What is Hip Dysplasia?
Hip dysplasia or DDH (Developmental Dysplasia of the Hip) is a condition when the hip joint does not develop properly in infants and young children. The problem may be in the socket, the head of the femur, or both; eventually leading to mechanical instability of the hip joint. It can involve one or both hips; however, it will generally affect the left hip.
Unlike other pediatric conditions DDH can not be detected with prenatal ultrasounds. It is present at birth and usually detected by the child’s pediatrician within the first 6 months after birth. The child is then referred to a pediatric orthopedic surgeon for treatment. If left untreated the unstable hip continues to grow improperly eventually leading to many developmental problems and physical deformities.
Causes of Hip Dysplasia:
There is no definite cause, although there are many factors that may contribute to this ailment.
- DDH is two to three times more common in Female than in male infants
- Family history plays an important role, if there is a family member with a history of DDH the greater the percentage is for it to occur
- Breech presentation (feet first) during pregnancy
- First Born
Symptoms of Hip Dysplasia:
DDH is rarely painful in infants and unlike other orthopedic conditions parents will usually not notice any abnormalities. Something for parents to look out for is
- Poor movement of one leg
- Uneven thigh folds
- One leg longer than the other
Diagnosis of Hip Dysplasia:
The presentation of hip dysplasia is typically subtle and thus requires a detailed physical examination. When examining your child the pediatrician will look for signs of DDH through various maneuvers of the hip. The pediatrician may mention:
- A clicking or clunking sound
- Asymmetric inner thigh folds
- Uneven leg lengths
- Decreased motion of hips
If your pediatrician is concerned about DDH your child may be sent for diagnostic imaging to help confirm the diagnosis. This is typically performed via ultrasound imaging. If the child is over 6 month of age then x-rays are required.
Treatment of Hip Dysplasia:
Treatment options will vary on what age your child was diagnosed with DDH.
Between birth and 6 months of age treatment includes the use of a harness. It consists of various straps that hold the child’s hip in a position that allows for the normal development of the hip joint.
How long your child will stay in the harness depends on the severity of the dysplasia. The average time in the harness is between 8-10 weeks. While in the harness your child will have a repeat ultrasound every 2 weeks to monitor the growth of the hip joint. There is an over 90% success rate when parents are compliant with the harness. Children in the harness generally meet their developmental milestones and will not cause any developmental delays.
If DDH is detected after 6 months treatment via a harness is no longer practicable and will require surgical intervention. This may include minor or major hip surgery depending on the age of the child and severity of the dysplasia.
Written by Avraham Farkas, PA