Developmental Dysplasia of the Hip

Treated in the first weeks with a harness, the great majority of hips develop normally. Detected at walking age, treatment means surgery, a period in a cast, and a meaningfully higher chance of hip problems in adult life.

An early diagnosis may spare a child invasive surgery and reduce the risk of early hip arthritis in adult life 5.

Breech position in the third trimester, a family history, being firstborn and female all raise risk. Breech presentation late in pregnancy or a close family history of hip problems in early life is a reason for an ultrasound scan at around four to six weeks even when the newborn examination is normal; being female or firstborn alone is not 4.

Later signs: asymmetrical thigh or buttock creases, one leg appearing shorter, restricted movement of one hip when changing a nappy, or a limp when walking begins. Any of these should be assessed rather than watched.

In the first months, a Pavlik harness holds the hip in position while the socket develops, worn continuously for several weeks with regular ultrasound monitoring.

After around six months, or if bracing fails, treatment becomes surgical 5. The hip is put back into its socket under anaesthetic, by closed or open reduction, usually followed by a period in a hip spica cast. In older children, bony surgery may be needed. Each step up carries more risk and more recovery.

After harness treatment, usually very little is needed — children develop normally. After surgery and casting, rehabilitation restores hip and knee range, rebuilds strength, and re-establishes normal gait.

Long-term follow-up into skeletal maturity is standard, because residual dysplasia can become apparent later and is easier to address before symptoms.

Treated in the first months with a harness, the hip usually develops normally. Found at walking age it usually needs surgery, and hip dysplasia is the most common cause of hip arthritis in women younger than 40 1.

The entire difference is timing, which is why newborn examination and ultrasound screening for at-risk babies exist and why any suspicion is checked rather than watched.

Not every baby. Clinical instability of the hip is found in 1% to 2% of full-term babies 1. Scanning all newborns finds more hip problems and leads to more treatment, but in a 2026 review of 819,277 infants it did not reduce late diagnosis or surgery compared with scanning selected babies 3. National screening in the UK scans babies with specific risk factors, at around four to six weeks, and those whose examination is abnormal 4.

Many mild forms of dysplasia settle without treatment 1. For hips that are unstable but not dislocated, or mildly dysplastic, in the first weeks, a repeat scan before any splint reduces treatment without increasing late-diagnosed cases 2. No screening programme catches every case 1. A limp, a leg that looks shorter or reduced hip movement later on therefore still needs checking.