Developmental Dysplasia of the Hip (DDH)

The youngest babies may wear a Pavlik harness (PDF) (Spanish). This is a soft harness that flexes. It pulls the baby’s legs away from their middle while still letting them move their legs some. The harness keeps the ball (femoral head) at the top of the thighbone deep in the socket.

This is the simplest form of reduction treatment. It works about 80% to 85% of the time.

If a Pavlik harness does not work for your child after a month or so, we may try a more rigid brace (fixed hip abduction brace like the Rhino Cruiser or Ilfeld brace). This type of brace may work better to hold your baby’s hips in a safe position and direct the femoral head into the socket.

At Seattle Children’s Orthopedics and Sports Medicine, we have a system to help make sure babies referred to us for severe dysplasia or a dislocated hip get care soon. This improves the chance that a harness or brace will work and they won’t need surgery.

If the Pavlik harness does not work or if your child is older than 6 months, they may need a spica cast (PDF) (Russian) (Spanish) (Vietnamese) or a special brace to hold the thighbone in the hip socket.

First, the doctor will need to put the thighbone in the socket. Your child will have general anesthesia so they sleep and cannot feel anything anywhere in their body. Then the doctor will move the thighbone into place. If possible, they will do this without surgery (closed reduction).

If the thighbone will not go in easily, the doctor will operate to put it in (open reduction). They will open the hip, release any soft tissues that are blocking the thighbone and then put the ball into the socket.

In some children, the hip tendon on the inside of the thigh (adductor tendon) is tight, so doctors need to release it. We do this by making a small cut through the skin and tendon.

After the hip is in place, the doctor will put on the cast or brace.

After about age 18 months, children usually need surgery to redirect or reshape the bones of the hip, the pelvis or the thighbone so their hips will stay aligned.

After surgery, your child will wear a spica cast (PDF) (Russian) (Spanish) (Vietnamese) on their hips and legs. The length of time in the cast depends on the child. For most children, it is 6 to 12 weeks. In some cases, the doctor may recommend changing the cast. This can allow for your child’s growth and let the doctor check the position of the hip again.

After the doctor removes the cast, your child will wear a brace to hold their hips in place, usually for about 3 to 6 months. They will wear the brace until X-rays show that their hip socket is developing in a healthy way.

This approach is common up to about age 5, when children typically start school and wearing a spica cast is not practical.  

If a child needs treatment for hip dysplasia from about age 5 to 10, this usually means surgery to treat shallow hip sockets. Physical therapy is an important part of recovery after hip surgery. At Seattle Children’s, we have physical therapists who specialize in hip conditions in kids.

Most of the time, we can treat hip dysplasia early in life with 1 of the methods described above. After treatment, most children have no further issues with their hips.

Sometimes, children, teens or young adults with hip dysplasia do have ongoing hip issues. Or they develop a new concern, like hip pain, as their body gets larger and their joints have to carry more weight. Some people with hip dysplasia are not diagnosed until symptoms, like a limp or pain, begin in adolescence.

The Child and Young Adult Hip Preservation Program provides treatment to help older children and teens keep their natural hip and delay or avoid hip replacement. We also work with young adults in their 20s who are seeking care. From some, nonsurgical treatment like physical therapy may help. If it doesn’t, they may need a hip preservation surgery, like periacetabular osteotomy. For those who do need an artificial hip, we offer this option as well. Learn more.

• Your child’s team includes doctors, surgeons, physician assistants and nurse practitioners from Orthopedics and Sports Medicine. We also involve specialists in imaging studies, orthotics, physical therapy and occupational therapy based on your child’s needs
• Accurate diagnosis is the first step to effective treatment. Our team is experienced in making high-quality imaging studies using ultrasound, MRI (magnetic resonance imaging), advanced 3T MRI, CT (computed tomography) scans and X-rays.
• Our first goal is to treat your child without surgery if we can. Often, this means a harness, brace, cast or physical therapy. We have onsite orthotists to build and fit orthotics to correct hip problems. We also have the largest team of physical and occupational therapists in the region who specialize in babies, children, teens and young adults.
• We recommend surgery only when we believe it will give your child the best results. If your child needs surgery, our surgeons have many years of experience in treating children with hip dysplasia. Each of our hip surgeons is board certified. Many have expanded fellowship training, including to treat hip conditions in young people even into their 20s.
• Dr. Todd Blumberg leads the Child and Young Adult Hip Preservation Program. He focuses on treating hip conditions from infancy into adulthood. Blumberg is the only dual fellowship-trained pediatric and hip preservation surgeon in the region. Seattle Children’s does more hip preservation surgeries for young people than any other center in the Pacific Northwest.
• Complex hip conditions may affect other parts of your child’s body too. That’s why we connect you with the many types of Seattle Children’s experts your child may need — on the same day, in the same clinic, whenever we can.

• Before we recommend surgery, we look at your child as a whole person. Your child’s team will take many factors into account. These include how serious their condition is, the effects on their health, how much more they will grow and what results you can expect from treatment. 
• We have the technology and skills to use X-ray imaging to guide hip surgery, if needed. This helps us place hardware, like screws, with precision. It also lets us see in real time the changes we make to the hip. Our operating rooms have the newest, low-dose imaging equipment available.
• Our surgeons are experienced in procedures to move the thighbone into the hip socket and to reshape the bones of the hip, pelvis or thigh, if needed. Our focus is on keeping your child’s natural hip if possible. However, we also place artificial hips at Seattle Children’s. Dr. Jesse Roberts is experienced in hip replacement surgery for young people. 

• We specialize in caring for young patients, from babies through young adults. Our experts have the knowledge, training and skills to diagnose and treat hip dysplasia and related issues that your child might have at any age.  
• Babies, children and teens are still developing. When we evaluate your child’s condition, plan their treatment and provide their care, we carefully consider their growth. We think about how growth may affect their hip over time. We also consider how their hip may affect the rest of their development and health. Here, your child’s team has special training in the physical, emotional and social needs of young people. 
• Even into their 20s, young people may benefit from different hip treatments than older adults do. So, it’s important to have a team, like ours, that understands hip development and the needs of this age group. After hip surgery here, people in their 20s can keep seeing our Child and Young Adult Hip Preservation team for long-term follow-up. To care for young adult patients, we also partner with orthopedic surgeons at UW Medicine. 
• If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images. We also have the largest group of board-certified pediatric radiologists in the Northwest. 

• Having a child with hip dysplasia can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can. 
• Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options. We support you in making choices that are right for your family. 
• For your convenience, our doctors see patients at locations in Seattle, Bellevue, Everett and Federal Way. We bring high-quality care closer to where you live. 
• Seattle Children’s serves families from around the Northwest and beyond. We can help with financial counseling, education, housing, transportation, interpreter services, spiritual care and more. Our Child Life specialists, Family Resource Center and Guest Services are here to help. Read more about our services for patients and families.

• Our team members partner with experts around the world on research. Together, they work to understand the causes of hip conditions, improve the accuracy of diagnostic tests and create better surgical approaches.  
• We track long-term results of our patients so we can improve care for young people with hip problems. For example, we ask patients with hip dysplasia about their experience before and after treatment to make sure our approach improves quality of life and function. 
• Our surgeons have led research to reduce your child’s exposure to radiation from imaging tests, like X-rays and CT (computed tomography) scans, before and during surgery.  
• As part of our constant work to improve results for kids, we developed standard plans (called protocols) to help your child recover after surgery. 
• Learn more about current orthopedics research at Seattle Children’s.