What is hip dysplasia?
Hip dysplasia is a condition typically discovered at birth or in the neonatal period; it is also known as developmental dysplasia of the hip or congenital dislocation of the hip. The severity ranges from mild difference to stiff dislocations. In some cases, it is discovered later in childhood or adulthood when imaging is obtained for other reasons. It can present with pain in adolescence. The incidence is 1 to 10 babies per 1000 live births.
The hip joint is made up of the “ball” or head of the upper part of the thigh bone (femur) and the “socket” or “cup” (acetabulum) of the pelvis. Dysplasia results when the socket formed during development is shallow and the head is not firmly or securely set within it. In the early stages of life, the ligaments that hold the hip joint in place may be loose, and there may be a tendency for the hip to be out of place. Early in the process, a dislocated hip is typically reducible with bracing only, but over time, it becomes more rigid and can require surgical treatment to minimize the long-term risk of arthritis.
Babies with a family history of hip dysplasia, first-born children, large babies, and babies who are in a breech position (bottom or feet first in the uterus) are at greater risk, and hip dysplasia is more common in girls than boys. Swaddling the child with hips and knees straight is discouraged because this may influence the formation of hip dysplasia.
How is developmental hip dysplasia diagnosed?
Pediatricians should examine the infant’s hip when first born and at subsequent checkups. Maneuvers are performed to feel how the hip is moving, and if there is any instability. An imaging test that uses sound waves called an ultrasound may be performed to detect the position of the femoral head in the socket. In older children, X-rays may be performed to exam the position of the hip. If developmental hip dysplasia is discovered by the primary care physician, a referral should be made to a pediatric orthopedic surgeon.
How is developmental hip dysplasia treated?
Although surgical treatment may be necessary in a small percentage of infants and children, if caught early, the majority will have successful treatment and good results with nonsurgical interventions. At 1-6 months of age, the infant with developmental hip dysplasia may be treated with a harness or brace for an initial 6-8 weeks, followed by gradual weaning. The harness, called the Pavlik harness, is made of cloth straps which place the legs in a position for appropriate hip development. A brace made of plastic can be used to achieve similar results. Better results have been recorded if the child is treated before 3 months of age. There is a 65-100% success rate depending on the severity of the condition.
If this treatment is not successful, the child’s hips may need to be positioned manually under general anesthesia in the operating room in a procedure called closed reduction. This is most often performed on children who are six to eighteen months old. After the procedure, the child is put in a spica cast that is applied to maintain the appropriate hip alignment while the joint heals. The spica cast may need to be worn for 2-3 months.
If closed reduction has been unsuccessful, children who are 18 months or older may undergo open reduction surgery to put the hip back into the joint and realign the bones. After surgery, a spica cast is placed to hold this position. In older children and adolescents with developmental hip dysplasia, other procedures may need to be performed to give the child a more normal hip joint.
Children need to be followed in the orthopedic clinic periodically until skeletal maturity to monitor the position and health of their hips. Even with successful bracing or surgical treatments, there is a 15% risk of need for further treatment as the child ages. X-rays and other imaging modalities such as an MRI or CT scan may need to be performed over the course of treatment.
What are the risks and benefits of hip dysplasia treatment?
Risks of treatment are skin irritation with harness wear, bracing and casting. Walking may be delayed in infants after treatment in this age group, but children are usually able to progress normally with development afterwards. Possible complications can include decreased blood supply to the head of the femur called osteonecrosis that may cause growth disturbances, nerve injury or redislocation of the hip.
When treated appropriately, there is a decreased risk for development of arthritis in the hip, problems with mobility, functional deficits and differences in leg lengths. Successful treatment restores the normal anatomy of the hip with normal ambulation and function.
Why choose the International Center for Limb Lengthening for treatment of hip dysplasia?
Your doctor at the International Center for Limb Lengthening will take the time to make sure you understand all of your options and then will customize your treatment to meet your child’s specific needs. We specialize in delayed treatment strategies in older children and adolescents as well as initial treatment of young children. Our patients benefit from our team-centered approach with world-renowned orthopedic surgeons and specialized physician assistants, nurses and physical therapists. We help patients with hip dysplasia achieve their best possible result.