormones during pregnancy
- A tight uterus that prevents fetal movement
- Baby in breech position
- The left hip is involved more frequently than the right due to intrauterine positioning
- Infant positioning in the first year of life
- Infants wrapped around a caregiver such that the hips are held apart generally have lower rates of DDH
- Infants swaddled or placed in a papoose with their hips extended have higher rates of hip dysplasia
Risk factors for DDH
First-born babies are at higher risk since the uterus is small. This means there is limited room for the baby to move. This can affect the development of the hip.
Other possible risk factors for DDH include:
- Family history of developmental dysplasia of the hip or very flexible ligaments
- Position of the baby in the uterus, especially with breech presentations
- Associations with other orthopedic problems that include metatarsus adductus, clubfoot deformity, congenital conditions, and other syndromes
- Frequent swaddling with the hips out straight (extended)
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Wudbhav N. Sankar, MD: So infant hip dysplasia or developmental dysplasia of the hip is a developmental condition that occurs around the time of childbirth, and it really represents a wide spectrum all the way from the severe form of the disease, which is a complete dislocation where the hip is completely out of the socket, to the mild form of the disease, where the hip is in the socket, but the socket's just a little bit shallow. Contrary to what some people would think, even a full hip dislocation is actually not painful to an infant. Most infants that have hip dysplasia actually have no symptoms whatsoever. So if you're a parent, you're not going to tell that your child does or doesn't have hip dysplasia. Now, pediatricians, as part of their routine screenings, are always going to check for this.
So they're going to move the hips every time they see the baby and they're taught, through their training to screen whether the hip is coming in and out of the socket. But the only way to actually diagnose that milder form of the disease where the hip is shallow, is really by getting an ultrasound. It allows us to get really excellent pictures of the hip, to understand what the anatomy looks like and what the position of the hip is.
We can even test the stability under ultrasound. And really importantly, it does not require any sedation. It does not expose the infant to any radiation. The goal when we treat kids with infantile hip dysplasia, is to normalize the hip. First, we've got to get the hip to settle deep into the socket. You can't achieve any of your other goals unless you get the hip to settle deeply in the socket and what we call concentrically in the socket.
Once the hip is in the socket, our secondary goal is to get that socket to develop, to kind of deepen and cover the ball, because that's what really supports the longevity and health of the hip, as you move forward decades into life. We always try non surgical treatment options and generally those are quite successful.
One of the most common devices is called the Pavlik harness. That's a Velcro strap apparatus that allows that femoral head or the hip to dock into the socket and helps promote that socket to develop. But that's really just one device. There are several other devices, some that are a little bit more rigid.
Some that hold the hips a little bit straighter, some hold them a little bit more bent and we often use very different devices for different patients so we can get the right fit of the right device to try to really maximize our success rate with non surgical options.
The infant hip is a little bit like clay. You have the ball and you have the socket. And the way the ball knows how to form round is because the socket is forcing on it during early development. Similarly, the only way the socket knows how to form deep is if the ball is pushing on it. So all of these hip dysplasia devices encourage the ball to settle deep into the socket, and that pressure that the ball pushes on the socket causes that clay, or the socket, to kind of grow and deepen around the ball itself.
What's really remarkable about hip dysplasia is that even in the setting of a dislocated hip, or a severely shallow hip, the hips are growing so rapidly at this age, and the babies are maturing so rapidly, that even something like that can be almost completely normalized in two to three months, which just speaks to the rapid development and the fascinating ability to remodel the human body.
Now, even though non surgical treatment is generally successful, there are obviously some situations where bracing doesn't work and a child has to have surgery. I tell all my families that we do the least amount of surgery to accomplish the goal. And the goal is to get the ball deep into the socket and to get that socket to develop as well as it can.
So the first option, once we put a child to sleep under anesthesia, is a closed reduction. That means we are manipulating the hip externally without making an incision to put the ball into the socket. If, however, the hip does not go, or if it doesn't go in deeply, or if it doesn't feel stable after it goes in, then under the same anesthesia, at the same time that the child is asleep, we make a small incision, we open the hip socket, we put the hip in under direct visualization, we get rid of all that stuff that's blocking the hip from finding its home, and then we close everything up.
