Hip Dysplasia - Developmental Dysplasia Of The Hip - HealthSurgeon - Healthy Living and Fitness

Hip dysplasia is most common in infants and young children. It is sometimes known as developmental dysplasia of the hip. This is a condition that causes the hip socket to be too shallow to cover the head, or ball, of the thigh bone. Therefore the thigh bone doesn’t fit properly into the socket, which can cause the hips to be unstable, and cause dislocation of the hip bone. This can affect one or both hips. The severity of this condition can range to mild looseness of the joint, or to where the ball is completely falling out of the socket.

Risk Factors & Causes

This condition can occur before the baby is born, early on in infancy, or in early childhood. It is rare for this to occur later on in a child’s life, but it can. The exact cause of what brings on hip dysplasia is unknown.

There are some factors that may raise your child’s risk of developing it. If you have a family history of hip dysplasia. Girls are two to four more times more likely to develop hip dysplasia than boys. First born babies have a tendency to be more prone because the uterus tends to be tighter. If your child was in a breech position, especially in the third trimester. Breech position is when the baby’s head is above their bottom. This can cause one or both of their legs to be stretched out straight even slightly, instead of being in the fetal position. This can stop the hip socket from developing appropriately. Tight swaddling when the baby is first born can also cause hip dysplasia to develop. Swaddling to where the legs are extended and cannot move can interfere with a healthy development of the hip joint. When swaddling make sure their arms are tight, but their legs have room to wiggle.

Diagnosis

If your infant has hip dysplasia this condition causes them no pain. During your child’s well-check visits your pediatrician should be checking your baby for signs of hip dysplasia. This is done when they move your child’s legs in different directions while feeling their hip bone. Hip dysplasia signs may not be noticeable at home. Some signs that a doctor may notice or you may notice as a parent are if the hip makes a popping sound when moved, your child’s legs are the same length, the hip or leg doesn’t move like the other one, or when they start to walk there is a limp.

Usually hip dysplasia is diagnosed when the child is under six months old. This is because a pediatrician will catch it at a well check visit. During the physical exam if they feel something off in the hip they may ask you what position your child was in during pregnancy. In case your child was in the breech position at any point. After that if your child is under 6 months old they may want to schedule an ultrasound. This is the preferred tool of diagnosing hip dysplasia in children under the age of 6 months old. The ultrasound will be able to check the femoral head, or ball, and the acetabulum or the socket of the hip joint to see how it is developing. If your child is 6 months or older the doctor will prefer to do an X-ray. At this age your child’s bones will be developed enough to see them on X-ray. X-rays tend to be more reliable than ultrasounds.

Treatment

Treatment for hip dysplasia depends on the severity. Treatment is focused on restoring complete hip function as well as correcting the positioning and structure of the joint.

If your child shows signs of hip dysplasia but the joint is reasonably stable and your child is under 3 months old your doctor may want to put them under observation. The joint has the possibility to form normally as the child grows. If the hip is too unstable or the socket is too shallow the doctor may suggest a Pavlik harness. The Pavlik harness is a good option for children up to 4 months old. It is a harness that holds the hip in place while allowing their legs some movement. Usually the harness is worn for 24 hours a day for 8-12 weeks. Time varies until the hip is stable. Follow up ultrasounds will be done to make sure the hip socket is developing normally.

If the Pavlik harness does not work, or the hip is partially or completely dislocating another option is the Abduction brace. This brace is made of a lightweight material that supports the hips and pelvis. This brace will be worn for around 8-12 weeks. Both of these options work best if the child is under 6 months old. If neither of the braces work, or treatment isn’t started until after 6 months of age the next treatment option is surgery.

There are two surgical options, closed reduction or an open reduction. In some severe cases or cases in older children, hip replacement surgery can sometimes be an option as well. A closed reduction surgery is when the surgeon puts the joint back into its place and then secures a hip spica cast. This cast will be left on for 2-4 months to hold the hip in place. An open reduction is done on children older than 18 months of age, or if a closed reduction doesn’t work. An open reduction means the doctor has to make an incision in the skin to get to the hip, then the surgeon will move the muscles, put the ball back into the socket, and close the incision with dissolvable sutures. After surgery the surgeon will use a hip spica cast to hold the hip in place for 6-12 weeks. After surgery you will need periodic follow up exams with an orthopedist until physical maturity occurs.

The biggest complication that can come from hip dysplasia is the chance of dislocating your hip. Other complications that can occur are having looser muscles and ligaments around the hip. Hip labral tears are more likely. Osteoarthritis can occur in the joint. Unstable hip joints, and recurring pain if left untreated.

With treatment most children with hip dysplasia have normal, active lives. Sometimes it may delay your child’s walking depending on when they get treatment. After treatment there usually are no long term effects.