At Children's Hospital Los Angeles, Dr. Rachel Goldstein watches infants and teenagers arrive for hip dysplasia care—many of them years later than they should. As Director of the Hip Preservation Program in the Jackie and Gene Autry Orthopedic Center, she leads one of the country's highest-volume centers for this condition, also known as developmental dysplasia of the hip (DDH). The work she and her team do is reshaping how pediatric hip dysplasia gets detected, treated, and managed, with implications for children who might otherwise face surgery, limited mobility, or premature hip replacement before adulthood.
The landscape of DDH care is shifting in ways both encouraging and troubling. A disturbing trend has emerged across high-volume centers nationwide: more infants are reaching walking age before their hip dysplasia is diagnosed. The problem accelerated during the pandemic and has never corrected, despite widespread awareness of its urgency. The stakes matter enormously. "Bracing with a Pavlik harness is not an option after 6 months of age," Dr. Goldstein explains. "So kids diagnosed late need surgery that otherwise could have been avoided." This gap in early detection has spurred new screening protocols aimed at catching the condition before it requires invasive intervention.
For breech infants—a high-risk group—the American Academy of Pediatrics and American Academy of Orthopedic Surgeons have issued updated guidelines that intensify surveillance. Babies born breech now receive a screening ultrasound at six to eight weeks of age, followed by a pelvic X-ray at six to eight months—even if the initial ultrasound appears normal. Many pediatricians remain unaware of these stricter standards, but Dr. Goldstein stresses their importance for early identification in vulnerable populations.
One innovation reducing the burden on families is point-of-care ultrasound, a service CHLA offers as the only center of its kind in Los Angeles. Babies see Dr. Goldstein and the ultrasound technician in a single visit, allowing immediate adjustments to bracing and real-time refinement of treatment plans. "This allows us to make bracing adjustments and refine treatment plans immediately, while families avoid the burden of multiple appointments," she notes.
Surgical approaches are evolving too. Historically, DDH surgery concentrated on reshaping the hip socket. Today's surgeons increasingly employ femoral osteotomies and derotational procedures—techniques that adjust the rotation of the femur to improve stability and encourage the socket to develop more completely. For closed reduction surgeries, a CHLA study published in the Journal of Pediatric Orthopaedics has challenged conventional wisdom: the routine six-week cast change may be unnecessary. Children treated with a continuous three-month spica cast showed very low rates of cast-related complications while avoiding repeated anesthesia exposure and repeated hospital visits that strain families.
Adolescents present a distinct challenge. Many teens with hip dysplasia were born with normal hips but failed to develop the secondary ossification needed to deepen the socket—a condition once considered borderline and therefore left untreated. Dr. Goldstein's work has helped establish that even these borderline cases respond dramatically to periacetabular osteotomy (PAO), a surgical procedure that can significantly reduce pain, protect joints from early degeneration, and potentially avoid premature hip replacement. This reframing means more teenagers are getting help before damage becomes irreversible.
Together, these seven shifts—from screening intensity to surgical innovation—reflect a field learning to intervene earlier, more efficiently, and more intelligently. The result is healthier childhoods and the possibility of pain-free mobility stretching across the lifespan.