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Hip Dysplasia: Causes, Symptoms and Treatment

Hip dysplasia is a condition where the hip socket is too shallow to properly support the femoral head. It is often congenital and commonly detected during newborn screening examinations.

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Things worth knowing about "Hip Dysplasia"

Hip dysplasia is a condition where the hip socket is too shallow to properly support the femoral head. It is often congenital and commonly detected during newborn screening examinations.

What Is Hip Dysplasia?

Hip dysplasia, also known as developmental dysplasia of the hip (DDH), is a condition in which the hip socket (acetabulum) is too shallow, too steep, or underdeveloped. As a result, the femoral head (the ball of the hip joint) is not properly covered and may slide partially or completely out of the socket – a condition known as hip dislocation (luxation). Hip dysplasia is one of the most common congenital musculoskeletal conditions and affects girls approximately four to five times more often than boys.

Causes

The exact causes of hip dysplasia are multifactorial. The following factors are known to increase the risk:

Genetic predisposition: A family history of hip dysplasia significantly increases the risk in newborns.
Hormonal influences: Maternal hormones such as relaxin can loosen the joint capsule of the newborn, contributing to joint instability.
Breech presentation: Babies in a breech position (bottom-first) during pregnancy are at a considerably higher risk.
Limited space in the womb: Conditions such as oligohydramnios (low amniotic fluid), multiple pregnancies, or a large baby may restrict normal hip development.
Swaddling practices: Tightly wrapping a baby with the legs extended and adducted can worsen an existing dysplasia.

Symptoms

In newborns and infants, hip dysplasia is typically painless and may present with the following signs:

Limited abduction (spreading) of one or both hips
Asymmetric thigh or buttock skin folds
Apparent leg length discrepancy
A clicking or snapping sensation when moving the hip joint during clinical examination

If left untreated, hip dysplasia can lead to pain, a limp, and early-onset hip osteoarthritis (coxarthrosis) in later childhood or adulthood.

Diagnosis

Hip dysplasia is diagnosed through a combination of clinical and imaging methods:

Clinical examination: The Ortolani and Barlow tests are performed on newborns to assess hip joint stability.
Ultrasound (sonography): Routine hip ultrasound screening in newborns is standard practice in Germany and several other countries. The Graf method classifies hip maturity into types (Type I to IV) based on ultrasound findings.
X-ray: Used from approximately six months of age and in older children or adults for further assessment.
MRI (Magnetic Resonance Imaging): Reserved for complex cases or pre-surgical planning.

Treatment

Treatment depends on the severity of the dysplasia and the age of the patient. The goal is to centre the femoral head within the acetabulum and promote normal joint development.

Conservative Treatment (Infants and Toddlers)

Abduction splinting: Devices such as the Pavlik harness or abduction splints hold the hips in a flexed and abducted position, which stimulates acetabular development. This approach is highly effective for mild to moderate dysplasia.
Closed reduction: For more severe dislocations, gentle manual repositioning under anaesthesia may be required, followed by immobilisation in a hip spica cast.

Surgical Treatment

When conservative measures are insufficient or diagnosis is delayed, surgical intervention may be necessary. Options include open reduction of the hip joint and osteotomies (bone reshaping procedures) of the pelvis or femur to correct joint alignment.

Treatment in Adults

In adults with late-diagnosed or previously untreated dysplasia, joint-preserving surgery such as periacetabular osteotomy (PAO) may be performed. In cases of advanced osteoarthritis, total hip replacement (arthroplasty) is the treatment of choice.

Prognosis

When diagnosed early and treated consistently, the prognosis for hip dysplasia is generally excellent. Most affected children develop a normal, healthy hip joint. The later treatment begins, the more complex and prolonged the intervention – and the greater the risk of permanent joint damage or arthritis in adulthood.

References

German Society for Orthopaedics and Trauma Surgery (DGOU): S2k Clinical Guideline on Hip Dysplasia (2016, updated 2021). AWMF Register No. 033-001.
Graf R. – Sonography of the Infant Hip and Its Therapeutic Implications. 6th edition. Stuttgart: Thieme, 2010.
Dezateux C., Rosendahl K. – Developmental dysplasia of the hip. Lancet, 2007; 369(9572): 1541–1552.

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