Developmental pediatric dysplasia of the hip, or hip dysplasia, describes a broad spectrum of abnormalities of the hip joint that may develop around the time of birth or during childhood.
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In the healthy hip joint, the upper end of the femur (thigh bone) meets the acetabulum to fit together like a ball and cup, in which the ball rotates freely in the cup. Cartilage, a smooth protective tissue, lines the bones and reduces friction between the surfaces during movement. In developmental hip dysplasia, however, one or more of these functions work incorrectly.
The conditions encompassed by the term “hip dysplasia” include:
- Dislocated hip: where there is no contact between the cartilage on the ball and the cartilage on the cup
- Dislocatable hip: where the ball and cup easily pop in and out
- Subluxatable hip: where the cartilage of the ball or femoral head and the cup are touching, but the ball is not properly seated in the cup
- Dysplastic hip: where the ball, cup, or both are malformed
Genetics plays a strong role in the incidence of hip dysplasia. The risk of hip dislocation at birth occurs approximately one in every one thousand. If a parent experienced hip dysplasia during childhood, the risk of his or her own child developing it increases by 12% compared with a parent with no history of the condition. A child whose sibling has this ailment will have a 6% higher chance of developing the condition. Even among children who have no hereditary link, a slightly greater risk exists in all first-borns.
Other pregnancies and birth influences include:
- Molding abnormalities: Head tilt (torticollis) and the turning in of the front of the foot (metatarsus adductus) usually occurs in a very small uterus. These conditions alert medical professionals to look for the presence of hip dysplasia.
- Breech birth: This occurs when the baby emerges from the birth canal buttocks-first. A breech-birth child is 10 times more likely to develop hip dysplasia than a child born headfirst.
Other factors: Hip dysplasia occurs in girls more than in boys and more frequently affects the left hip than the right. About 80% of cases follow this pattern. The condition can, however, be present in both hips.
Adolescent hip dysplasia is usually caused by developmental problems of the hip, a condition that is routinely screened for at birth but can remain undetected if mild. Hip dysplasia means the hip joint hasn’t developed properly and the ball of hip joint doesn’t sit firmly or deeply enough in the hip socket.
When developmental hip dysplasia occurs at birth, the abnormality may be detected during a routine physical examination of the newborn. During this examination, the physician gently flexes the child’s hips in different directions. If the hip appears unstable, the doctor may feel a “clunk” as the hip moves out of alignment.
In a smaller percentage of cases, the problem does not become apparent until later in infancy or early childhood. A later diagnosis may be detected during routine examinations of hip stability in the pediatrician’s office. Signs that may bring undiagnosed developmental hip dysplasia to the attention of parent and physician include:
- Limb asymmetry including asymmetry in skin folds
- A leg length discrepancy on the affected side
- A limp
- A waddling gait (indicating both legs are affected)
- Restricted range of motion
To confirm a diagnosis of developmental hip joint problems in children up to 4-6 months of age, the orthopedist uses a sonograph. This ultrasound technology offers a significant advantage over the conventional X-ray exam. This is because images with the hip in motion have no risk of radiation. In order to ensure proper development of the bones that make up the hip joint, early intervention should take place.
Our physicians at Medical City Children’s Orthopedic and Spine Specialists have experience and expertise in the treatment of hips. Our board-certified physicians specialize in the treatment of children and adolescents and can give your child the care and attention they deserve.
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