A normal hip consists of a ball-and-socket joint. The “ball” is the rounded top of the femur or
thighbone. The “socket” is a cup shaped bone that the ball fits into called the
acetabulum. Together the “ball-
and-socket” creates the hip joint that is held tightly together by surrounding
ligaments. In babies and children with developmental hip dysplasia, or DDH, the
hip joint has not formed normally. The “socket” is shallow, meaning that the
“ball” of the thighbone cannot fit firmly into the socket. This issue can cause
the hip to dislocate or slip out of place.
In the United States,
approximately 1 to 2 babies per 1,000 are born with DDH. Although it can happen
in either hip, it is much more common on the left side and most prevalent in first-born
females. Other risk factors include babies born in the breech position, a
family history of DDH and low levels of amniotic fluid.
Although it is most
often present at birth, DDH may also develop during the first year of life. Therefore,
pediatricians screen for DDH at a newborn’s first examination and every well
baby check up thereafter. Because of their increased risk, the American Academy
of Pediatrics now recommends all female breech presentation babies to be
screened for DDH with an ultrasound.
After 4 weeks of life, the ultrasound can display images of the hip
bones to diagnose DDH.
When DDH is detected at
birth, it often can be corrected with the use of a harness or brace. A soft
positioning device, called a Pavlik harness, is typically worn for 6-12 weeks
to keep the thighbone in the socket.
Most doctors recommend wearing the brace full time for 6 to 12 weeks.
Sometimes, an additional 4 to 6 weeks of only night time wear is indicated.
It helps tighten the ligaments around the hip joint and promote normal
socket formation. Parents play an essential role in making sure the harness
treatment is effective. Your doctor will teach you how to safely preform daily
tasks such as diapering, bathing, feeding and dressing.
If the hip is not
dislocated at birth, the condition may not be noticed until your child starts
walking. Contact your pediatrician if your baby has: legs of different lengths,
uneven skinfolds on the thigh, less movement and flexibility on one side, or
walks with a limp, waddle or duck like gait.
If DDH is not detected
until later in the infant’s life, the treatment gets more complicated with less
predictable results. Treatment may require a longer period of wearing the
Pavlik harness or a more rigid brace that will hold your child’s hips in the
right position if the Pavlik is not sufficient. In some cases, surgery is
required to re-locate the hip followed by applying a cast to hold the bones in
place.
If diagnosed early and treated
successfully, children are able to develop a normal hip joint and should have
no limits in function. Left untreated,
DDH can lead to pain and arthritis by early adulthood. It also may produce a difference in leg
length or a “duck-like” walking pattern. Even with appropriate treatment, hip
deformity and arthritis may develop later in life. This is especially if
treatment begins after the age of 2 years.
Early detection and prevention is key to managing DDH.
Parents can help by practicing safe swaddling and carrying techniques shown in
the column to the right. For more information regarding car seat positioning
and ideal baby carriers visit:http://hipdysplasia.org/developmental-dysplasia-of-the-hip
SAFE SWADDLING AND POSITIONING:
In order for swaddling to allow for healthy hip development, the legs should be able to bend up and out at the hips. This position allows for natural development in the hip joints.
The baby's legs should not be tightly wrapped straight down and pressed together. Swaddling infants with the hips and knees straight may increase the risk of hip dysplasia and dislocation.
When proper hip position is maintained while baby wearing, there can be substantial benefit for natural hip delvelopment. The spread squat position, also known as the M postiion or jockey position is recommended.
1. http://www.hipdysplasia.org
2. http://orthoinfo.aaos.org/topic.cfm?topic=a00347
3. http://childrenshospital.org
4. http://stanfordchildrens.org
