Home Pediatric OrthopaedicsDDH Treatment (Hip Dysplasia) in India

DDH Treatment (Hip Dysplasia) in India

Expert treatment for developmental dysplasia of the hip in children using Pavlik harness, closed reduction, or open surgery

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Overview

Dr. Gurudeo Kumar is Bihar's leading pediatric orthopaedic surgeon specializing in Developmental Dysplasia of the Hip (DDH) treatment. With 15+ years of experience and 180+ successful DDH treatments, Dr. Kumar offers comprehensive care from newborn screening to complex reconstructive surgery. His expertise spans all DDH treatment modalities including Pavlik harness application, closed reduction with spica casting, and open reduction with femoral or pelvic osteotomy. DDH, formerly known as congenital hip dislocation, is a condition where the hip joint doesn't develop properly, ranging from mild acetabular dysplasia to complete hip dislocation. Early detection and treatment are crucial for normal hip development. Dr. Kumar's multidisciplinary approach combines advanced imaging (ultrasound for infants, radiographs for older children), individualized treatment protocols, and long-term follow-up to ensure optimal hip development. At Arthoscenter, we achieve 94% success rates in DDH treatment with minimal complications. Our child-friendly environment, family-centered care approach, and experienced pediatric anesthesia team ensure the best outcomes for your child. Dr. Kumar's gentle surgical techniques and meticulous attention to preserving the femoral head blood supply minimize the risk of avascular necrosis. We provide comprehensive support including parental education, spica cast care training, and physiotherapy guidance throughout the treatment journey.

Symptoms & Indications

This surgery may be recommended if you experience:

Unequal skin folds in the thigh or buttocks area

Limited range of motion during diaper changes

One leg appears shorter than the other

Asymmetric hip abduction (legs don't spread equally)

Clicking or popping sound from the hip

Delayed walking or limping (in older children)

Positive Ortolani or Barlow test in newborn exam

Waddling gait or toe-walking pattern

Pain or discomfort during hip movement

Uneven crawling pattern or preferring one side

Procedure Details

Duration

Pavlik harness application: 30-45 minutes; Closed reduction: 60-90 minutes; Open reduction: 120-180 minutes

Anesthesia

None for Pavlik harness; General anesthesia for closed/open reduction

Preparation for Surgery

Comprehensive pre-treatment evaluation includes detailed hip ultrasound (for infants under 4-6 months) or radiographs (for older children), physical examination assessing hip stability and range of motion, and assessment of severity using Graf classification (ultrasound) or Tonnis classification (radiograph). Treatment planning is age-dependent and severity-based. For newborns, double diapering or Pavlik harness may be initiated immediately. Pre-surgical workup for older children includes complete blood count, routine anesthesia evaluation, and family counseling about treatment expectations and spica cast care. Parents receive detailed education about positioning, handling, and monitoring their child during treatment.

Surgical Steps

Age-appropriate anesthesia (general anesthesia for surgery, none for Pavlik harness)

For Pavlik harness treatment (0-6 months): Proper harness fitting ensuring 90° hip flexion and gentle abduction

Harness adjustment to maintain hip reduction while allowing safe movement

For closed reduction (6-18 months): Gentle hip reduction under anesthesia using traction

Confirmation of stable reduction with arthrogram or fluoroscopy

Application of hip spica cast in human position (hips flexed 90-100°, abducted 40-50°)

For open reduction (>18 months or failed closed): Anterior or medial approach incision

Removal of obstacles to reduction (pulvinar, hypertrophied ligamentum teres)

Capsulotomy and reduction of femoral head into acetabulum

Femoral shortening osteotomy if needed to reduce pressure on femoral head

Pelvic osteotomy (Pemberton, Dega, or Salter) for acetabular dysplasia correction

Fixation with K-wires or screws, wound closure in layers

Application of hip spica cast for 8-12 weeks

Cast removal and initiation of physiotherapy and hip surveillance program

Recovery Timeline

What to expect during your recovery journey

Immediate Post-Treatment (Week 1-2)

For Pavlik harness: Harness worn 23 hours/day, removed only for bathing. Weekly clinic visits for harness adjustment and hip ultrasound monitoring. For surgery: 1-2 day hospital stay, pain management, spica cast care education. Monitor for cast complications (pressure sores, swelling, circulation issues).

