What is Infant Hip Dysplasia?

Hip dysplasia, also known as developmental dysplasia of the hip (DDH) or congenital dislocation of the hip, is a condition that affects the infant’s hip joint. It occurs because the hip socket is too shallow to cover the head/ball of the thigh bone. 

In DDH, the ball of the thigh bone may be partly outside the socket. It may also be completely out of the socket, which is a type that affects 1 in 500 babies.

In some cases, the head of the thigh bone may slide in and out of the socket. 

Infant hip dysplasia may develop on one or both sides, but it usually affects the left hip three times more often.

If left unmanaged, the hip joint will fail to grow well. This can lead to pain and/or limping while walking and hip arthritis. 

Signs of Hip Dysplasia

Parents or caregivers may notice the following signs:

• Hips that pop or click when moved
• One leg appears shorter (affected side)
• A hip or leg that doesn’t move like the other side
• A thigh or buttock fold that doesn’t line up with the other side
• Widened area (perineum) between the genitals and the anus (both hips dislocated)
• A leg that drags while crawling
• Limping while walking

Healthcare providers check all babies for signs of infant hip dysplasia in the first 6–8 weeks during their well-child visits. For high-risk babies, the provider may order an ultrasound for those under 6 months of age. They may also order an X-ray for babies aged 4–6 months. 

Given these interventions, DDH is often diagnosed in the first few months. However, it is important to note that signs of hip dysplasia may appear later at 2–3 years of age. As such, it’s crucial to inform the healthcare provider ASAP once the above signs appear.

Causes of Infant Hip Dysplasia

While the exact cause behind DDH remains unknown, the following factors can increase risk:

• Family history of hip dysplasia 
• Gender - DDH affects 1 in 600 girls compared to 1 in 300 boys
• Firstborns, as the uterus is still ‘tight’; 
• Breech (bottom or feet-first) position
• Multiple pregnancy due to crowding in the uterus
• Child of a first-time mother as she may have a difficult, prolonged delivery due to ‘inexperience’
• Tight swaddling, resulting in infant hip dysplasia 

Hip dysplasia is usually present in babies with spina bifida, a condition where the spine is undeveloped; or cerebral palsy, which affects the infant’s balance, posture, and movement. 

Infant Hip Dysplasia Treatment

About 1 in 100 children will need to undergo hip dysplasia treatment. The good news is that 95% can be successfully treated. 

The goal of treatment is to keep the ball of the thigh bone in the hip socket so that the joint grows normally. And depending on the severity of the condition, the pediatric orthopedic surgeon may recommend the following options: 

Observation

Babies aged 3 months and below who have signs of hip dysplasia may only need to undergo observation. Since their hip is still ‘stable,’ there’s a huge probability that their hip joint will develop properly in the weeks or months to come.

Braces

A brace called a Pavlik harness is usually placed on babies 6 months and below. This shoulder harness is attached to foot stirrups, thus keeping the ball of the thigh bone in the socket.

This treatment for infant hip dysplasia usually lasts for 6–12 weeks. The healthcare provider will check the baby every 1–3 weeks to determine if brace adjustments need to be done. 

Should the Pavlik harness fail to keep the hip joint in position, the surgeon may place an abduction brace to support the baby’s hips and pelvis. This brace is left in place for 8–12 weeks. 

Closed Reduction With Cast

If signs of infant hip dysplasia (congenital or carrier-caused) persist even after the use of braces, or if the baby only starts treatment after 6 months of age, the surgeon may perform a closed reduction with casting. They will move the thigh bone back to the socket and keep the baby in a hip spica cast for 2–4 months.

Open Reduction With Cast

If the closed reduction procedure is unsuccessful, or if the baby only starts treatment at 18 months of age, then an open reduction is warranted. In this procedure, the surgeon will operate on the baby to put the ball of the thigh bone back into the socket. In some cases, they may try to deepen the socket to keep the thigh bone in place.

The child with infant hip dysplasia will then be placed on a hip spica cast for 6–12 weeks. 

Preventing Infant Carrier Hip Dysplasia

Although rare, some babies develop signs of hip dysplasia after birth. This usually occurs when the baby’s hips or legs are tightly swaddled. 

That said, this should not deter parents or caregivers from baby-wearing. When doing so, the baby’s legs need to have a lot of wiggle room so that they can move their hips and kick about freely. 

More importantly, parents or caregivers should opt for infant carriers that prevent infant hip dysplasia. Abiie®’s Huggs® Hip Seat Baby Carrier With Patented Hipbelt and Huggs® Hip Seat BaseLite are designed to place the hips in the “M” position. This promotes hip development while reducing strain on the user’s back. The International Hip Dysplasia Institute has deemed these products “Hip-Healthy Products.” 

The Takeaway

DDH is a condition that affects the infant’s hip joint. Why it occurs is still unknown, but several factors can increase a baby’s risk. 

Signs of hip dysplasia include a clicking/popping sound, a shorter leg, a hip/leg that doesn’t move as much, and thighs/buttock folds that don’t line up. Kids who are already walking may experience some limping.

Treatments for infant hip dysplasia include observation, braces, and closed/open reduction with casting.

Hip dysplasia due to infant carrier use may also occur if the baby’s legs are swaddled tightly. To prevent this, parents and caregivers should use ergonomically designed carriers —like our Huggs® carriers. They are designed to keep the hips in the recommended “M” position so that they continue to develop normally.