HIP DYSPLASIA

Hip Dysplasia

When children have problems with their hips, their whole body reacts to any pain, and therefore, this medical condition becomes frustrating to live with.  Hip dysplasia, a medical condition also known as acetabular dysplasia, involves complications with the hip bone or pelvis and the thigh bone where the thigh bone does not completely fit into the hip socket.  This usually leads to the hip joint being partially or completely dislocated. The condition usually occurs congenitally although in some cases, it can develop later in childhood.

Our passion creates a desire to medially help children become happy kids.  At Medical City Children’s Orthopedic and Spine Specialists, our board-trained and certified physicians passionately care for children, and thus, we believe and so do thousands of patients that we offer the best medical care available for children with hip problems — especially hip dysplasia.

Hip Dysplasia in Babies (Developmental Dysplasia Of The Hip)

Developmental Dysplasia of the Hip is also known as congenital dysplasia in babies. It occurs when the baby’s hip socket is too shallow to cover the head of the thigh bone and so the hip joint does not fit properly. The femur may even come out of the socket in several cases leading to hip dislocation.

The hip joint consists of a rounded ball-like head of the thigh bone or femur that attaches to the cup-shaped hip socket of the pelvis.  The severity of hip dysplasia in babies varies and while some babies only have a minor misfit in one or both of their hip joints, in some others, the ball easily comes completely out of the socket.

Symptoms of Developmental Dysplasia of the Hips (DDH)

For babies less than 6 months of age, ultrasounds help doctors diagnose DDH.  Some of the most common symptoms of hip dysplasia in babies include:

• Legs that turn outward or are different lengths
• Limited range of motion
• Folds on their legs, the skin of the thigh and buttocks look uneven
• “Clicky hips” — a popping sensation on the movement of the hips

If DDH does not become diagnosed early, the joint cartilage may break down resulting in arthritis.
Common dysplasia symptoms in teenagers are:

• Pain in the groin or side of the hip
• Popping or catching sensation while performing some activities.
• Pain that worsens during extended periods of sitting, walking, and/or jogging
• Limping
• Increased difficulty in performing strenuous activities.

With the most qualified doctors and a vast wealth of experience to draw from, there’s no better place to take your child for treatment. Doctors. Shyam Kishan, Kathryn Wiesman, and Richard Hostin, our team of board-certified and fellowship-trained doctors effectively diagnose, treat, manage and restore your child’s quality of life.

Causes of Hip Dysplasia in Babies

Although the exact cause of hip dysplasia in babies is unknown, there are a few factors that have been associated with this condition.
Some of these include:

• A family history of DDH includes either the parents or close and extended relatives
• Gender also plays a role as females are twice as likely to develop DDH
• Firstborn babies may also present a higher risk
• Tight swaddling when the baby’s legs are extended may interfere with the healthy development of joints
• Wrong positioning in the womb prevents one or both of their hip sockets and legs from developing properly

Diagnosis

Developmental or Acetabular dysplasia usually gets diagnosed in the first few days or months of the baby’s life. Routine newborn physical exams are performed within 72 hours of delivery and checking the hips is part of the evaluation. During the exam, your doctor will ask about your child’s very short medical history and the baby’s position during pregnancy. Your family history will also alert the doctors if hip problems exist in your family.

If there’s any suspicion or issue with your child’s hips, other routine tests like the Ortolani or Barlow test may occur to confirm the diagnosis and determine a treatment plan. Additional testing that may occur for your child include:

• Ultrasound or Sonogram

Ultrasounds make use of high-frequency sound waves to create pictures of the hip joint, including the femoral head (ball) and the acetabulum (socket).  Doctors prefer this tool to diagnose hip dysplasia in babies up to 6 months of age.

• X-Rays

When the child becomes older than six months of age, the bone begins to form on the head of the femur, and an ultrasound procedure becomes unreliable as a diagnostic tool. After six months of age, an X-ray will provide a more detailed image for your doctor to review.

