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Health condition · Clinically reviewed

Hip dysplasia, from the newborn check to periacetabular osteotomy.

A spectrum, not a single disease. Caught early, most hips do well in a Pavlik harness. Missed until adulthood, dysplasia is a common driver of early hip osteoarthritis - and there is still a lot to do about it.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NIPE, BOA, RCPCH and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including NIPE screening, Pavlik harness care and periacetabular osteotomy.

Key facts

Hip dysplasia at a glance.

The essentials in plain English - what it is, who it affects, and how it is picked up and treated in the UK today.

  • What it is

    Developmental dysplasia of the hip (DDH) - a spectrum from mild acetabular shallowness to complete dislocation of the femoral head.

  • Who it affects

    Around 6 times more common in girls; the left hip is most often involved. Neonatal, infant, adolescent and adult presentations all occur.

  • Risk factors

    Female sex, breech presentation, first-born, family history, oligohydramnios and packaging deformities such as torticollis or foot deformity.

  • UK screening

    Every newborn is examined under the NIPE programme - Ortolani and Barlow tests, with hip ultrasound at 6 weeks for babies at higher risk.

  • Early treatment

    Pavlik harness for 6 weeks to 6 months of age; closed or open reduction and spica cast for older infants.

  • Adolescent/adult

    Persistent dysplasia is treated with periacetabular osteotomy (Ganz PAO) at specialist commissioned hip preservation centres.

Why this guide matters

One condition, several right answers.

A newborn dysplastic hip and an adult with acetabular dysplasia and groin pain need very different care. The three points below shape everything else on this page.

  • Screening does the heavy lifting

    NIPE examinations and risk-based ultrasound catch most cases early, when a Pavlik harness alone is usually enough.

  • Adolescents and adults are often missed

    Persistent groin pain, labral tears and early osteoarthritis in young adults deserve an X-ray and a hip preservation opinion.

  • The specialist matters

    Complex DDH surgery and adult periacetabular osteotomy are specialist commissioned services concentrated in a small number of UK units.

How the diagnosis is made

From the newborn check to the operating theatre.

The steps a UK team will normally follow - so you know what to expect at each age and why.

  1. 01

    Screening

    NIPE newborn examination

    Ortolani and Barlow manoeuvres within 72 hours of birth, repeated at the 6 to 8 week check by GP or health visitor.

  2. 02

    Screening

    Risk-based referral for USS

    Babies with breech presentation, family history or a clicky hip are referred for a hip ultrasound at around 6 weeks of age.

  3. 03

    Screening

    Older infant assessment

    Asymmetric skin folds, reduced hip abduction, apparent leg-length difference or a limp on walking prompt further imaging.

  4. 04

    Confirming

    Hip ultrasound (under 6 months)

    Graf classification measures alpha and beta angles - the standard test before the femoral head has ossified.

  5. 05

    Confirming

    X-ray from 6 months onwards

    Acetabular index, centre-edge angle and Sharp angle guide diagnosis in older children, adolescents and adults.

  6. 06

    Planning

    MRI or CT for planning

    Cross-sectional imaging is used before osteotomy or when a labral tear, cartilage damage or femoroacetabular impingement is suspected.

  7. 07

    Planning

    Specialist paediatric or preservation team

    Paediatric orthopaedic teams manage children; adolescent and adult dysplasia is referred to a commissioned hip preservation unit.

Typical pathway: from newborn check to definitive plan within a few weeks in most UK hospitals.

Symptoms

What hip dysplasia actually looks like.

Findings vary with age - from a hip clunk in a newborn to a young adult with stubborn groin pain and early cartilage change.

  • Hip click in the newborn

    A palpable clunk on Ortolani or Barlow manoeuvre - the classic finding at the NIPE newborn check.

  • Reduced hip abduction

    The affected hip does not open out fully when the knees are flexed and gently spread apart.

  • Asymmetric skin folds

    Uneven thigh or buttock creases in infancy can be a soft sign - useful when combined with other findings.

  • Apparent leg-length difference

    One leg looks shorter with the knees bent (Galeazzi sign) - suggests the femoral head is not seated correctly.

  • Limp or toe-walking

    A painless limp or Trendelenburg gait once walking begins is a red flag for a missed dysplastic hip.

  • Groin pain in adolescents

    Deep groin or lateral hip pain during sport, especially in teenage girls, can be the first adult sign of dysplasia.

  • Early osteoarthritis in adults

    Progressive stiffness and pain in your 20s, 30s or 40s can point to previously undiagnosed acetabular dysplasia.

  • Red flag - packaging deformities

    Torticollis, metatarsus adductus or a foot deformity alongside a suspicious hip warrants urgent imaging.

Treatment

How hip dysplasia is treated in the UK.

Harness and cast in babies, osteotomy and hip preservation in older children and adults, and joint replacement when the cartilage is already gone.

  • Pavlik harness

    First-line for babies aged 6 weeks to about 6 months - a soft harness that holds the hips in a safe, flexed and abducted position.

  • Closed reduction and spica

    Used from around 6 to 18 months when a harness has not worked - the hip is reduced under anaesthetic and held in a hip spica cast.

  • Open reduction

    A specialist commissioned operation when closed reduction fails or the child presents late - the joint is opened and reset directly.

  • Femoral or pelvic osteotomy

    Reshapes the femur or pelvis in children with persistent dysplasia - performed at specialist commissioned paediatric orthopaedic centres.

  • Periacetabular osteotomy

    The Ganz PAO reorients the acetabulum in adolescents and adults - offered at commissioned UK hip preservation units (see /treatments/periacetabular-osteotomy/).

