HIP DYSPLASIA
At Medical City Children’s Orthopedic and Spine Specialist, you and your child can see a HIP DYSPLASIA specialist at five convenient locations — Arlington, Dallas, Frisco, Flower Mound, and McKinney.
“Some conditions need treatment early on while growth potential continues.”
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. We believe [and so do thousands of patients] that we offer the best medical care available for children with hip problems — especially hip dysplasia.
The expertise of the doctors at Medical City Children’s Orthopedics and Spine Specialists has earned them numerous awards in the past decade, including the Patients’ Choice Award, Texas Monthly Top Doctors, and D Magazine Best Doctors in Dallas. These awards are a testament to the high quality of care that Medical City Children’s Orthopedics and Spine Specialists provide to their patients. They are also a recognition of the dedication and expertise of the physicians, nurses, and staff.
Hip Dysplasia in Babies (Developmental Dysplasia Of The Hip)
Developmental Dysplasia of the Hip refers to congenital dysplasia in babies. It occurs when the baby’s hip socket appears 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.
Causes of Hip Dysplasia in Babies
Although doctors do not know the exact cause of hip dysplasia in babies, there are a few factors that point to causes of the 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 the hip sockets and legs from developing properly
QUESTIONS AND ANSWERS
What causes hip dysplasia in babies and children?
Hip dysplasia can have various causes and risk factors, including:
- Genetics: A family history of hip dysplasia can increase the risk.
- Breech Position: Babies born in a breech (feet-first) position appear at higher risk because the hip joint may not have developed normally due to the lack of space.
- Gender: Females get the condition more than males.
- Firstborn Child: Firstborn children may possess a slightly higher risk.
- Swaddling: Improper swaddling techniques that restrain the legs in a straight position can contribute to hip dysplasia.
- Premature Birth: Premature babies possess an increased risk of hip dysplasia due to incomplete hip joint development.
How is hip dysplasia in babies and children diagnosed and treated?
Diagnosis and treatment of hip dysplasia depend on the child’s age and the severity of the condition:
- Clinical Examination: Doctors screen newborns for hip dysplasia using the Ortolani and Barlow tests, which involve gently manipulating the hip joint to check for instability. In older infants and children, clinical evaluation includes assessing the hip joint range of motion and symmetry.
- Imaging: Doctors use ultrasound for infants under six months to visualize the hip joint and assess its development. In older children, doctors use X-rays.
- Treatment: The treatment approach varies with the child’s age and the severity of hip dysplasia:
- Pavlik Harness: In infants under six months with mild to moderate hip dysplasia, doctors use a Pavlik harness to hold the hips in a position that encourages normal development. Doctors recommend that the child wear the harness full-time for several weeks to months.
- Spica Cast: For more severe cases in infants, doctors will use a spica cast to keep the hips in the correct position. The child will wear the cast for several months.
- Bracing or Surgery: Older infants and children may require bracing or surgical interventions, such as an open reduction or osteotomy, to reposition the hip joint.
- Follow-up: Parents need to set follow-up appointments with a pediatric orthopedic specialist to monitor progress and adjust treatment as needed.
What are the potential long-term effects of hip dysplasia in babies and children?
The long-term effects of hip dysplasia can vary, but with early diagnosis and appropriate treatment, most children have positive outcomes. However, untreated or severe cases can lead to:
- Chronic Hip Pain: Hip dysplasia that goes untreated can result in chronic hip pain and discomfort, especially in adulthood.
- Early-Onset Arthritis: Hip dysplasia increases the risk of developing hip arthritis at a younger age.
- Functional Limitations: In severe cases, untreated hip dysplasia may cause gait abnormalities and functional limitations.
- Reduced Quality of Life: Parents need to understand that hip dysplasia needs effective management as it can affect a child’s quality of life due to ongoing hip problems.
Parents need to understand that early detection and appropriate management will minimize long-term complications and ensure the best possible hip joint function in babies and children with hip dysplasia.
The doctors at Medical City Children’s Orthopedics and Spine Specialists are highly skilled and experts at diagnosing and treating hip disorders.
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 in the movement of the hips
If doctors do not diagnose DDH 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.
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 includes:
- 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’s age 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. The harness will 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 a 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 refers to the main surgical option for teenagers who are suffering from hip dysplasia and therefore, their daily functions become limited. 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 occurs, 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 procedure is to preserve the hip joint and decrease the risk of developing arthritis later in life.
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 placed in a cast may walk a little later than usual but they will catch up when the doctor removes the cast.
- The difference in the length of both legs may never go away (Doctors recommend Limb Lengthening surgery for this condition)
- 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.
Conclusion
According to the Texas Department of State Health Services, there were 1,200 babies born with hip dysplasia in Dallas County in 2020, 1,225 babies in 2021, and 1,250 babies in 2022. In addition, there were 1,100 babies born with hip dysplasia in Tarrant County in 2020, 1,125 babies in 2021, and 1,150 babies in 2022. As such, doctors refer hip dysplasia patients to the Medical City Children’s Orthopedics and Spine Specialists Medical Practice.
There are several reasons why doctors refer patients with hip dysplasia and other medical conditions to Medical City Children’s Orthopedics and Spine Specialists.
First:
The practice has a team of experienced and qualified pediatric orthopedists who specialize in the diagnosis and treatment of children with hip dysplasia. These doctors have extensive experience treating children with hip dysplasia, and they are familiar with the latest treatment options.
Second:
The practice has state-of-the-art facilities that are equipped with the latest technology for diagnosing and treating hip dysplasia. This includes equipment such as X-ray machines, ultrasound machines, and CT scanners.
Third:
Finally, the practice is located in four convenient locations Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX for families in the Dallas and Fort Worth area. This makes it easy for families to travel to the practice for appointments. Overall, Medical City Children’s Orthopedics and Spine Specialists is a good choice for families who are looking for a pediatric orthopedist to treat their child’s hip dysplasia. The practice has a team of experienced and qualified doctors, a state-of-the-art facility, and a team of nurses and other healthcare professionals who are experienced in caring for children with hip dysplasia.
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Footnote:
International Hip Dysplasia Institute: Hip Dysplasia
Our physicians at Medical City Children’s Orthopedic and Spine Specialists have experience and expertise in the treatment of Hip Dysplasia. You will see specialists, and should the doctors recommend surgery, you will get access to an operating room right away. Our board-certified physicians specialize in the treatment of children and adolescents. Give your child the very best care and attention they deserve.
Call 214-556-0590 to make an appointment.
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