Developmental Dysplasia of the Hip - Treatment Overview
developmental dysplasia of the hip (DDH) focuses on
moving your child's upper thighbone (femur) into its normal position and
keeping it in place while the
joint grows. The hip socket will not form and grow
properly if the ball at the top of the thighbone (femoral head) does not fit
snugly in the joint.
Sometimes in babies with signs of DDH the
thighbone and hip socket start to grow as they normally would, without
treatment. But it is hard to predict whether this will happen.
that are fully dislocated or that can be dislocated easily by certain movements
are usually treated as soon as they are detected.
Treatment for DDH usually includes one of the
Pavlik harness. This device usually is
tried first if your baby is younger than 6 months. The harness has fabric
straps and fasteners that fit around your baby's chest, shoulders, and legs.
The harness holds the baby's legs in a spread position, with the hips bent so
that the thighs are out to the sides. Your doctor monitors the harness's
effectiveness through regular exams and imaging tests. The Pavlik harness
successfully makes the hip normal most of the time. But if your doctor
doesn't see improvement in the hip after about 3 to 4 weeks, the harness is
removed and other treatment options are explored. See
a picture of a
Spica cast. This body cast is made of
plaster or fiberglass to form a hard covering over the waist, hips, and legs.
To make it stronger, the cast may have a bar between the legs. Your child needs general anesthesia when this cast is put on him or her. See pictures of
a spica cast with a bar and a
spica cast without a bar.
Other forms of treatment
Braces and splints. Your child may wear a brace
or splint as a first treatment for DDH instead of a Pavlik harness or spica
cast. In some cases a brace or splint follows another type of treatment, such as surgery. In these cases, the device is used to help support
the hips and legs as they heal. In particular, children with DDH who also have
other problems with their feet or knees may benefit from wearing a
Surgery. Few children need osteotomy
surgery to correct a deformed thighbone or hip socket. This procedure
repositions the thighbone, usually after cleaning the socket of fat deposits.
If needed, surgery may include reshaping the socket or thighbone. After
surgery, your child probably will need to wear a spica cast to position the hip
joint until it completely heals.
Physical therapy. An older child may need
to do physical therapy exercises to restore movement of the
legs and strengthen muscles after being in a spica cast.
Traction. A very rarely used treatment for DDH,
traction involves weights, pulleys, and ropes to gradually stretch and loosen
the hip joint's muscles and tissues while holding the bones in their correct
position. This allows doctors to place the ball at the top of the thighbone
(femoral head) back into the hip socket. Traction may also help prevent
problems with the blood supply to the joint. Typically, traction takes about 2
to 4 weeks. The treatment can be set up in a hospital or at home. Afterward,
your child will probably wear a spica cast.