What Is DDH?
Developmental Dysplasia of the Hip (DDH) refers to a spectrum of conditions in which the hip joint does not develop normally. In the mildest form, the acetabulum is too shallow to fully cover the femoral head. In the most severe form, the femoral head is completely dislocated and sitting outside the socket entirely.
When caught in infancy (0–6 months), treatment is simple: a Pavlik harness worn for 6–12 weeks allows the hip to develop normally. Outcomes are excellent. The problem arises when the diagnosis is missed.
Every year DDH goes undiagnosed is a year the hip adapts to the wrong position — early diagnosis changes the entire treatment trajectory.
Why Is DDH Missed?
- Newborn hip screening (Barlow/Ortolani tests) has sensitivity limitations — some dislocations develop in early infancy, not at birth.
- In countries without universal ultrasound screening, mild acetabular dysplasia may not produce obvious clinical signs.
- Bilateral dislocations may not cause the asymmetric signs typically associated with unilateral cases.
- Families in low-resource settings may have limited access to paediatric orthopaedic care.
What Happens When DDH Is Diagnosed Late?
The consequences depend on the age at diagnosis and the severity of the dislocation.
Diagnosed at 6–18 Months (Walking Age)
Once a child begins walking, a dislocated hip produces a characteristic limp (Trendelenburg gait). Treatment at this age requires a surgical or semi-surgical approach.
- Closed reduction: Under general anaesthesia, the hip is manipulated into the socket without an incision and held in a spica (body) cast for 3–4 months.
- Open reduction: If closed reduction fails, an open surgical approach removes soft tissue obstructions. Often combined with acetabular or femoral osteotomy.
Diagnosed at 18 Months–8 Years
By this age, the displaced femoral head and socket have each adapted to the abnormal position. Open reduction plus osteotomy (Salter, Pemberton, or Dega procedure) is the standard approach. Results are generally good if performed before age 6; above that age, residual dysplasia and future osteoarthritis risk both increase.
Diagnosed in Adolescence or Adulthood
Late-diagnosed DDH typically presents as hip pain and a progressive limp. A shallow acetabulum concentrates joint stress on the superior rim of the socket. Without intervention, hip arthritis typically develops in the 30s or 40s — unusually young for joint replacement.
Options at this stage include:
- Periacetabular Osteotomy (PAO/Ganz osteotomy): Gold standard for symptomatic dysplasia in young adults with preserved cartilage. The acetabulum is cut free from the pelvis, rotated to better cover the femoral head, and fixed with screws. Reliably delays or prevents hip replacement by 15–20+ years.
- Total Hip Replacement: For patients with advanced cartilage damage. In DDH cases, this is technically complex — the socket is often in an abnormal position and may require bone grafting or a custom implant.
What We Offer at Central Ortho & Spine
Our hip team has experience across the full spectrum of DDH management — from open reductions in toddlers to Ganz osteotomy and complex total hip replacement in adults. International families are encouraged to send AP pelvis and Lauenstein (frog-leg) X-rays for remote review before their visit. Surgical planning including 3D CT analysis is completed during a single consultation visit to Istanbul.