Harness/Cast Phase (Week 3-12)

Pavlik harness treatment continues for 6-12 weeks with weekly/biweekly monitoring. Ultrasound assessments track hip development. For post-surgery: Full-time spica cast wear for 8-12 weeks. Adaptations to car seats, high chairs, and sleeping arrangements. Family adjusts to care routine. Regular X-rays monitor hip position.

Cast Removal Phase (Month 3-4)

Spica cast removed in clinic under sedation if needed. Hip X-rays confirm maintained reduction. Skin care for areas previously under cast. Gradual return to normal bathing and dressing. May transition to nighttime abduction brace. Physical therapy assessment for range of motion and strength.

Early Rehabilitation (Month 4-6)

Pavlik harness typically discontinued if hips stable. Post-surgery children begin active physiotherapy focusing on hip range of motion, muscle strengthening, and developmental milestones. Abduction brace may be used part-time or at night. Close monitoring with regular X-rays every 4-8 weeks. Gradual return to age-appropriate activities.

Advanced Rehabilitation (Month 6-12)

Focus on achieving age-appropriate gross motor skills. For infants: crawling, pulling to stand, cruising. For toddlers: walking, running, climbing. Continued physiotherapy 1-2 times per week. Regular X-ray surveillance every 3-6 months. Assessment of leg length and gait pattern. Most children walk independently by 18-24 months post-treatment.

Long-term Follow-up (Year 1-5+)

Annual X-rays until skeletal maturity (age 16-18) to monitor for residual dysplasia, AVN, or growth disturbance. Assessment of gait, leg length discrepancy, and hip range of motion. Most children achieve normal hip development and function. Some may require additional procedures (osteotomy) during growth. Lifelong hip surveillance recommended.

Frequently Asked Questions

Common questions about this procedure

Q1.What is DDH and how common is it?

Developmental Dysplasia of the Hip (DDH) is a spectrum of hip abnormalities ranging from mild acetabular dysplasia to complete hip dislocation. It occurs when the hip joint doesn't develop properly, either before birth or during infancy. DDH affects approximately 1-2% of all newborns, with higher rates in females (4-5 times more common), firstborn children, breech presentation babies, and those with family history. Early detection through newborn screening and clinical examination (Ortolani and Barlow tests) is crucial, as treatment outcomes are significantly better when started early. Risk factors include female gender, breech position, oligohydramnios, family history, and swaddling practices that force legs into extension.

Q2.How is DDH diagnosed in babies?

DDH diagnosis involves multiple approaches depending on the baby's age. All newborns should receive clinical examination including Ortolani test (relocating a dislocated hip) and Barlow test (attempting to dislocate a reduced hip). Hip ultrasound is the gold standard for infants under 4-6 months, as it visualizes the cartilaginous structures not visible on X-ray. The Graf classification system grades hip development from Type I (normal) to Type IV (dislocated). For babies over 4-6 months, X-rays become more reliable as ossification centers develop. Physical signs include asymmetric thigh or gluteal folds, limited hip abduction (less than 75° on affected side), apparent leg length discrepancy (Galeazzi sign), and later, delayed walking or limping. High-risk babies (breech, family history, clinical findings) should receive ultrasound screening at 6 weeks even if examination is normal.

Q3.What is the Pavlik harness and how does it work?

