DDH Treatment in Turkey

Developmental Hip Dislocation (DDH) Treatment in Turkey | Infants and Children

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Developmental dysplasia of the hip (DDH), commonly called congenital hip dislocation, is a condition in which the hip joint of an infant or child is unstable or has not formed fully. It ranges from a mild abnormality in the hip socket to complete dislocation of the head of the thigh bone from its place.

The problem may not be visible at birth, and it can be discovered later even though the first examination was normal. For this reason, an infant's hips are re-examined at several visits during the first months. The earlier the condition is found, the simpler the treatment options tend to be, but the right treatment differs from one child to another according to age, the degree of dislocation, and the response to treatment.

This guide explains in simple language, and based on scientific references, what DDH is, how it is diagnosed, what the treatment options are from observation and harness to surgery, what the risks are, how follow-up works, and what parents should know before considering treatment in Turkey. It is general education and does not replace an examination of your child by a pediatric orthopedic surgeon.

What is developmental hip dislocation (DDH)?

The hip is a ball-and-socket joint. The ball is the head of the thigh bone (femur), and the socket (acetabulum) is a cup in the pelvis that holds the head. The socket takes its healthy shape when the head sits in the right place while the child grows.

The term DDH describes a spectrum of conditions:

• Hip instability: the head is inside the socket but may slip out during examination.
• Subluxation (partial dislocation): the head has partly come out of the socket.
• Dislocation (complete dislocation): the head is completely out of the socket.
• Dysplasia: the socket is shallow or underdeveloped, and the head may still be in place.

Doctors use the term "developmental dysplasia" because the condition can develop after birth, while the name "congenital hip dislocation" is more familiar to the public. How cases are defined varies between studies, which is why reported prevalence figures differ from one source to another.

Many mild cases improve by themselves in the first weeks. The American Academy of Orthopaedic Surgeons (AAOS) guideline notes that about 60% to 80% of abnormalities found on clinical examination, and more than 90% of those found on ultrasound, resolve in early infancy. This does not mean every case will resolve, however: an established dislocation needs treatment.

Causes and risk factors of developmental hip dislocation

There is no single cause that explains every case. Some factors raise the likelihood, and many affected children have no obvious risk factor. The factors mentioned are:

• Breech position of the baby: the baby lies bottom-first before birth.
• Family history: hip dislocation or dysplasia in a relative.
• Female sex: girls are affected more often.
• Improper swaddling: keeping the legs straight and pressed together, as noted by the American Academy of Pediatrics (AAP).
• Low amniotic fluid: an association appeared in a recent scientific analysis, but the evidence is weaker.

In a meta-analysis published in 2025 that combined 20 studies on more than 64,000 infants, breech position and family history were the strongest factors, with moderate certainty, while certainty for the other factors was lower. The analysis found no association with cesarean delivery, a first pregnancy, twins, or prematurity. Older and newer sources differ on some of these points, so no factor should be treated as a confirmed cause in an individual child, and parents should not be blamed for the condition.

Symptoms and signs of hip dislocation in infants and children

An infant may show no obvious symptoms, which is one reason regular examination by a doctor matters. Signs that may draw attention include:

• Uneven skin folds in the thighs: found in many healthy babies, so it does not indicate dislocation by itself.
• Different leg lengths: one leg looks shorter.
• Limited spreading of the leg: difficulty opening the leg sideways compared with the other side. After about 3 months this becomes one of the most important clinical signs.
• Galeazzi sign: one knee looks lower than the other when the child lies on the back with hips and knees bent.
• In older children: delayed walking, a limp, or a waddling gait if both hips are affected.

These signs do not necessarily mean dislocation, but they call for the child to be seen by a doctor. The doctor examines an infant with two important tests: the Ortolani test, which can feel the head returning into the socket, and the Barlow test, which assesses whether the head can slip out. According to the AAP, Ortolani is among the most important clinical tests in newborns.

How is developmental hip dislocation diagnosed?

Clinical examination: the doctor checks movement, stability and spreading of both hips, and repeats the examination at later visits, because a single normal examination does not completely exclude the condition.

Ultrasound: the most suitable imaging method in the first months, because the head of the thigh bone is still cartilage and does not show well on X-ray. Some doctors classify the hip by the Graf method, relying on the alpha angle and other measurements. The AAOS does not recommend routine ultrasound for all newborns, but it does recommend imaging before 6 months when there is a breech position, a family history, or clinical instability.

X-ray: becomes more useful than ultrasound after about 4 months, when the head of the thigh bone begins to ossify. The doctor uses it to measure the acetabular index, which changes with age and cannot be interpreted without knowing the child's age.

Advanced imaging: MRI or CT may be used in selected cases, for example to assess the position of the head after reduction inside the cast.

