Hip dysplasia is quite common in some children & infants. According to health reports, approximately 2 out of 10 newborn babies suffer from some type of hip instability & 3 out of every 1,000 infants get seriously affected & need significant treatment. It is not a suddenly occurring disorder bu progresses slowly as the affected child grows. It can either start in the uterus of the mother or develop later on in the initial years of the child’s life. It is recognized as an abnormality in the child’s hip joint which can be mild to severe in nature. Instability (weakness) in the hip joint of the child has risk of facing dislocation as well. More severe form of hip dysplasia can result in partial or complete dislocation as this disorder reaches severe stages with time.
What is Hip Dysplasia?
Hip joint is a ‘ball-&-socket’ type of joint. Upper end of femur (thigh bone) is round like a ball while the hip has a hollow & half-spherical socket in which the ball end of the femur fits. Hip dysplasia, also called as developmental dysplasia of the hip (DDH) is a term used to identify the condition in which the hip socket fails to cover the ball region in the uppermost portion of the thigh bone, in children, after birth. It is a congenital (birth) disorder & needs prompt detection & treatment. This hip joint is additionally supported by various ligaments & tissues. Dysplasia of the hip increases risk of sudden dislocation of hip joint, due to a minor injury or even in case of shock to the hip.
There are several causes that are found to give rise to hip dysplasia in infants or children. Some of the major causes are described below.
- Hereditary – In most cases, main cause of hip dysplasia is found to be genetics. There are more chances of children having hip dysplasia if the same disorder is seen in parents or their siblings.
- Fetal Position – Infants found to have been in a breech position during pregnancy are more likely to suffer from hip dysplasia.
- Swaddling – Improper swaddling techniques, in which the child’s knees are straight & hips are in an adducted position, are known to considerably raise risk of DDH in children.
- Gender – Girls have been found to be more at risk of DDH as compared to boys.
- Oligohydroaminos – Deficiency of amniotic fluids in infants can also raise risk of DDH as the fetus grows.
- Other Causes – Babies with feet deformity like fixed foot or neck stiffness (torticollis) are at a larger risk of developing hip dysplasia.
Following signs & symptoms can be helpful in recognizing if a child is suffering from DDH.
- Asymmetry – Asymmetry in buttock levels is commonly seen in children suffering from DDH. This can be confirmed with an x-ray test or an ultrasound test.
- Hip Click – Sound like a ‘click’ or ‘pop’ is usually heard when the child walks in an outward motion, this may suggest DDH. However, an extensive diagnostic test is more reliable as clicking or popping sound may also be caused by developing ligaments in a normal child’s hip.
- Limited Motion – Child’s range of movement in the hip joint region gets restricted & legs cannot be spread to normal extent outwards. This is a more recognizable symptom of DDH in children.
- Limb Length Discrepancy – Child’s legs may seem to be of different lengths & are more noticeable.
- Uneven Skin Formation – Child’s thigh skin may show unevenness in its formation & which can be easily observed.
- Rigidity – Child’s hip motion is restricted & one side may show less flexibility.
- Uneven Gait – Child’s gait shows remarkable unevenness, such as limping, waddling or walking in-toe.
Hip dysplasia is a term which is used to identify a number of similar disorders of the hip bone in patients. It is further categorized to identify the exact disorder according to severity of dislocation.
- Subluxatable – It is a mild form of hip dysplasia. In this type, the socket in the hip bone is larger than the ball end of femur. This causes a slight gap between the ball & socket. In subluxatable type of hip dysplasia, thigh bone can be moved inside the hip joint but some instability can be felt.
- Dis-Locatable – In this kind of hip dysplasia, the ball end of femur is loosely fitted in socket of the hip. It causes weak positioning of hip joint & faces risk of total dislocation due to extreme stretching.
- Dislocated – This is the most severe form of hip dysplasia which causes the upper end of femur to be completely disjointed from the socket in hip bone.
Pediatric surgeons may use the following types of tests to identify hip dysplasia.
- Visual Symptoms – Experienced pediatric surgeons can identify signs of hip dysplasia by thorough physical examination. In some cases, doctor may also check for undue friction in hip joint when the baby’s leg is moved in different positions.
- Imaging Tests – In some cases, pediatric surgeons would recommend a few imaging tests like an ultrasound test or an x-ray test for confirming diagnosis & detecting exact type of hip dysplasia in babies.
