Child Orthopedics

Frequently Asked Questions

How long can we (or should we) delay surgery for our child who has hip dysplasia? We know this problem goes away in some children. How long can we wait to find out before it's too late?

Developmental dysplasia of the hip (DDH) is a fairly common problem. Many studies have been done to find the best way to identify and treat it. There's some debate about routine screening.

Should every child be checked for this problem? When is it necessary to order special imaging tests such as X-rays or ultrasound? How soon should treatment begin? And how long can surgery be delayed?

There isn't clear evidence to support a definite answer for all of these questions. We do know there are some children at greater risk for DDH. Any child who is born breech should be screened. Likewise, screening is advised when there's a family history of DDH.

When DDH is suspected or diagnosed in the young child (birth to six months), conservative care can be tried. Proper positioning of the hip is important. This can be accomplished by using double or in some cases, even triple layers of diapering.

Holding the hip in a flexed and abducted position (away from the body) helps hold the hip in the socket during growth and development. If the condition is severe enough, a special device called a Pavlik harness can be used. This is strapped on over the child's clothing. It also holds the hip in the best position to train the hip and prevent dislocation.

Regular follow-up exams are needed to make sure the treatment is working. Surgery may be needed if conservative care isn't effective. The average age at the time of this operation is around six years old. Although the procedure has been done in children as old as 11, it is usually done by the time the child is nine or 10 years old.

Your pediatrician and orthopedic surgeon will work together with you to determine the best time for surgery should your child need it. Take all of the preventive steps suggested and make sure you continue with regular follow-up appointments. This will ensure the best results for your child.

Jeffrey E. Martus, and Daniel J. Sucato, MD. Developmental Disorders of the Hip Age 0-8 Years. In Current Opinion in Orthopaedics. November 2007. Vol. 18. No. 6. Pp. 529-535.

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