Regardless of whether you do a closed or an open reduction, once you get the hip into position, you have to hold it in that position. And that's where the spica cast comes in play. That's the body cast that goes from about the nipple line down to below the legs. And by holding the hip in that position, that allows that socket to mold around the ball and allows that ball to get used to its position.
So depending on the surgical treatment that's done, the time in the spica casket can vary between 6 to 12 weeks. And there's no doubt that the spica cast is the most challenging part of the treatment plan, certainly for parents. We have a great team at CHOP, including a dedicated hip dysplasia nurse that spends a lot of time with the families, teaching them how to do clothing, how to do positioning, how to position for breastfeeding, how to get them into a car seat, and so on, so that the whole process is safe for the baby and as comfortable for the baby as it can be, and as comfortable for the family.
For the vast majority of infants that have been diagnosed with hip dysplasia, who we identify early in life, who get treated with a brace or a harness, you can expect essentially a normal hip. Most of these kids do very, very well with normal childhood running and playing, playing all the sports that parents expect for them and having a healthy, productive life.
For those patients that need to go to surgery, the success rates are really quite high, but experience is absolutely crucial. Going to a high volume center where they take care of a lot of infants, both with closed reductions and open reductions, is really key. So we at CHOP draw patients from all across the country and all across the world, and they come here because of our expertise and our large volume in taking care of patients.
We're a leading center at the Hip Dysplasia Study Group, and that's what's helped guide many centers around the country to figure out how best to treat their infants. I love taking care of infants with hip dysplasia. It's one of my favorite parts of my practice. And the reason is because I get to meet these babies at the time that they're born and we can identify a problem and non surgically we can often cure these hips.
I really develop great relationships with these families. And it's really special for me when I see these babies that I knew either were in a cast or in a brace and to see them and hear what they're doing when they're 13, 14, 15 years of age.
What are signs and symptoms of hip dysplasia in infants?
Hip dysplasia symptoms are subtle during the newborn period. Hip dysplasia is painless during infancy and early childhood though it can cause pain and disability later in life if left untreated.
Possible symptoms of DDH include:
- A leg that appears shorter on the side of the dislocated hip
- A leg not spreading (abducting) as widely as the more typical side
- The folds in the skin of the thigh or buttocks appearing uneven
- A “clunk” felt with diaper changes or other positioning of the leg
Do babies with hip dysplasia walk?
Children with DDH typically learn to walk at a normal age. Depending on the severity of hip dysplasia, a child may have a limp or “waddle” while walking or running.
How does DDH affect adolescents over time?
Pain and leg length differences can develop during adolescence. In adulthood, shallowness in the hip socket is considered the number one cause of arthritis. It is also the most common reason why an adult may require a hip replacement (artificial joint).
How is hip dysplasia in infants diagnosed?
After birth, a pediatrician or newborn specialist will screen newborn babies for developmental dysplasia of the hip before they go home.
During the examination, the physician will ask for prenatal and birth history as well as family health history. However, not all hip dysplasia can be determined by physical examination alone.
Diagnostic tests your child’s doctor may use to diagnose hip dysplasia include:
- Ultrasound (sonography) - High-frequency sound waves and a computer create images of the baby hip joint. This test uses no radiation and is best for younger infants (6 months of age)
- X-ray - Electromagnetic energy beams produce images of the hip joint. This is the standard test used to diagnose or monitor DDH after 6 months of age.
- Computed tomography scan (CT or CAT scan) - A combination of x-rays and computer technology produce detailed, cross-sectional images of the hip, helping assess the shape of the bones and joint. CT scans are not typically used for diagnosis but may be used to confirm hip position after treatment.
- Magnetic resonance imaging (MRI) - A combination of large magnets, radiofrequencies and a computer produce detailed images of the hip. MRI does not expose infants to radiation and is the best imaging test to look at the soft tissues (ligaments, muscle, tendons) around and in the hip joint.
Hip dysplasia treatment for babies
Treatment for DDH will be determined by your baby’s physician. Hip dysplasia care plans will be tailored to:
- Gestational age, overall health and medical history
- Severity of the condition based on physical exam and imaging
- Baby’s tolerance for procedures or therapies
- Your opinion or preference
The goal of treatment is to put the femoral head back into the deepened hip socket so that the hip can develop normally. Treatment options for babies with dysplasia vary and may include:
Pavlik harness
The Pavlik harness is used up to 6 months of age. It guides the hip into place, while allowing the legs to move to some extent. The harness is put on by your baby’s physician and is usually worn full time for several weeks, then part-time for an additional number of weeks.
