"Developmental Hip Dysplasia of the Hip"- Issue 17

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.

References:
1. http://www.hipdysplasia.org
2. http://orthoinfo.aaos.org/topic.cfm?topic=a00347
3. http://childrenshospital.org
4. http://stanfordchildrens.org