Pediatric surgeons will decide & recommend appropriate treatments for hip dysplasia depending upon the child’s age, severity of symptoms & disability.
Following non-surgical treatment methods for hip dysplasia are dependent on the child’s age group.
- Pavlik Harness – Harness-device called the ‘Pavlik Harness’ is advised for children between 1 – 2 months of age. This harness is useful in keeping the thigh bone firmly inside the socket. This harness keeps hips within the proper position but allows unrestricted movement of legs. This harness is also advantageous in promoting normal hip socket development as well as tightening ligaments in the hip joint.
- Brace – Children belonging to age group of 1 – 6 months, also need harness (or another similar device) that helps in strengthening the hip joint. In a few cases, pediatric surgeons may use an abduction brace to firmly hold the joint in proper place till it becomes normal. Certain other cases might require ‘spica cast’ (body cast) to hold the hip joint in place. This procedure is done under general anesthesia in order to avoid discomfort to the baby.
- Skin Traction – In older children, doctors normally suggest use of spica cast (or an abduction brace as well). Skin traction technique is also used in some cases. In this procedure, traction provides necessary strength to softer tissues around the hip joint & keeps it in a natural position.
Parents should discuss their concerns regarding hip dysplasia with the family doctor. He/she might refer them to an experienced pediatric surgeon. Before initial appointment, parents should make a note of the following points.
- Parents should make a note of signs & symptoms which babies are experiencing, including any that may seem irrelevant to the reason for which the appointment is scheduled.
- Mothers should write down a list of all medications, which they took during pregnancy.
- Request a copy of previous health record of the baby & forward it to the current pediatric surgeon, in case doctors have changed.
- Make a list of doubts & important questions to ask pediatric surgeons.
Following comprehensive list of questions may help parents to choose a better treatment option for hip dysplasia in children.
- What is hip dysplasia?
- What is the most likely cause of hip dysplasia in my child?
- What types of tests does my child require to undergo?
- Do these tests need any special preparation?
- What treatments of hip dysplasia are available & which do you suggest for my baby?
- Are there any side-effects of the recommended treatment?
- Are there any other options to the primary treatment approach that you want to recommend?
- Can my baby live a normal life after undergoing surgery for hip dysplasia?
- Will my baby be able to walk normally?
- Will my child feel any discomfort following treatment?
In addition to these questions, parents should not hesitate to ask any doubts that they might be having during the initial appointment.
Depending upon the age & disability of baby, surgery can be performed for treating hip dysplasia.
- 6 Months to 2 Years Old – When spica cast treatment is unsuccessful in aligning the hip joint into a normal position, pediatric surgeons may then suggest an ‘open-type surgery’. Pediatric surgeons make a large incision on hip to get a better diagnosis of the problem. In case it is necessary, pediatric surgeons can shorten the ball end of femur in a way which would make the ball end to snugly fit in the hip socket. Post-surgery the baby will need to wear a spica cast so as to keep the joint in proper position.
- 2 Years & Above – Due to increased level of activity in a child at this age, instability in the joint gets more pronounced. Hence, an open surgery is performed to properly place the thigh bone in hip joint. Child is required to wear a body cast to maintain the joint firmly in place. Children are usually put in a body cast for a few weeks in order to allow bones to heal.
In many babies with hip dysplasia, a brace or body cast is needed to maintain the hip bone in the joint during the healing phase. Cast may still be required for approximately 2 to 3 months following surgery. Pediatric surgeons may also change the cast during this time span. X-ray scans & other regular follow-up sessions are necessary after hip dysplasia treatment until the baby’s growth is complete.
Kids treated with spica casting method may have delay in walking. However, when cast is taken off, walking development takes place normally. Pavlik harness & other positioning equipment may cause irritation of skin near straps & a difference in leg length may be observed. Disturbances in development of upper thighbone are rarely seen, but may happen due to inappropriate blood supply to growth region in the thighbone. Even after proper treatment & surgery a hollow hip socket may still persist.
When diagnosed at an early stage & treated successfully, children having normal hip joint & should have no restrictions in functioning. Delayed surgery or if hip dysplasia was left untreated, it can lead to harsh pain & conditions of osteoarthritis by early adulthood. It may create a difference in length of leg or generate a ‘duck-like’ gait alongside reduced activity. Even with well-suited treatments, hip impairment & osteoarthritis may occur later in life. This is most probable scenario when treatment of hip dysplasia begins after 2 years of age.
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