• MRI

Sometimes your doctor may order an MRI test. This MRI can provide the doctor with detailed information about any damage to the cartilage and the severity of your child’s condition. Sometimes, when symptoms of hip dysplasia appear later in life, physical exams are conducted to look for the following symptoms:

• A tilt in the pelvis
• The difference in leg length
• Muscle wasting
• Limping

Treatment

Treatment options for DDH vary depending on your child’s symptoms and diagnosis. The doctors at Medical City Children’s Orthopedic and Spine Specialists specifically consider each case and develop treatment plans based on your child’s unique situation, risk factors, causes, symptoms, and age.

Non-Surgical Treatment 

If the patient is three months or younger, and has a reasonably stable hip, your doctor may just decide to routinely assess and observe the acetabulum and femoral head as they develop as a high probability exists that the joint will form normally on its own as your child grows.

Pavlik Harness

If your child’s hip appears unstable or too shallow, then the Pavlik harness becomes an option. Doctors use the Pavlik harness for babies up to 4 months of age to hold their hips in place while allowing for some leg movement.  The child should wear the harness all day and night or at the doctor’s discretion until an X-ray or ultrasound reveals successful healing.  Typically, this takes about 8 to 12 weeks with routine imaging to monitor progress.

After a successful treatment, your doctor will continue to monitor the progress of the hip for a couple of years to ensure a completely successful treatment.

Abduction Brace

Although treatment with the Pavlik Harness has a very high success rate, it doesn’t work for some babies. In these cases, the baby’s hips continue to appear partially or completely dislocated. In this case, doctors will recommend the abduction brace. This brace consists of a lightweight material that supports your child’s hips and pelvis. If your child’s hips stay stable with the use of this brace, then it gets worn for about 8 to 12 weeks. However, if the abduction brace doesn’t work, then surgery becomes the next option.

Surgical Treatment 

Surgical treatment of hip dysplasia usually becomes the final option considered in the treatment of Developmental Dysplasia of the hip. Depending on the level of severity and unique conditions, your doctor will choose the best surgical option available. The following are some of the surgical treatments:

Hip Arthroscopy 

This surgical procedure allows the doctors to view the hip joint without making a large incision through the skin and other tissues. During hip arthroscopy, the surgeon inserts a small camera called an arthroscope through the incision into the hip joint. The camera displays images on a video monitor and the surgeon uses these images to guide miniature surgical tools into the incision. This surgery doesn’t require the large incisions used in open surgery, and therefore, less painful and with a faster recovery rate.

Periacetabular Osteotomy (POA) 

Periacetabular Osteotomy is the main surgical option for teenagers who are suffering from hip dysplasia and are limited in their daily functions. During Periacetabular Osteotomy, a series of cuts are made into the bone by your orthopedic surgeon. These series of cuts are made around the hip socket to rotate the socket into the proper position. Upon placing the socket in the proper position, metal screws hold the bone in place.

This procedure allows the hip socket to provide better coverage of the top of the femur head and to reduce stress on the rim of the hip socket that causes cartilage damage. If a labral tear occurred, the periacetabular osteotomy may combine with hip arthroscopy to repair the tear.  If this procedure gets performed before advanced hip arthritis occurs, it may serve as a lifelong treatment. The ultimate goal of the procedure is to preserve the hip joint and decrease the risk of developing arthritis.

Complications of Hip Dysplasia

Even after treatment of hip dysplasia, some complications may happen over time. Some of these complications are negligible while others will require further treatment.

Babies and Young Children 

• Children who are given cast treatment may walk a little later than usual but they will catch up when they are no longer in the cast.

• The difference in the length of both legs may never go away (Limb Lengthening surgery is recommended for this)

• If it was not an initial option, surgery may occur later to correct the hip socket.

Teenagers and Young Adults

In teens and young adults, hip dysplasia can lead to any or all of the following:

• Hip joint osteoarthritis
• Labral tear in the cartilage helps to keep the hips stable.