Hip dysplasia

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Updated by: Allison Duey-Holtz
Updated on: 8/2/17


Developmental abnormalities involving the relationship between the femoral head and the acetabulum


Signs and symptoms

Anatomic characteristics/exam findings:

  • Birth to 4 months:
    • Asymmetric frog hip abduction
    • Positive Barlow or Ortolani
    • Positive Galleazi
  • 6 months and older:
    • Asymmetric frog hip abduction
    • Positive Galleazi
    • Abnormal gait with unilateral toe walking or hyperlordosis

Hip “click” in isolation without other positive exam findings is not directly indicative of hip dysplasia; as opposed to the “clunk” sensation of positive Barlow and Ortolani Asymmetric thigh folds alone are not good predictors of hip dysplasia in absence of other positive exam findings

  • Risk factors:
    • Female
    • Breech presentation
    • Family history of DDH
    • Inappropriate swaddling

DDH is present in 1 per 100 live births, whereas dislocation at birth is present in approximately 1 per 1,000 infants

  • Children who have normal findings should continue to have their hips examined at each of the recommended health supervision visits until a normal gait is demonstrated


  • Improper relative positioning of femoral head to pelvic acetabulum leads to dysplastic development.
  • Laxity is expected in infants up to 6 weeks of life give they are born with inherent hip laxity due to systemically retained maternal estrogen and in order to allow delivery.


Birth to 4-6 months (depending on patient size and tolerance): Pavlik Harness

>6 months to 2 years: Rhino hip abduction orthosis

>2 years: likely requires surgical intervention

Pending improvement with bracing; may require open or closed reduction with subsequent spica casting.

Referring provider's initial evaluation and management:


Differential diagnosis

  • Spasticity/adductor muscle tightness or contracture
  • Benign hip click
  • Congenital coxa vara
  • Congenital short femur

Diagnostic tests

  • Birth to 6 months:
    Dynamic hip ultrasound
  • 6 months and older:
    AP/frog lateral pelvis X-ray

Babies with breech presentation who have normal ultrasounds at 6 weeks of life should have a pelvis X-ray at 6 months of age given risk of late onset DDH.

When to initiate referral/ consider refer to Orthopedic Clinic:

  • If positive risk factors with no abnormal exam findings; recommend dynamic hip ultrasound at 6 weeks of life
    • If ultrasound is normal, no referral required
    • Recommend AP/frog lateral pelvis X-ray at 6 months if breech
  • If positive clinical exam findings; refer to orthopedics:
    • If positive Barlow or Ortolani; do not need ultrasound prior to appointment.
    • If other other exam findings noted; order ultrasound (if pt <6 months) or pelvis X-ray (if pt >6 months) prior to appointment

What can referring provider send to Orthopedic Clinic?

1. Using Epic

  • Please complete the external referral order

In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:

  • Urgency of the referral
  • What is the key question you would like answered?

Note: Our office will call to schedule the appointment with the patient.

2. Not using Epic external referral order:

  • In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288
  • It would also be helpful to include:
  • Chief complaint, onset, frequency
  • Recent progress notes
  • Labs and imaging results
  • Other Diagnoses
  • Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient's problems.

Specialist's workup will likely include:

After referral to Ortho Clinic:

  • Clinical exam:
    • Evaluate for hip abduction
    • Positive Barlow or Ortolani
    • Positive Galleazi