PassFinals
Paediatrics

Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) is a spectrum from a shallow acetabulum through instability and subluxation to dislocation; early recognition and a stable, concentric hip position allow the socket and femoral head to develop together.

In a nutshell

Developmental dysplasia of the hip is a spectrum of abnormal development from instability to dislocation. Use the NHS England NIPE newborn and 6 to 8 week examinations, and arrange selective ultrasound for an abnormal examination or national risk factor. The current screen-positive pathway uses ultrasound at 4 to 6 weeks for babies born at or after 34+0 weeks, or 38+0 to 40+0 weeks corrected age if born earlier. Treatment is specialist-led, commonly harness treatment early and reduction or surgery when late or persistent.

Classic presentation

A breech-born infant has an unstable hip on screening or reduced abduction at 6 weeks; an older child presents with a painless limp or waddling gait.

Key points

  • Ortolani reduces a dislocated hip; Barlow tests whether a located hip can be dislocated. Perform only when trained.
  • A click alone is not diagnostic; instability, limited abduction and risk factors matter.
  • Use current NIPE ultrasound windows and actively follow up missed appointments.
  • Early reducible DDH may respond to a Pavlik harness with specialist monitoring.
  • Late presentation or failed reduction may require spica immobilisation, open reduction or osteotomy.
  • Teach safe hip positioning with flexion and abduction rather than tight extension and adduction.

First-line investigation

NIPE examination followed by selective hip ultrasound through the NHS England pathway.

Management

Screen and refer

  • Complete the newborn and 6 to 8 week NIPE hip examinations and refer an abnormal examination or national risk factor for selective ultrasound.1,3
  • Use ultrasound at 4 to 6 weeks for babies born at or after 34+0 weeks, or 38+0 to 40+0 weeks corrected age when born earlier.3

Maintain reduction

  • A paediatric orthopaedic team may use a Pavlik harness for early reducible dysplasia, with monitoring of reduction, growth and skin.4
  • Failed, irreducible or late-presenting DDH may require closed or open reduction, spica immobilisation or osteotomy in a specialist pathway.4

Prevent avoidable relapse

  • Teach safe hip positioning and continue specialist follow-up for residual dysplasia, gait, leg length and later degenerative disease.1,4

Exam traps

  • A normal newborn examination does not replace the 6 to 8 week examination.
  • Bilateral dislocation can be missed because leg lengths may appear equal.
  • Do not diagnose DDH from an isolated click without instability or other clinical concern.
  • Late presentation is not managed by reassurance; it needs paediatric orthopaedic assessment.

Key sources

  1. NHS England, Newborn and infant physical examination (NIPE) screening programme handbook (National screening handbook updated 10 October 2025; includes hip examination, risk factors, 6 to 8 week examination and management pathways)Updated 10 Oct 2025
  2. NICE NG194, Postnatal care (NICE postnatal care guidance, including newborn physical examination and referral considerations)Published 20 Apr 2021
  3. NHS England, NIPE newborn hip screening: screen positive pathway (Screen-positive hip pathway updated 10 October 2025; current timing for selective ultrasound and specialist review)Updated 10 Oct 2025
  4. Royal National Orthopaedic Hospital, developmental dysplasia of the hip service information (UK specialist paediatric orthopaedic information on assessment and treatment options; use the local specialist pathway for exact protocols)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.