Hip Dysplasia in Children
Hip dysplasia, also known as developmental dysplasia of the hip (DDH), refers to problems with the formation of the hip joint in children. It can be the result of a problem within the ball (femoral head), the socket (acetabulum) or in both components of the joint. The most common form of hip dysplasia involves a socket that is too shallow. In the past, this condition, which is most commonly inborn or develops in the first few years of life, was referred to as congenital dysplasia of the hip (CDH).
Hip dysplasia can affect one or both hips, and may be mild or severe. Mild cases result in a hip that is unstable and partially dislocated (a subluxation), while severe cases involve a hip joint that is permanently dislocated, either partially or fully.
Risk Factors for Hip Dysplasia in Children
The exact cause of hip dysplasia in children is unknown, but some babies are at a higher risk for his condition. Risk factors for hip dysplasia include:
- Family history of hip dysplasia
- Being born in a breech position
- Being a firstborn girl
- Being born with other orthopedic problems, such as clubfoot
- Experiencing a lack intrauterine fluid during gestation
When hip dysplasia occur later in life, the risk factors for the disorder may be different.
Symptoms of Hip Dysplasia in Children
While babies and children with hip dysplasia may be asymptomatic, they may show one or more of the following symptoms:
- A hip that moves differently than the other hip
- Extra skin folds on the inner thighs
- One leg that appears shorter than the other
- Walking on the toes of one foot
- Walking with a limp or waddle
Even though a child may not present with any symptoms of hip dysplasia, it is important that every child be carefully evaluated for the disorder since it can lead to early and disabling osteoarthritis.
Diagnosis of Hip Dysplasia in Children
As with many other childhood abnormalities, the earlier hip dysplasia is diagnosed and treated, the better.
In order to detect abnormalities in the hip joint, the doctor manipulates the joint while listening for a "hip click." This click is not always painful, but is usually audible. If the click signaling dysplasia is heard or felt, it signifies that the hip has moved out of its normal position. If so, the doctor will order X-rays or an ultrasound. When the patient is a young baby, the ultrasound is necessary because X-rays do not show all the bones in a baby younger than 6 months of age.
Treatment of Hip Dysplasia in Children
There are varying treatments for hip dysplasia in child, depending on the age of the patient and the and the severity of the condition.
Nonsurgical Treatments for Hip Dysplasia
Where nonsurgical treatment is sufficient to correct the problem, it is, of course, preferable to surgical intervention. There are several noninvasive treatments available for hip dysplasia in children.
In young babies, a Pavlik harness is normally used to keep the hip in its proper position. This harness is worn 24 hours a day for 6 to 12 weeks. About 90 percent of newborns treated with the Pavlik harness fully recover from hip dysplasia.
In children over 6 months of age, the Pavlik harness may not be enough to correct the dysplasia. If necessary, the child will be put under anesthesia until the hip assumes its proper position and then placed in a spica cast. Although this cast is necessary to remedy the dysplasia, it allows less movement and must be replaced approximately every 6 weeks. The child will usually remain in a cast for about 4 months.
Surgery for Hip Dysplasia
When a child is one year old or older when diagnosed with hip dysplasia, surgical intervention is often necessary to position the hip joint properly. The younger the child at the time of surgery, the greater the chance for a successful outcome. The types of surgery performed, in order of complexity are: hip reduction, hip osteotomy and hip arthroplasty (replacement).