When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Developmental dysplasia of the hip

Last reviewed: 3 Apr 2025
Last updated: 28 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • positive Ortolani test
  • positive Barlow test
  • limited hip abduction
Full details

Other diagnostic factors

  • abnormal positioning of the leg or delayed crawling/walking
  • toe-walking (especially unilateral)
Full details

Risk factors

  • female sex
  • positive family history
  • breech presentation
  • postural deformity
  • restricted intrauterine space
  • incorrect lower-extremity swaddling
Full details

Diagnostic tests

1st tests to order

  • ultrasound of hips
  • hip x-ray
Full details

Treatment algorithm

ONGOING

<6 months of age

6-18 months of age

>18 months to 6 years of age

>6 years of age

Contributors

Authors

Ishaan Swarup, MD, FAAOS, FAAP

Assistant Professor of Clinical Orthopaedic Surgery

UCSF Benioff Children’s Hospitals

University of California

San Francisco

CA

Disclosures

IS states he has received consulting fees from OrthoPediatrics. He is also the author of a paper cited in this topic.

Acknowledgements

Dr Ishaan Swarup would like to gratefully acknowledge Dr Scott Shipman and Dr Kathleen Moen, previous contributors to this topic.

Peer reviewers

Alex Gornitzky, MD

Assistant Professor of Pediatric Orthopaedic Surgery

University of Michigan

East Lansing

MI

Disclosures

AG declares that he has no competing interests.

Andreas Roposch, MD, MSc, FRCS

Consultant Orthopaedic Surgeon

Reader in Clinical Epidemiology and Surgery

UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust

London

UK

Disclosures

AR declares that he has no competing interests.

Nicholas M. Clarke, ChM, FRCS

Professor

Consultant Orthopaedic Surgeon

Developmental Origins of Health and Disease (DOHaD)

School of Medicine

University of Southampton

Southampton

UK

Disclosures

NMC has received honoraria for visiting professorships in North America and also for lectures in respect of congenital hip dysplasia. He is also a founding member of the International Hip Dysplasia Institute, which has received charitable funding.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Shipman SA, Helfand M, Moyer VA, et al. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics. 2006;117:e557-e576. Abstract

American Academy of Orthopaedic Surgeons. Detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age. Mar 2022 [internet publication].Full text

Shaw BA, Segal LS. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics. 2016 Dec;138(6).pii:e20163107.Full text  Abstract

American College of Radiology. ACR Appropriateness Criteria: developmental dysplasia of the hip — child. 2018 [internet publication].Full text

Julie S, Quinn RH, Murray J, et al. Management of developmental dysplasia of the hip in infants up to six months of age: intended for use by general pediatricians and referring physicians. J Am Acad Orthop Surg. 2019 Apr 15;27(8):e356-9.Full text  Abstract

Samora J, Quinn RH, Murray J, et al. Management of developmental dysplasia of the hip in infants up to six months of age: intended for use by orthopaedic specialists. J Am Acad Orthop Surg. 2019 Apr 15;27(8):e360-3.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Acetabular immaturity
    • Proximal femoral focal deficiency
    • Residual effects of septic arthritis
    More Differentials
  • Guidelines

    • ACR–AIUM–SPR–SRU practice parameter for the performance of the ultrasound examination for detection and assessment of developmental dysplasia of the hip
    • Evidence-based clinical practice guideline: detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer