Pediatric Radiology

, Volume 49, Issue 12, pp 1652–1668 | Cite as

Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging

  • Christian A. Barrera
  • Sara A. Cohen
  • Wudbhav N. Sankar
  • Victor M. Ho-Fung
  • Raymond W. Sze
  • Jie C. NguyenEmail author
Musculoskeletal imaging


Developmental dysplasia of the hip (DDH) describes a broad spectrum of developmental abnormalities of the hip joint that are traditionally diagnosed during infancy. Because the development of the hip joint is a dynamic process, optimal treatment depends not only on the severity of the dysplasia, but also on the age of the child. Various imaging modalities are routinely used to confirm suspected diagnosis, to assess severity, and to monitor treatment response. For infants younger than 4 months, screening hip ultrasound (US) is recommended only for those with risk factors, equivocal or positive exam findings, whereas for infants older than 4–6 months, pelvis radiography is preferred. Following surgical hip reduction, magnetic resonance (MR) imaging is preferred over computed tomography (CT) because MR can not only confirm concentric hip joint reduction, but also identify the presence of soft-tissue barriers to reduction and any unexpected postoperative complications. The routine use of contrast-enhanced MR remains controversial because of the relative paucity of well-powered and validated literature. The main objectives of this article are to review the normal and abnormal developmental anatomy of the hip joint, to discuss the rationale behind the current recommendations on the most appropriate selection of imaging modalities for screening and diagnosis, and to review routine and uncommon findings that can be identified on post-reduction MR, using an evidence-based approach. A basic understanding of the physiology and the pathophysiology can help ensure the selection of optimal imaging modality and reduce equivocal diagnoses that can lead to unnecessary treatment.


Children DDH Developmental dysplasia of the hip Hip Infants Magnetic resonance imaging MRI Spica cast Ultrasound 


Compliance with ethical standards

Conflicts of interest

Dr. Sankar receives royalties from Wolter Kluwer Health for edited textbooks.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Orthopedic SurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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