During this time, your child is seen frequently by doctors to examine the hip and check for proper harness fit. During treatment, ultrasound or X-rays will be used to check hip placement and socket development.
Most infants can be successfully treated with the Pavlik harness, but sometimes, their hips may continue to be partially or completely dislocated.
Other bracing options
An abduction brace (dynamic Ilfeld hip abduction splint) is more rigid and can be used beyond 6 months of age for older and larger infants.
These braces are set specifically for each child and have often been successful for infants who were not successfully treated with the Pavlik harness.
Other braces used at CHOP include:
- Tubingen hip flexion and abduction orthosis, commonly used in Germany
- Rhino or “bucket” hip abduction brace
CHOP is among the few pediatric centers offering all four bracing options.
CHOP also offers ultrasound at clinic visits so hip experts can fine-turn brace adjustments, increasing success rate for all bracing options.
Body casting (spica casting)
If the harness or braces are not successful, a procedure may be needed to put the hip back into place manually; this is known as a closed reduction. If successful, a custom molded body cast (spica cast) is put on the baby to hold the hip in place. The hip spica cast is usually applied from the chest down to the ankle and usually includes part of the unaffected leg as well.
The cast is worn for approximately three months. Bracing or physical therapy may be necessary after cast removal to promote deepening of the hip socket and to strengthen the muscles.
Cast care instructions:
- Keep the cast clean and dry
- Check for cracks or breaks
- Pad rough edges to protect the skin from scratches
- Do not scratch skin under the cast by inserting objects inside
- Use a hairdryer placed on a cool setting to blow air under the cast and cool down hot, itchy skin
- Never blow warm or hot air into the cast
- Do not put powder or lotion inside the cast
- Cover the cast during feedings to prevent spills from entering the cast
- Prevent small toys or objects from being put inside the cast
- Elevate the cast above the heart to decrease swelling
- Do not use the abduction bar on the cast to lift or carry the baby
When to call your baby’s physician:
Contact your baby’s physician or healthcare provider if your baby develops one or more of the following symptoms:
- Fever
- Increased pain
- Increased swelling above or below the cast
- Drainage or foul odor from the cast
- Cool or cold toes
Surgery for hip dysplasia in infants
If a closed reduction is not successful, an open reduction, which surgically repositions the ball within the socket, is considered.
This procedure involves opening the hip joint and directly visualizing the ball and socket. After open reduction infants will require a spica cast but generally for less time than after a closed reduction.
Long-term outlook for a baby with developmental hip dysplasia
Newborn screening for developmental hip dysplasia has allowed for earlier detection. If identified early, treatment for hip dysplasia is often successful. The later a child is diagnosed, the more likely it is that surgery will be necessary.
Even after successful treatment of hip dysplasia, follow-up care is very important as a child grows into an adolescent. The hip socket needs to be monitored to be sure that it, too, is developing properly.
Occasionally, additional surgeries are needed to deepen the socket and minimize the risk of arthritis as an adult.
Contact the Hip Disorders Program for expert care in DDH
CHOP’s Hip Disorders Program is a center for families seeking care for babies, children, teens and young adults with complex hip problems. We offer a complete range of non-surgical and surgical options. No matter where you live, CHOP experts are here to help, with nurse navigators ready to coordinate your family’s visit, as well as your child’s testing and treatment.
Treating Infants with Complex DDH
Treating infants with complex DDH requires the best diagnostic tools, a full range of brace options and when needed, complex surgery.
When Pediatricians Should Refer a Patient with Infant Hip Dysplasia
Dr. Sankar addresses common questions about infant hip dysplasia, when to request an ultrasound, bracing options and when surgery is needed.
Infant Screening for Developmental Dysplasia of the Hip (DDH)
Learn about when a referral for ultrasound and/or pediatric orthopedic consultation for babies with an abnormal physical exam or major risk factors for DDH may be warranted.
Why choose CHOP
The Hip Disorders Program at Children's Hospital of Philadelphia (CHOP) specializes in the diagnosis and treatment of all pediatric hip disorders.
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