Developmental dysplasia of the hip (DDH) is the common name for conditions in which the head of the thigh bone and the socket in the pelvis do not sit fully together. The picture ranges from mild laxity to complete dislocation. What matters is this: it is a problem treated with a simple harness if found in infancy, and with surgery if found late. That is why DDH is not a condition whose symptoms are awaited, but one that is screened for.

Why does early diagnosis matter so much?

In the newborn period the hip joint is still forming. When the head of the thigh bone is held in the right position, the socket develops accordingly. Treatment started in the first months aims to let the joint complete its own natural development. As months pass, the shape of the socket becomes fixed and the surrounding soft tissues shorten; treatment gets harder.

Who is at higher risk?

  • A breech birth — one of the strongest risk factors
  • Hip dislocation or early hip replacement in the family
  • Being a girl
  • Being a first baby, and limited space in the womb (twin pregnancy, low fluid)
  • Foot deformity or neck tilt (torticollis)
  • Traditional swaddling that wraps the legs straight and tightly

DDH also occurs in babies with no risk factors, which is why screening covers all babies, not only the risk group.

The screening programme in Turkey

In the Ministry of Health's Developmental Dysplasia of the Hip Screening Programme every baby is assessed by examination in the newborn period; babies whose examination is suspicious or who carry risk factors are referred for further assessment. The recommended time for hip ultrasound is the first 3-6 weeks of life, at the latest 4-6 weeks.

Ultrasound is preferred in this period because the infant hip is still largely cartilage and does not show on X-ray. After six months, as ossification progresses, assessment is made by X-ray.

What is looked at on examination?

The doctor assesses the hips with specific manoeuvres and also looks at:

  • Whether the legs open (abduct) equally on both sides
  • The symmetry of the thigh and buttock creases
  • Any difference in knee height with knees bent and feet together
  • Leg length difference

None of these findings makes the diagnosis on its own; examination and, where needed, ultrasound are assessed together.

How is it treated?

In the early period treatment uses soft devices such as the Pavlik harness, which hold the hip flexed and abducted. The baby feeds, sleeps and lives normally in the harness. The hip's response is followed by ultrasound at intervals and the duration set accordingly.

Hips found later, or those that do not settle in a harness, may need closed reduction and casting, and at older ages surgery. This explains why early screening is emphasised so strongly.

What families can do at home

  • Leave the legs free when swaddling. Hips should be able to open and bend; the legs should not be pressed straight and together.
  • When carrying, choose positions and carriers in which the baby's legs can stay open in an "M" shape.
  • Do not force the legs straight while changing nappies.
  • Do not skip check-up appointments; in DDH the only real protection is timely assessment.

When to seek help without delay

  • If one leg opens noticeably less than the other
  • If the thigh creases are clearly asymmetrical
  • If a walking child limps, waddles or has a leg length difference
  • If there is a risk factor such as breech birth or family history and the ultrasound has not yet been done

For other common musculoskeletal questions see our articles on bow legs and knock knees and flat feet. For your baby's hip assessment and well-child follow-up you can book an appointment at Özel Düztepe Yaşam Hospital in Şahinbey.