It is important for parents to know that ultrasound measurements depend on the examiner's skill and that image quality varies between centers, so it is preferable for the images to be read by a trained specialist.

When does a child need treatment, and when is follow-up enough?

Not every case of DDH is surgical, and not every case needs immediate treatment.

• Follow-up: a case may be monitored with repeated examination and imaging if the hip is clinically stable but ultrasound shows immaturity. The AAOS notes that the evidence supports observation without a device in this situation, and the Dutch guideline suggests observing a centered hip in a 3-month-old for 6 to 12 weeks before starting a device.
• Treatment: when the hip is clinically unstable or not centered, the doctor usually starts a stabilizing device.
• Late treatment: the later the dislocation is found, the more complex the options become. The AAP notes that open surgery is generally recommended after 18 months of age.

The individual decision always rests with a pediatric orthopedic surgeon after examining and imaging the child.

Treating developmental hip dislocation without surgery

Pavlik harness and other stabilizing devices

The Pavlik harness is a fabric device worn on the infant's chest and legs. It keeps the hips bent and spread apart in a position that helps the head settle into the socket, while allowing the child to move the legs within limits. It is used most often with young infants.

Doctors and guidelines do not agree on one device for everyone:

• The AAOS guideline prefers the von Rosen device over the Pavlik, Craig and Frejka devices when starting treatment of an unstable hip, but with a "limited" strength of recommendation because the evidence is scarce.
• The Dutch guideline (2022) prefers the Pavlik harness as the first step for a decentered hip in children under one year.
• The devices should therefore not be seen as equivalent alternatives for every case; the doctor chooses what suits the child's age and degree of dislocation.

Duration of use: there is no single agreed duration. The British expert consensus (BSCOS, 2023) suggests at least about six weeks after the hip returns to place, while the Dutch guideline recommends assessing the child every six weeks and stopping the device when the hip improves or the child reaches 12 months. Practice varies from one center to another.

How treatment is monitored: with clinical examinations and periodic ultrasound. If the head does not return to the socket within about three weeks, doctors usually advise not continuing the harness and changing the plan.

Risks and limits:

• Skin irritation around the straps.
• Temporary femoral nerve palsy: seen as weak knee extension. Studies have recorded it in roughly 2% to 4%. It usually occurs in the first two weeks and typically resolves with adjusting or pausing the harness.
• Avascular necrosis of the femoral head (explained below) is a complication reported with device treatment.
• Treatment failure: the likelihood of failure rises with higher grades of dislocation, a later start of treatment, a positive Galeazzi sign, and the appearance of femoral nerve palsy. Failure rates differ between studies according to the group and the definition, so they cannot be compared as a single figure.

If the hip is slow to improve, the doctor will move to another plan, which does not mean the harness was used wrongly.

Follow-up without immediate treatment

In some mild cases, for example a stable hip with a normal examination but immaturity on ultrasound, the doctor may judge that repeated examination and imaging is more suitable than fitting a device immediately. Treatment starts if the hip does not improve or instability appears.

When does a child need surgery?

Surgical intervention may be considered in these situations:

• Treatment with a device did not bring the head back into place or keep it there.
• The dislocation was discovered at an older age, after the early infant stage.
• A shallow socket persists after reduction, especially at walking age.

The AAOS and POSNA educational materials state that children between about 6 months and 2 years are often treated with closed reduction and a cast, sometimes preceded by skin traction in some centers, and if that does not succeed the next step is open reduction, and that children older than 2 years usually need open surgery. These are general guides, not firm limits.

Closed reduction and open reduction: what is the difference?

Closed reduction means returning the head of the thigh bone into the socket under anesthesia, without a surgical incision, by carefully moving the hip with the help of imaging. It is usually used after a device has failed, or in children slightly older than infants. It is often followed by a cast that holds the hips in position (Spica cast), and the surgeon may also release the adductor tendon if the legs cannot be spread widely.

Open reduction is done through a surgical incision through which the surgeon reaches the joint to return the head into the socket and remove whatever prevents it from returning. It is used when closed reduction fails or is not possible, and in older ages. The surgeon chooses the approach (anterior, anterolateral or medial) according to preference and the child's condition. A cast is applied after the operation, and bone surgery on the pelvis or thigh bone may be added depending on the case.

The surgeon often uses imaging during the procedure, including a joint dye study (arthrogram), to assess how stable the reduction is and whether anything blocks it. After closed or open reduction, a cast is placed in many cases for about three months according to the surgeon's decision, and it may be followed by a stabilizing brace if the socket remains shallow, as the Dutch guideline recommends.

How often does closed reduction succeed? There is no single figure that fits every child. A 2024 scientific analysis showed that the chance of closed reduction not succeeding rises as the degree of dislocation rises, and that age alone did not predict failure in that analysis. Each child is therefore assessed according to the degree of dislocation.

