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Developmental dysplasia of the hip

Last reviewed: 3 Nov 2023
Last updated: 20 Jul 2023



History and exam

Key diagnostic factors

  • positive Ortolani test
  • positive Barlow test
  • limited hip abduction
More key diagnostic factors

Other diagnostic factors

  • abnormal positioning of the leg or delayed crawling/walking
  • toe-walking (especially unilateral)
Other diagnostic factors

Risk factors

  • female sex
  • positive family history
  • breech presentation
  • postural deformity
  • restricted intrauterine space
  • incorrect lower-extremity swaddling
More risk factors

Diagnostic investigations

1st investigations to order

  • ultrasound of hips
  • hip x-ray
More 1st investigations to order

Treatment algorithm


<6 months of age

6-18 months of age

>18 months to 6 years of age

>6 years of age



Ishaan Swarup, MD, FAAOS, FAAP

Assistant Professor of Clinical Orthopaedic Surgery

UCSF Benioff Children’s Hospitals

University of California

San Francisco



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


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



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




AR declares that he has no competing interests.

Nicholas M. Clarke, ChM, FRCS


Consultant Orthopaedic Surgeon

Developmental Origins of Health and Disease (DOHaD)

School of Medicine

University of Southampton




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.

  • Differentials

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

    • Evidence-based clinical practice guideline: detection and nonoperative management of pediatric developmental dysplasia of the hip in infants up to six months of age
    • ​Management of developmental dysplasia of the hip in infants up to six months of age - intended for use by orthopaedic specialists​
    More Guidelines
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