The Pavlik harness is the first-line treatment for DDH in infants under 6 months old. It's a dynamic orthosis that maintains the baby's hips in a flexed (90-100°) and abducted (40-50°) position - the optimal position for hip development. Unlike rigid casts, the harness allows controlled movement while keeping the femoral head properly positioned in the acetabulum, promoting normal hip socket development. The harness is worn 23 hours per day, removed only for bathing. Treatment duration is typically 6-12 weeks, with weekly adjustments and ultrasound monitoring. Success rates are 85-95% for hips that are reducible. The harness has four main straps: chest strap, shoulder straps, stirrup straps, and leg straps. Proper fitting is crucial - too tight risks femoral nerve palsy or AVN, too loose fails to maintain reduction. Parents must never adjust straps themselves and should report any concerns immediately.

Q4.When is surgery needed for DDH and what are the options?

Surgery becomes necessary when non-surgical treatment (Pavlik harness) fails, when diagnosis is delayed beyond 6-18 months, or when the hip is irreducible (cannot be repositioned without surgery). Closed reduction (6-18 months): Performed under general anesthesia using traction to gently reduce the hip, followed by hip spica cast for 8-12 weeks. Success rate 70-80%. Open reduction (>18 months or failed closed): Surgical approach to remove obstacles preventing reduction (thickened ligamentum teres, pulvinar, inverted labrum). May include femoral shortening osteotomy (removing bone segment to reduce pressure) or pelvic osteotomy (reshaping acetabulum - Pemberton, Salter, or Dega procedures) to improve hip coverage. Surgery is followed by spica cast for 8-12 weeks. The earlier treatment begins, the better the outcomes - hips diagnosed and treated before 6 months have best results with lowest AVN risk.

Q5.What is avascular necrosis (AVN) and how is it prevented?

Avascular necrosis (AVN) or osteonecrosis of the femoral head is the most serious complication of DDH treatment, occurring when blood supply to the growing femoral head is disrupted. This can lead to abnormal hip development, early arthritis, and poor long-term outcomes. AVN rates vary by treatment: Pavlik harness 0-5%, closed reduction 5-15%, open reduction 5-10%. Risk factors include excessive hip abduction during treatment, delayed diagnosis (>18 months), repeated reduction attempts, and forcing unstable reductions. Prevention strategies include: gentle reduction techniques, avoiding forceful manipulation, proper Pavlik harness adjustment (never forcing legs apart >60°), delaying closed reduction until after 6 months if possible, femoral shortening to reduce pressure on femoral head, and careful monitoring with regular X-rays. Dr. Kumar uses meticulous surgical technique, femoral shortening when indicated, and gentle reduction principles to minimize AVN risk. Early signs on X-ray include failure of ossific nucleus to appear or grow, increased density, and later fragmentation.

Q6.How do I care for my baby in a spica cast?

Caring for a baby in a hip spica cast requires patience and adaptation but becomes routine with practice. Diapering: Change frequently (every 2-3 hours) to prevent skin breakdown. Tuck diaper edges under cast opening, use waterproof tape around perineal area. Consider using sanitary pads along cast edges for additional protection. Positioning: Use pillows to support the cast and prevent pressure sores. Never lift child by the cast itself. Create comfortable positions for feeding, playing, and sleeping. Car travel: Special car seat inserts or modifications may be needed - consult occupational therapist. Bathing: Sponge baths only. Use waterproof cast covers or plastic wrap with tape. Keep perineal area clean and dry. Skin care: Check skin at cast edges twice daily for redness, sores, or irritation. Use soft cloth or moleskin padding if needed. Monitor for: Excessive crying, fever (>100.4°F), foul odor from cast, swelling/color changes in toes, inability to move toes. Engage your baby with age-appropriate activities - reading, singing, supervised tummy time on pillows. Join parent support groups for practical tips.

Q7.Will my child walk normally after DDH treatment?

