Hip Dysplasia Assessment

A Hip Dysplasia Assessment is a diagnostic evaluation that checks whether the hip joint — the ball-and-socket connection between the thigh bone and the pelvis — has formed and is sitting correctly.

In a healthy hip, the rounded head of the thigh bone fits snugly inside a deep cup in the pelvis called the acetabulum (the hip socket). When a child has hip dysplasia, that socket may be too shallow, tilted, or the ball may sit partially or fully outside it. This assessment uses physical examination and imaging — such as ultrasound in infants or X-ray in older children — to measure the exact shape and position of the joint so the care team can plan treatment early.

This assessment is ordered whenever a doctor suspects that the hip joint has not developed normally. It is most commonly used in newborns and infants, but can also be performed in older children and adolescents when symptoms appear later.

• Developmental dysplasia of the hip (DDH) — a condition present at or shortly after birth where the hip socket is too shallow or the joint is unstable
• A positive newborn screening test, such as the Barlow or Ortolani manoeuvre (hands-on checks that feel for an unstable hip)
• Asymmetric skin folds on the thighs or buttocks noticed by a parent or clinician
• Limping, a waddling walk, or one leg appearing shorter than the other
• Restricted movement when spreading the baby's legs apart (limited abduction)
• High-risk factors: breech presentation (baby bottom-first in the womb), family history of hip dysplasia, or a first-born girl
• Adolescent hip pain that has not responded to other diagnoses

There are some situations where certain parts of this assessment may need to be adapted. Ultrasound is preferred under four to six months of age because the hip bones are still cartilage and do not show well on X-ray. X-ray becomes the standard tool once the bones have hardened. Your doctor will choose the right method based on the child's age and clinical picture.

A Hip Dysplasia Assessment is a diagnostic procedure, and in most cases it carries very little risk to the child.

• Ultrasound: no known risks — it uses sound waves, not radiation, and is considered safe for infants of any age
• X-ray: involves a very small dose of radiation; the care team uses shielding to protect nearby body parts, especially the reproductive organs
• Physical examination manoeuvres: rarely, they may cause brief discomfort, but they do not damage a normal hip and are performed gently by trained clinicians
• Sedation (if an MRI scan is added for complex cases): young children may need light sedation to keep still; sedation carries its own small set of risks, which the anaesthesia team will explain separately
• Emotional distress: some infants and young children become upset during the examination, which is normal and temporary

For a standard hip dysplasia assessment using physical examination and ultrasound or X-ray, almost no special preparation is needed. There is no fasting requirement and no need to stop routine medications. If the doctor also orders an MRI with sedation, the anaesthesia team will give specific fasting instructions in advance — usually no milk or solid food for several hours before the appointment.

Parents or guardians should bring the child's health records, including any previous imaging results, birth notes, and a record of any family history of hip problems. Dressing the child in easy-to-remove clothing makes the examination quicker and less stressful.

The following tests or checks are usually part of the assessment:

• Clinical history: the doctor asks about the pregnancy, birth position, family history, and when any symptoms were first noticed
• Physical examination: the doctor gently moves each hip through its range of motion and checks leg lengths and skin fold symmetry
• Ultrasound (Graf method): a probe is pressed lightly against the hip to produce an image; the doctor measures the angle of the socket to grade its depth and shape
• X-ray (in children usually older than four to six months): the child lies flat and a single image of the pelvis is taken; lines and angles are drawn on the image to assess socket coverage
• MRI (in selected complex cases): gives detailed images of cartilage and soft tissue around the hip when ultrasound or X-ray results are not conclusive

Here is what typically happens during the visit, in order:

• 1. The family meets the paediatric orthopaedic specialist, who reviews the history and any previous records.
• 2. The child is undressed from the waist down (a nappy may be kept on for comfort during early steps).
• 3. The doctor performs the physical examination, checking hip stability, leg length, and movement.
• 4. The child is positioned for imaging — lying still on a table for ultrasound or X-ray.
• 5. The radiographer (imaging technician) captures the images; parents are usually allowed to stay in the room during ultrasound and may stand behind a protective screen during X-ray.
• 6. The specialist reviews the images, often in the same session, and discusses the findings with the family.

Because the assessment itself does not involve surgery or sedation in most cases, there is no physical recovery period needed after the visit. The child can return to normal feeding, activity, and daily routines immediately. If sedation was used for an MRI, the child will be monitored in a recovery area until fully awake and the anaesthesia team confirms it is safe to go home — usually within a few hours.

• Results and next steps: the specialist will explain what the images show and, if treatment is needed, discuss the options — these may range from watchful waiting to a positioning brace (such as a Pavlik harness, which holds the hip in place) to surgery, depending on the severity and the child's age
• Follow-up imaging: many children with hip dysplasia need repeat ultrasound or X-ray appointments at intervals set by the doctor to track how the joint is developing
• Activity: no restrictions following a standard examination; if a brace is prescribed, the specialist or orthotist (brace specialist) will explain how long it should be worn each day and how to care for the skin underneath
• Skin care under a brace: the care team will show parents how to check for pressure marks or redness and when to contact the clinic
• Developmental monitoring: the child's overall motor development — rolling, sitting, standing, walking — will be watched at regular check-ups alongside the hip assessments
• Family questions: parents are encouraged to write down questions before each follow-up visit, as the treatment plan may be adjusted as the child grows