It was unexpected: your first-born baby girl seemed fine after the delivery, but a few days after, the doctor noticed her legs were moving unevenly. She went through two different casts, and now a specialist is opening up about the possibility of surgery. Is this really necessary? Will she be okay?
What is hip dysplasia in the first place?
Hip dysplasia is the dislocation of the hip joint because of differences in the shape or size between the hip socket and the head of the thigh bone. The exact cause of this is unsure, but certain factors can make your child at risk for this condition.
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What is hip dysplasia?
Before we talk about hip dysplasia, let’s first discuss the hip joint.
The hip joint is configured as a “ball-and-socket” joint. The upper part of the thigh bone is shaped like a ball, which fits well into a socket-shaped portion of the hip bone or pelvis.
Some babies are born with an underdeveloped and shallow hip socket. Because of this, the head of the thigh bone sometimes doesn’t completely fit in this socket, or the socket doesn’t cover the whole head of the thigh bone. This joint becomes loose for most cases, while in others, the thigh bone comes out of the socket. This condition is called hip dysplasia.
Other names include developmental dysplasia of the hip (DDH), and congenital hip dislocation. Sometimes, hip dysplasia is referred to as “clicky hips”.
If your child has a mild case of hip dysplasia, it might not be easily noticeable in the first few years of life. Some reports even note that some children are diagnosed as far as their teenage years.
How common is hip dysplasia?
Hip dysplasia is not so uncommon. It ultimately affects 10 out of every 1,000 people. Moderate to severe DDH cases are seen in 1-2 babies out of every 1,000 that are born.
This condition is more common in females. It is usually diagnosed in the left hip, but both hips can also be affected.
Why does my baby have it?
Unfortunately, there is no proven cause of hip dysplasia. If the following apply to your situation though, there’s a higher chance or your child to have DDH:
- Family history of DDH – Studies show that there’s a higher chance of DDH if it’s happened to your family before.
- Low levels of amniotic fluid – Amniotic fluid is the fluid inside your womb. If there’s too little, it could cause unusual fetal positions that are prone to DDH.
- First-born delivery – For babies born normally (through the vaginal canal), first-borns are more prone to hip dysplasia because their mother’s hip and pelvic bones are quite rigid.
- Large baby or breech delivery – Babies who are large are also prone to staying in unusual positions in the womb.
- Tight swaddling of the baby while the knees and legs are straight – If you swaddle your baby the wrong way, it could lead to a misalignment of their hip joints. Make sure that as you swaddle your baby’s legs, they remain in the fetal position. This is a natural position that is comfortable and safe to their hip joints.
What are the signs and symptoms of hip dysplasia?
It may be surprising to many, but hip dysplasia isn’t always diagnosed at birth. This condition would usually manifest within the first few months after birth.
Some symptoms of hip dysplasia in infants include:
- Unequal movement between two legs
- A well turned-out foot
- A shorter leg length on the affected side
- Uneven skin folds in the buttocks or thighs
- A popping sound may be heard whenever the affected hip is moved
For older children, symptoms include:
- Limping, walking with toes
- Pain when walking
- A waddling gait
How is this diagnosed?
Hip dysplasia is usually diagnosed through a physical examination. Your doctor will also ask you some questions about your child’s history, especially regarding the delivery.
During well-baby clinic visits, it is typical of the pediatrician to check for hip dysplasia using certain maneuvers that check how smooth it is to move your infant’s legs between certain positions.
Sometimes, there may be a need to confirm using diagnostic tests. These include either an ultrasound or an x-ray of the hip. For difficult cases, an MRI may be requested.
Let’s start with treatment
There are different options for treatment, depending on how serious your child’s condition is. You may be referred to a specialist, such as an orthopedic surgeon, to determine what treatment is best for your child.
There are non-surgical options available
Your doctor may opt to simply observe your child’s condition. This is usually reserved for mild cases and for kids younger than 3 months old. At this point, studies show that most kids end up with normal hip joints and don’t need any further intervention.
The first option available is to place a Pavlik harness on your child for a certain number of hours in a day. This harness helps keep their hip in place but allows freedom for movement with their other limbs.
You may need regular follow-up consults and imaging tests with your doctor to check on your child’s progress and to determine when it can be removed. Be warned though – your child may need to wear this for 2-3 months. Children older than 6 months may not be treated with a Pavlik harness and are placed straightaway in a cast or brace.
If the Pavlik harness isn’t enough to correct your child’s DDH (note that this really happens from time to time), the harness may be replaced with an abduction brace. This is a brace placed around your child’s hip and pelvis for support. Your child may need to wear this for 2-3 months as well.
Sometimes surgery is needed
If your child’s hip is still dislocated after using the Pavlik harness and the abduction brace, your doctor may decide that your child needs to undergo surgery. This will be done under general anesthesia. There are two main types of surgery: closed reduction and open reduction.
In closed reduction surgery, an arthrogram will be done. In this procedure, imaging contrast will be injected in the area so that the surgeon can visualize the joint and bones involved. They set the hip in the right position. In an open reduction surgery, the surgeon will create an incision and will reposition the hip through this incision.
After surgery, they will place your child in a spica cast from the abdomen to the legs, to hold them in the proper position.
Are there any complications?
The cartilage that lines the hip joint may be damaged by the rough movement between the displaced bones. This is called a hip labral tear and may be painful. This same mechanism makes them prone to developing osteoarthritis as well.
For kids who have been treated, it may take some time before they walk. As long as treatment is successful, they’ll soon catch up with other kids. If your child was not treated in time, they may learn to walk much later in life, and may have to walk with a limp. They will also be prone to constant hip pain and stiff joints.
How does this affect daily life?
If your child is in a Pavlik harness, you may be in for a rough ride. It may be difficult to complete everyday tasks and activities. It’s best to address these issues with your healthcare team so that they can teach you how to best care for your child.
Some of the issues they can help you with include changing your baby’s clothes (this is definitely possible, even while they’re on a cast!). When it comes to cleaning the harness, use a detergent and an old toothbrush. You can clean it even while it’s being worn.
Many mothers worry about their child’s comfort, especially at night. Most of the time, the best position for your baby as they sleep is lying on their back. For babies with skin irritation, it is advisable to wrap soft, breathable material around the bands of the cast.
Hip dysplasia, or DDH, happens when the hip joint becomes dislocated. There are different risk factors that make your child prone to this condition.
Treatment usually starts with the use of casts, but surgery may be a possible option for some cases. Most babies will still be able to walk properly after successful treatment.
Sarah is a healthcare writer, motivated by her love of reading books while growing up. She took up human biology and further studies in medicine, in order to fulfill her passion for helping kids. While she isn’t a biological mother yet, she has taken a young Siberian husky named Indy under her wing. She would love to someday travel the world and meet kids from different cultural backgrounds.