  • Hip arthroscopy

    A keyhole option for associated labral tears and impingement in dysplastic hips (see /treatments/hip-arthroscopy/) - carefully selected cases only.

  • Total hip replacement

    For end-stage osteoarthritis from long-standing dysplasia - see /treatments/hip-replacement-surgery/. Usually a later step after preservation options.

  • MDT and charity support

    Specialist commissioned paediatric orthopaedic and hip preservation teams, supported by Steps Charity Worldwide and the International Hip Dysplasia Institute.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialty society consensus and specialist commissioning standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, paediatric orthopaedic team or hip preservation surgeon knows your child or your history and can tell you which parts apply to you.

  • Public Health England / NHS. Newborn and Infant Physical Examination (NIPE) programme handbook.

  • British Orthopaedic Association / British Society for Children’s Orthopaedic Surgery. Consensus statement on DDH.

  • NHS England. Specialised commissioning service specifications for complex paediatric orthopaedics and hip preservation surgery.

  • RCPCH. Standards for newborn hip examination and follow-up.

  • Steps Charity Worldwide and the International Hip Dysplasia Institute - patient information resources.

Red flags

When a hip needs urgent attention.

Most dysplasia follows a settled pathway. These are the situations that need a lower threshold for imaging or referral.

  • Missed dislocation in a walking child

    A painless limp, Trendelenburg gait or toe-walking in a toddler needs urgent hip imaging - a dislocated hip may still be silent.

  • Bilateral high dislocation

    A wide-based, waddling gait with marked lumbar lordosis suggests bilateral DDH and needs specialist paediatric orthopaedic review.

  • Neurological signs

    Weakness, spasticity or delayed milestones alongside hip signs may point to cerebral palsy or a neuromuscular cause of hip dysplasia.

  • Sudden severe hip pain

    Acute inability to weight-bear in a child needs same-day assessment to exclude septic arthritis, Perthes disease or slipped upper femoral epiphysis.

  • Persistent groin pain in a teenager

    Especially with a positive impingement test - warrants a hip preservation opinion and MRI before osteoarthritis sets in.

  • Failed Pavlik harness

    If the hip is not reduced by around 3 to 4 weeks in a harness, the plan should change - continuing risks avascular necrosis.

  • Avascular necrosis of the femoral head

    A recognised complication of treatment - progressive pain, stiffness or a change on imaging needs specialist review.

  • Late-presenting dysplasia in adulthood

    New hip pain in your 20s to 40s with a shallow acetabulum on X-ray - refer to a commissioned hip preservation service before OA is fixed.

  • Associated packaging deformities

    Torticollis, metatarsus adductus or clubfoot alongside a suspicious hip - lower the threshold for hip ultrasound.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference across the ages - keeping the newborn checks, trusting the harness, watching how the walking develops, and taking adult hip pain seriously.

A quiet reminder

Early answers beat heroic surgery, every time.

A hip picked up at the newborn check and treated in a harness usually needs nothing else for life. A hip missed until adulthood is a harder story - but still very much worth treating.

  1. 01 Newborn

    Attend every hip check

    The NIPE examinations at birth and 6 to 8 weeks are the best chance to catch DDH early - never skip them.

  2. 02 Baby

    Trust the harness

    Pavlik harness treatment is highly effective when started early - follow the paediatric orthopaedic team’s instructions closely.

  3. 03 Child

    Watch the walking

    Report any limp, uneven leg length or reluctance to weight-bear - early re-referral prevents late diagnosis.

  4. 04 Adult

    Don’t accept "just hip pain"

    Persistent groin pain, especially in a young woman, deserves an X-ray and a hip preservation opinion before joint replacement is on the table.

Frequently asked

Everything we get asked about hip dysplasia.

Quick answers on screening, harness care, periacetabular osteotomy and the link with hip osteoarthritis.

  • What is hip dysplasia?

    Hip dysplasia, or developmental dysplasia of the hip (DDH), is a spectrum of conditions where the hip socket has not formed deeply enough to hold the femoral head securely. It ranges from mild acetabular shallowness to complete dislocation and can present in newborns, older children, adolescents or adults.

  • How is hip dysplasia screened for in the UK?

    Every newborn is examined under the NIPE programme within 72 hours of birth and again at 6 to 8 weeks, using the Ortolani and Barlow manoeuvres. Babies with risk factors - breech presentation, family history, oligohydramnios or a clicky hip - are referred for hip ultrasound at around 6 weeks.

  • What are the risk factors for DDH?

    The main risk factors are female sex (roughly a 6 to 1 ratio), breech presentation, a first-degree family history, first-born status, oligohydramnios, and packaging deformities such as torticollis, metatarsus adductus or foot deformity. The left hip is most commonly affected.

  • How is hip dysplasia treated in babies?

    Below 6 months of age, most babies are managed in a Pavlik harness for several weeks under close paediatric orthopaedic supervision. From about 6 to 18 months, closed reduction under anaesthetic with a hip spica cast is used, and open reduction is reserved for hips that cannot be reduced closed.

  • What is a periacetabular osteotomy?

    The periacetabular osteotomy, or Ganz PAO, is a hip preservation operation for adolescents and adults with symptomatic dysplasia and reasonable joint cartilage. The pelvis is cut around the socket so it can be rotated over the femoral head and fixed with screws. It is offered at commissioned UK centres such as Oxford, Great Ormond Street and Warwick.

  • Can hip dysplasia lead to arthritis?

    Yes. Untreated or under-treated dysplasia is one of the commonest causes of early hip osteoarthritis in younger adults, often through labral tears and cartilage overload. Hip preservation surgery aims to prevent that, and total hip replacement is available if osteoarthritis is already established.

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