The vast majority of children treated for DDH achieve normal or near-normal hip function and walk without limitations. Outcomes depend heavily on timing of diagnosis and treatment initiation. Children diagnosed and treated in the first 6 months with Pavlik harness have excellent outcomes - 90-95% achieve completely normal hip development. Those requiring closed or open reduction at 6-18 months typically have good outcomes (85-90% normal function) though walking may be delayed by several months compared to peers. Children diagnosed after 18 months or those with complications (AVN, residual dysplasia) may require additional surgeries during growth and have increased risk of early hip arthritis in adulthood. Most children walk independently by 18-24 months after treatment completion. Some may have subtle differences - slight limp, minor leg length discrepancy (managed with shoe lift), or mild activity limitations. Long-term follow-up is essential through skeletal maturity. With modern treatment protocols and experienced surgeons like Dr. Kumar, the prognosis is very good for early-diagnosed DDH.

Q8.What is the cost of DDH treatment at Arthoscenter?

DDH treatment costs at Arthoscenter vary based on the treatment required: Pavlik Harness Treatment: ₹25,000 - ₹40,000 including harness device (₹15,000-20,000), initial fitting and education, weekly follow-ups for 8-12 weeks, serial ultrasound monitoring, and adjustments. Closed Reduction with Spica Cast: ₹1,20,000 - ₹1,80,000 including pre-operative evaluation and arthrogram, general anesthesia, closed reduction procedure, hip spica cast application, 1-2 day hospital stay, and follow-up care with cast changes. Open Reduction Surgery: ₹2,50,000 - ₹3,50,000 including comprehensive pre-operative workup, surgical procedure (open reduction ± femoral/pelvic osteotomy), hospital stay 2-3 days, implants if needed, spica cast, and 6-month follow-up care. All packages include Dr. Kumar's expertise, comprehensive imaging, physiotherapy consultation, and parent education. Many procedures are covered under government schemes (Ayushman Bharat, state health insurance). We offer transparent pricing, installment options, and assistance with insurance claims. Early treatment with Pavlik harness is most cost-effective. Book ₹999 consultation to discuss your child's specific needs and accurate cost estimate.

Q9.Can DDH be prevented or is it genetic?

DDH has both genetic and environmental components, making complete prevention difficult but risk reduction possible. Genetic factors: Family history increases risk 10-12 fold, suggesting genetic predisposition. If one child has DDH, siblings have 6% risk (vs 1-2% general population). Girls are affected 4-5 times more than boys, indicating hormonal/genetic factors. However, most DDH cases occur without family history. Prevention strategies: Avoid tight swaddling that forces legs into extension - use "hip-healthy swaddling" allowing leg flexion and abduction. Babywearing in proper position (legs in "M" or frog position, not dangling straight). Early newborn screening for all babies, especially high-risk (breech, family history, firstborn). For breech babies, consider ultrasound screening at 6 weeks even if exam normal. Proper car seat positioning avoiding excessive hip extension. While you cannot prevent DDH entirely, these measures reduce risk. Most importantly, early detection through newborn screening and prompt treatment when diagnosed ensures excellent outcomes. If you have family history of DDH, inform your obstetrician and pediatrician for appropriate screening.

Q10.What follow-up care is needed after DDH treatment?

Long-term follow-up is essential after DDH treatment to ensure proper hip development and detect complications early: First Year After Treatment: - Monthly visits for first 3 months after harness/cast removal - X-rays every 3-4 months to monitor hip development - Assessment of developmental milestones (sitting, crawling, walking) - Physical therapy evaluation and exercises - Monitoring for limping, leg length discrepancy, or pain Years 1-5: - Every 6-12 months clinic visits - Annual X-rays to check acetabular index, center-edge angle, and femoral head development - Gait analysis and range of motion assessment - Screening for AVN signs (may appear 1-2 years post-treatment) - Address any leg length discrepancy with shoe lifts if needed Until Skeletal Maturity (age 16-18): - Annual follow-ups with X-rays - Monitor for residual dysplasia requiring osteotomy - Activity modification if needed - Transition to adult orthopedic care Lifelong Considerations: - Awareness of increased hip arthritis risk in adulthood - Maintain healthy weight to reduce joint stress - Stay active with low-impact exercises - Seek early evaluation for hip pain Dr. Kumar provides comprehensive surveillance program with dedicated pediatric follow-up clinic ensuring optimal long-term outcomes.

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