Can the dislocation return after reduction? It can. In the same analysis, redislocation after an initially successful closed reduction occurred in about 8% of hips in children under two years, mostly in the first months after reduction. This is why follow-up is an essential part of treatment.

Pelvic osteotomy and femoral osteotomy

If the socket remains shallow after reduction, or the dislocation is found at an older age, the surgeon may turn to bone surgery called an osteotomy:

• Pelvic osteotomy: reorients the socket or changes its shape so it covers the head of the thigh bone better. Techniques include Salter, Pemberton and Dega. Some techniques reorient the whole socket and others reshape it, and the surgeon chooses according to the child's anatomy and age.
• Femoral osteotomy: shortens the thigh bone or adjusts its rotation, which reduces pressure on the femoral head after reduction and corrects excessive twisting of the bone. It may be done together with pelvic osteotomy.

There is no fixed age for each procedure. Scientific reviews point to generally good results for pelvic osteotomy, but acknowledge that the available evidence is limited and does not clearly favor one technique over another. In a systematic review of Salter osteotomy, complications appeared in about 9% of hips and avascular necrosis was the best known of them (about 2.5%); these figures belong to those studies.

Choosing treatment by the child's age

This outline is for education only. The ages are approximate and not firm limits, and it does not replace the doctor's assessment.

• Newborns (first weeks of life): many mild cases improve by themselves, so they are monitored with repeated examinations. If there is clinical instability, a stabilizing device is usually fitted.
• 1 to 6 months: the harness or a stabilizing device is the most common choice, with ultrasound monitoring of the hip. If the hip does not improve, the doctor changes the plan.
• 6 to 18 months: closed reduction with a cast is often used when a device has failed or the diagnosis was late, and open reduction may be needed if it does not succeed.
• 18 months to 3 years: open reduction becomes more common, and bone surgery may be added depending on the case.
• Older than 3 years: the child usually needs open reduction with bone surgery, and results are less predictable.

Timing is affected by the severity of the dislocation, the degree of socket deformity, whether the joint can be reduced, the child's growth, and the experience of the treating center.

Risks and complications

Every DDH treatment carries risks that the doctor explains before a decision is made. The most important are:

Avascular necrosis of the femoral head (AVN): reduced blood supply to the head of the thigh bone, which may affect its growth and shape and the long-term result of treatment. It is one of the main things doctors watch for, and it is mentioned with device treatment and with closed and open reduction. Its rates vary widely between studies, and one figure cannot be compared with another:

• In a 2016 systematic review of seven studies covering 441 children (538 hips) treated with closed reduction before the age of two, with an average age at reduction of about 9.6 months and average follow-up of 7.6 years, clinically significant avascular necrosis appeared in about 10% of hips. Figures published in different studies ranged from 4% to 60%.
• In another systematic review (2014) of open reduction through the medial approach only, covering 734 hips with average follow-up of about 11 years, the rate was about 20%. The necrosis was linked to more unsatisfactory results at the end of follow-up.
• The difference between the two figures does not mean one procedure is better than the other: the ages, the cases, the approach, the follow-up time and the definition of the complication all differed.

Redislocation: as mentioned, it may occur after closed reduction in a share of hips, usually in the first months.

Unsuccessful reduction: the child may need open reduction or a repeat reduction, especially with higher degrees of dislocation.

Persistent socket dysplasia: the socket may remain shallow after a successful reduction, and the child may later need bone surgery.

Complications of osteotomy: such as delayed bone healing, loss of correction, problems with fixation hardware, or a difference in leg length. There are not enough documented figures to generalize rates for them, apart from what was mentioned above for Salter osteotomy.

General risks: as in any surgery and anesthesia: infection, skin problems under the cast, rare nerve or blood vessel injury, and temporary stiffness. The medical team explains these risks and how they are monitored.

Recovery after treatment and caring for a child in a cast

Recovery differs greatly between harness treatment, surgical reduction and bone surgery, so there is no single timetable for everyone.

After reduction (closed or open): the Dutch guideline recommends a cast for about 12 weeks and then a stabilizing brace if the socket remains underdeveloped, and a prospective study describes an average cast time of about 12 weeks (range 4 to 30). POSNA mentions two to three months for older children. The duration depends on the surgeon's decision.

After bone surgery: the surgeon decides the method of fixation and the length of casting or bracing according to the type of osteotomy and the child's condition.

General cast care tips (consistent across educational materials from well-known children's hospitals; your surgeon determines the details):

• Change the child's position every 2 to 4 hours to avoid skin pressure.
• Keep the cast dry and clean, and change diapers in a way that tucks a small diaper under the cast edges with a larger diaper over it, changing them often.
• Check the skin, the cast edges and the toes (warmth, color and movement) every day.
• Do not use powders or lotions at the cast edges.
• Support the cast when carrying the child, and do not lift the child by the arms.
• Call the surgeon for redness or sores on the skin, increasing pain, a wet or damaged cast, or an object inside it.

