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Advanced Developmental Dysplasia of the Hip in Children

Late-presenting or refractory developmental dysplasia of the hip in children beyond the period of Pavlik harness effectiveness, requiring closed reduction, open reduction, or pelvic and femoral osteotomy depending on age and severity.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

What is Advanced Developmental Dysplasia of the Hip in Children?

Developmental dysplasia of the hip (DDH) covers a spectrum from instability to dislocation; advanced DDH refers to children diagnosed late, after failure of Pavlik harness, or with persistent residual dysplasia.

Treatment in 6 to 18 months typically begins with closed reduction under anesthesia, arthrography, and hip spica casting, with conversion to open reduction if a stable concentric position is not achievable.

In older children (18 months to 8 years), open reduction is commonly combined with pelvic osteotomy (Salter, Pemberton, or Dega) and femoral derotational shortening osteotomy as needed.

Symptoms

Limb length discrepancy and asymmetric thigh creases
Limited hip abduction with positive Galeazzi sign
Trendelenburg gait or limp once walking begins
Persistent acetabular dysplasia and femoral head subluxation on imaging
Pain and early osteoarthritis in older children with chronic dislocation

Risk Factors

Failed Pavlik harness treatment after 4 to 6 weeks
Late diagnosis after walking age
Breech presentation, family history of DDH, female sex
Persistent acetabular index above 30 degrees after age 18 months
Teratologic dislocation with neuromuscular conditions

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Limp or asymmetric movement noticed after walking begins
  • Persistent dysplasia on follow-up after harness treatment
  • Failed closed reduction at attempted treatment
  • Limb shortening or hip pain in older children

Treatment Methods

01
Closed reduction under anesthesia with arthrography and hip spica casting in younger children with safe zone
02
Open reduction via medial or anterior approach when closed reduction fails
03
Pelvic osteotomy — Salter, Pemberton, or Dega — to improve acetabular coverage
04
Femoral derotational and shortening osteotomy to reduce femoral head pressure and avoid avascular necrosis
05
Hip spica cast for 6 to 12 weeks postoperatively followed by abduction bracing and structured physiotherapy

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Çocuk Sağlığı ve Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.