DDH 0 – 6 Months

Developmental Dysplasia of the Hip (DDH) in Infants 0–6 Months: Modern Study Review

High-Yield Summary

Developmental Dysplasia of the Hip (DDH) in infants under 6 months is a critical diagnosis to identify early to prevent long-term hip dysfunction and osteoarthritis. Early detection and treatment with a Pavlik harness remain the cornerstone of management, aiming to maintain concentric reduction and promote normal acetabular development. Ultrasound is the preferred imaging modality for diagnosis and monitoring in this age group. Prompt intervention improves outcomes and reduces the need for surgical procedures.

Key Diagnostic Findings

Anatomy

• The hip joint comprises the femoral head and acetabulum; in DDH, the femoral head may be dislocated, dislocatable, or subluxatable due to abnormal acetabular development or ligamentous laxity.
• Teratologic dislocations represent severe, often irreducible dislocations with acetabular hypoplasia.

Clinical Presentation

• Ortolani positive: Hip is dislocated but reducible with a palpable “clunk” on abduction.
• Barlow positive: Hip is located but can be dislocated with adduction and posterior pressure.
• Subluxatable hip: Partial displacement without full dislocation.

Imaging

• Ultrasound (Graf method): Gold standard for infants <6 months; assesses femoral head position and acetabular morphology dynamically.
• Radiographs: Limited utility before 4-6 months due to incomplete ossification of the femoral head.

Classification Systems

Current Gold Standard Treatment

Non-operative Indications and Treatment

• Pavlik Harness: First-line treatment for infants 0–6 months with reducible or dislocatable hips.
• Position hips in 90–110° flexion and 40–60° abduction (avoid forced abduction beyond tolerance to prevent femoral nerve palsy).
• Weekly clinical and ultrasound monitoring to confirm stable reduction.
• Duration: Typically 6 weeks after stable reduction is confirmed.
• Monitoring: Assess hip stability, femoral nerve function, and harness fit weekly.

Operative Indications and Treatment

• Failure to achieve or maintain reduction after 2–3 weeks of Pavlik harness treatment.
• Irreducible hips or teratologic dislocations, especially if diagnosed after 2 months of age.
• Closed reduction and spica casting: Indicated if Pavlik harness fails or if diagnosis is delayed beyond 2 months.
• Open reduction and pelvic osteotomy: Reserved for hips that remain unstable or dysplastic after closed methods, typically performed between 6–12 months.

Modern Complications & Outcomes

Complications

Outcomes

• Early diagnosis and treatment with Pavlik harness yield >90% success in stable reduction and normal hip development.
• Delayed treatment increases risk of surgical intervention and poorer functional outcomes.
• Long-term follow-up is essential to monitor for residual dysplasia and growth disturbances.

Classic Clinical Notes

DDH 0-6mo.

Approach to DDH – Newborn – 6 months

The hip can be one of three things:

1. Ortolani positive – dislocated, but reducible
2. Barlow positive – located, but dislocatable
3. Subluxatable

Any of the above gets:

• a Pavlik harness, ultrasound to be sure that it is in, and reassessment in a week.
• hips should be flexed 90-110, and the knees should be able to be brought to within 4-5 cm of one another (ie – don’t crank them too far into abduction). Basically, do a Barlow once the Pavlik is on to see at what point of adduction the hips dislocate – then tighten up the posterior straps to prevent adduction to this point, but no more.
• at one week, check motion, check femoral nerve, check stability, get an ultrasound

* if stable in a week – continue Pavlik for 6 weeks
* if not stable but reduced – continue Pavlik until they are stable, then 6 weeks after that
* if not reduced within 2-3 weeks in the Pavlik – give up. Closed reduction and spica.

* if not able to reduce and keep reduced within the first 2 months, even with a Pavlik or closed reduction – may have a teratologic dislocation, and the acetabulum has never really formed. Back off – aim for range of motion and plan for open reduction and acetabular osteotomy at 6-12 months.

Note: this algorithm works best in the NEWBORN. After 2 months, and up to 6 months, you can still try the Pavlik even in the dislocated hip. But these need to be watched very carefully. Ultrasound to confirm that the hips are reduced. If you are starting late and are not totally reduced with the Pavlik within a couple weeks, back off. The kid needs a closed reduction and a spica cast (GO TO discussion on closed reduction and spica cast)

Last Updated on January 25, 2026 by orthonet