There is currently no documented source that determines when physiotherapy should start after bone surgery or when age-appropriate activities are allowed, so the surgeon decides these.

Long-term results

Success in returning the head to the socket is a first step, but it does not always mean fully normal development of the joint. The socket continues to grow as the child grows, and a deficiency in coverage of the head may remain and appear on later X-rays.

In long-term follow-up studies of children treated decades ago after a late-detected dislocation, several factors were linked to worse results in adulthood, such as persistent socket dysplasia, subluxation, avascular necrosis, and reduction at an older age. One such series found that 27 of 60 patients needed additional surgery more than three years after reduction. These are figures for old treatments and late cases, and they should not be applied to an infant treated with a harness today. No documented recent figures are available on the chance of hip arthritis for today's children, so no percentages are given.

The important message for parents: some children need follow-up for years even after the first treatment succeeds.

Follow-up after returning to the child's home country

Treatment of DDH does not end with one procedure, with the removal of the cast, or with the end of the treatment trip. After treatment the hip needs periodic review and imaging to assess the growth of the socket and the femoral head and to make sure the dislocation has not returned and the socket is not remaining underdeveloped.

What the sources say:

• Most British experts (BSCOS) reject discharging a hip treated with a harness with no follow-up at all, and many believe follow-up should continue until walking age with normal X-rays; some hospitals mention review for at least two years after a harness.
• POSNA stresses the need for regular examinations and X-rays to ensure normal growth continues and the problem does not return.
• Some children may be left with a socket abnormality that needs later surgery.

There is no uniform timetable for all children; the surgeon sets it according to age, condition and the procedure performed.

To make follow-up after returning home work, parents are advised to:

• Before travelling: agree on who will follow the child in your home country (a pediatric orthopedic doctor), and ask the treating team about the follow-up plan and its timing.
• Before returning: ask for a written medical report stating the diagnosis, the grade, the procedure and the type of cast or device, together with the follow-up plan and the date of the next X-ray.
• Imaging files: obtain discs or files of the X-rays and ultrasounds to give to the doctor who will follow the child.
• What needs urgent review: increasing pain, a change in the color of the toes, sores on the skin under the cast, or any concern raised by the treating team.

When does a child need an additional operation?

Some children may need an additional procedure later, including:

• Repeat reduction if the dislocation returns.
• Pelvic or femoral osteotomy if the socket remains underdeveloped or coverage of the head is not enough.
• Treatment of complications of avascular necrosis.
• Correction of residual deformities after the child grows.

This does not mean the first treatment was wrong; it may reflect the way the joint grows. The need is determined by follow-up and imaging.

Cost of developmental hip dislocation treatment in Turkey

The cost of treating developmental hip dislocation in Turkey is estimated at between USD 6,000 and 15,000. This is a general estimate, not a price quotation and not a confirmed price for a specific case.

The price varies according to:

• The complexity of the case and the child's age.
• The type of treatment: harness or stabilizing device, closed reduction, or open reduction.
• Whether pelvic or femoral osteotomy is needed.
• Any additional surgical procedures.

A specific price cannot be attributed to each procedure without assessing the case. What the price includes also differs from one offer to another, and it should not be assumed to cover examinations, imaging, the harness, anesthesia, the cast, accommodation, medication, physiotherapy or follow-up. Always ask for a detailed written offer after your child's medical reports and images are reviewed, and ask explicitly what is billed separately, including complications or the need for additional surgery.

Travelling to Turkey for treatment: what to know before deciding

Treatment of DDH can extend over a period and needs follow-up, so the decision to travel should be well considered. It helps to:

• Send previous reports and images (ultrasound and X-ray) for an initial assessment before travelling.
• Make sure the person who will assess the child is a pediatric orthopedic specialist with experience in pediatric hip surgery, and ask about their experience with DDH in particular.
• Know the degree of dislocation and the stage of joint development, the proposed plan, and the alternatives.
• Ask about the type of anesthesia and the pediatric anesthesia team.
• Ask about the cast care plan if the child needs one, and how problems are handled.
• Arrange follow-up after returning home and collect the reports and images (see the follow-up section).
• Understand that follow-up may continue for years, depending on the child's condition.

This guide does not give advice on flight timing or length of stay in Turkey; the surgical team determines these according to the child's condition. Nor does the evidence we reviewed show that treatment in any particular country is medically better than another; what matters is the experience of the treating team and good follow-up of the child.

Medical note: this information is for general education. It does not replace consultation with a specialist doctor and is not a diagnosis or a prescription.