Hip Dysplasia (DDH)

Developmental dysplasia of the hip (DDH) is a spectrum of conditions in which the hip joint - specifically the relationship between the femoral head (ball) and the acetabulum (socket) - does not develop normally. It ranges from mild acetabular shallowness to complete dislocation. DDH is typically identified through newborn screening and hip ultrasound. Physiotherapy supports the medical management of DDH - and plays a particularly important role in the periods before, during, and after harness wear or surgical treatment.

What causes DDH, and how is it identified?

DDH is multifactorial. Risk factors include:

• Female sex (DDH is 4-6 times more common in girls)
• Breech position in the womb
• First-born child
• Family history of DDH
• Oligohydramnios (reduced amniotic fluid) or other intrauterine constraint

In Singapore, newborn hip screening is performed through clinical examination (Barlow and Ortolani tests). An ultrasound is performed if the clinical screen is positive or risk factors are present. The Graf classification is used to grade DDH severity on ultrasound, and management decisions are based on this grading combined with age and clinical findings.

What is the Pavlik harness, and what does physio do during harness wear?

The Pavlik harness is the standard first-line treatment for DDH in infants under 6 months. It holds the hips in a flexed and abducted position (knees up and out) that encourages the femoral head to locate correctly in the acetabulum and stimulate socket development. It is worn 23 hours a day and adjusted regularly by the physiotherapist and/or orthopaedic team.

During harness wear, physiotherapy provides:

• Parent education: handling and carrying techniques that protect the harness position; safe bathing, dressing, and nappy changing; car seat positioning
• Developmental support: age-appropriate stimulation that respects the harness constraints - tummy time adaptations, visual and sensory play, facilitation of head control and upper limb development
• Monitoring: checking for pressure areas, skin integrity, and any signs of avascular necrosis risk

What about after harness or surgical treatment?

After harness removal, many infants have delayed gross motor development - not because of neurological problems, but because the harness limited the movement experiences that drive motor learning. Physiotherapy after harness removal focuses on:

• Facilitating milestone progression: rolling, sitting, weight-bearing through the legs, crawling, pulling to stand, and walking
• Hip muscle strengthening: the gluteals and hip external rotators, which are important for joint stability and normal gait
• Gait analysis: once the child is walking, checking for any persisting asymmetry or abnormal movement patterns

For children who required surgical reduction or open hip surgery, post-operative physiotherapy is more intensive and follows the surgeon’s protocol closely.

What does a session at Goji involve?

Our physiotherapist will review your child’s ultrasound and orthopaedic correspondence, take a developmental history, and perform a physical assessment. For infants, this includes hip range of motion, muscle tone, reflexes, and a developmental screen appropriate to their age. For older children, it includes gait analysis, hip strength, and functional movement. You will leave with a clear programme and confidence in how to support your child’s development at home.

Frequently asked questions

My baby is in a Pavlik harness. Do they need physio as well as orthopaedic follow-up?

Physiotherapy is a valuable complement to orthopaedic management during harness wear - particularly for parent education on handling and developmental support. It does not replace orthopaedic follow-up. Both are recommended.

My baby’s harness has come off and they are not trying to stand yet. Is this a problem?

Delayed standing and walking after harness removal is common and expected. The harness limits the movement experiences that drive normal gross motor development. Most children catch up well with physiotherapy support, but the degree of delay depends on how long the harness was worn and the child’s age at removal. Our physiotherapist will assess where your child is and what support is needed.

My toddler was diagnosed with DDH at 18 months. Is physio still relevant?

Yes, though the pathway differs. Late-diagnosed DDH in a walking child requires orthopaedic assessment first, as surgical reduction might potentially be needed at this age. Post-surgical physiotherapy plays a significant role in restoring mobility, strength, and normal gait pattern.

Can DDH cause problems in adulthood?

Inadequately treated DDH is one of the leading causes of early-onset hip osteoarthritis. Well-treated DDH - particularly when identified and treated in infancy - generally has very good long-term outcomes. This is why early identification and prompt treatment matter.

My child has one leg that looks shorter than the other. Could this be DDH?

Apparent leg length discrepancy, asymmetric thigh or gluteal skin folds, and limited hip abduction are all signs that should prompt GP or paediatric review and hip ultrasound. Please have your child assessed by your paediatrician or GP before seeking physiotherapy, so the diagnosis is clear before we begin.

Is DDH genetic? Should my other children be screened?

DDH has a heritable component - having a first-degree relative with DDH is a risk factor. In Singapore, screening decisions are based on clinical and risk factor assessment at the newborn check. If you have concerns about a sibling, discuss screening with your paediatrician.