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Hip

Developmental pediatric dysplasia of the hip, or hip dysplasia, is the term used to describe 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 (thighbone) 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 headand 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 is approximately one in 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 hip dysplasia will have a 6% higher chance of developing the condition. Even among children who have no hereditary link, there is a greater risk in all first-borns.

Oher pregnancy and birth influences include:

  • Molding abnormalities:Head tilt (torticollis) and the turning in of the front of the foot (metatarsus adductus) is often the result of being constrained in a uterus that is too small. These conditions alert medical professionals to be on the lookout for the presence of hip dysplasia.
  • Breech birth: This is 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 is much more common in girls 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.

“With hip dysplasia, it is important to see a pediatric orthopedic physician early while the child is still young and growing. Nonoperative treatments have high success rates in the very young. Delaying the treatment could turn a potentially small surgery into a big surgery. Some things are better treated early while growth potential is still possible”

Shyam Kishan, M.D.

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Hip Dysplasia

When developmental hip dysplasia is present 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 is unstable, the doctor she 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. Later diagnosis of hip dysplasia 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 dysplasia in children up to 4-6 months of age, the orthopedist uses an ultrasound. This technology offers a significant advantage over conventional X-rays because images may be taken with the hip in motion, and has no risk of radiation.

In order to ensure proper development of the bones that make up the hip joint, early intervention is essential.

The 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.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at three convenient locations: Dallas, Frisco and McKinney.