Developmental Dysplasia of the Hip (DDH)

Developmental dysplasia of the hip (DDH) describes a spectrum of conditions where the hip joint does not form or sit correctly in its socket. It ranges from mild instability to full dislocation. Early detection is key, and physiotherapy plays an important role in monitoring development, advising on positioning, and supporting recovery after bracing or surgery.

Understanding DDH

The hip is a ball-and-socket joint. In DDH, the socket may be shallow, or the ball may sit loosely or out of the socket. Because a baby’s joints are still developing, early treatment can guide the hip to grow normally.

Risk Factors

• Breech position in late pregnancy
• Family history of hip dysplasia
• First-born babies
• Female babies (more commonly affected)
• Associated conditions such as torticollis or foot positioning problems
• Tight swaddling with the legs held straight

Signs and Symptoms

In Babies

• Asymmetrical skin folds on the thighs or buttocks
• One leg appearing shorter than the other
• Limited or stiff movement when opening one hip
• A click or clunk during nappy changes

In Toddlers

• A limp or waddling walk
• Walking on the toes on one side
• Delayed walking
• A leg that turns outward

Screening and Diagnosis

DDH is usually screened at birth and during routine baby checks. Diagnosis is confirmed by:

• Clinical examination: Specific hip stability tests
• Ultrasound: For babies under around 6 months
• X-ray: For older infants and toddlers

If we identify signs during a physiotherapy assessment, we refer promptly for medical imaging and orthopaedic review.

Physiotherapy Role

Physiotherapy works alongside your paediatrician or orthopaedic specialist:

Positioning Education

• “Hip-healthy” carrying, swaddling, and equipment advice
• Encouraging positions that keep the hips comfortably spread
• Guidance for use of carriers, slings, and car seats

Monitoring and Development

• Tracking motor milestones and movement symmetry
• Identifying and managing associated conditions (e.g. torticollis)
• Supporting tummy time and active play

After Bracing (e.g. Pavlik Harness)

• Maintaining movement and strength within medical guidelines
• Supporting development while restrictions are in place
• Helping families adapt daily routines

Post-Surgical Rehabilitation

• Regaining hip range of motion
• Rebuilding strength and weight-bearing tolerance
• Restoring normal walking patterns and confidence

Expected Outcomes

When DDH is detected early and managed appropriately:

• Most hips develop normally with bracing
• Children who need surgery recover well with rehabilitation
• Walking and physical activity are typically unaffected long term

Early identification gives the best results, which is why prompt assessment of any hip concern is so important.