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Hip Dysplasia

By Betsy Miller

This article first appeared in the May 2007 issue of Pediatrics for Parents. Reprinted with permission of Betsy Miller

Developmental dysplasia of the hip (DDH) – many people have never heard of it, but it is surprisingly common. Developmental dysplasia of the hip, formerly called CDH (congenital dysplasia of the hip), is believed to be the most common defect in newborn babies and accounts for 75% of all congenital defects.

A baby may be born with DDH or may develop it in early life. In most cases it is only in the left hip, but both sides can be affected. Many babies are born with unstable hips that usually stabilize within the first two weeks after birth. Unstable hips are not the same as DDH. With DDH, the problem persists and requires early medical treatment.

About one in 1,000 babies have hip dysplasia. Its more common in children with the following risk factors:

• Family History: DDH tends to run in families with hip problems.
• Girls: DDH occurs in girls nine times more often than boys.
• First born, breech, or large babies: The position of the baby in the womb and crowding in the womb increase the risk.
• Left hip: Most babies lie with their left hip against the mother’s spine, which limits motion of that hip. This may be why the left hip is more likely to have DDH.
• Connective tissue disorders, club foot, cerebral palsy, torticollis (limited motion on one side of the neck), and central core disease: Children with these conditions are at a higher risk of also having DDH.

Make sure that your child’s doctor knows about all medical conditions that your child has, and about any family history of risk factors.

Babies are examined for DDH when they are newborns and during their regular checkups. If the doctor suspects DDH, or if your baby is at risk, the American Academy of Pediatrics (AAP) recommends a hip ultrasound. Ultrasound is used for babies up to four months of age because their bones are too soft to show up well on X-rays. The ultrasound may reveal a problem that does not show up in an examination. Or it could show that the child’s hips are fine.

If a hip problem is suspected, then the baby or child is seen by a pediatric orthopedic doctor. These doctors have special training to diagnose and treat orthopedic problems in babies and children. Developmental dysplasia of the hip cases range from mild to severe, but the goal of treatment is always the same – to get the femoral head into the best position in the hip socket so that the hip joint can develop normally. The pediatric orthopedic doctor chooses the best treatment for each child. Treatment may include a Pavlik Harness, a brace, or in severe cases, surgery and a cast. Each of these treatments is described below.

Pavlik Harness

If DDH is caught very early, the Pavlik harness is effective 90% of the time. This soft brace keeps the baby’s legs apart and at the ideal angle in the hip sockets to encourage proper hip development.

The doctor may wait until the baby is six to eight weeks old to see if the hips stabilize on their own. If not, then the baby is fitted with a Pavlik harness. The baby may need to wear the harness 24 hours a day. The doctor adjusts the harness as the baby grows. For six weeks the doctor examines the baby’s hips, and uses ultrasound or X-rays to see how the hip joints are developing. If the baby’s hips improve, then this treatment is continued as needed until the baby is up to six months old. If the hips do not improve, then the doctor removes the harness and tries a different treatment.

Many children are finished with treatment after the Pavlik harness is removed and only need follow-up checkups. Others need to wear a brace (hip abduction orthosis), or may need surgery.

Brace (Hip Abduction Orthosis)

Children six months of age or older may wear a brace, also called a hip abduction orthosis, as treatment for DDH. A variety of braces are used. Most come in several sizes. The pediatric orthopedic doctor selects the brace. It may be worn 24 hours a day, or for a shorter period of time. The doctor examines the child’s hip and uses X-rays to see how the hip joints are developing. If the hips improve, then this treatment may be continued until no longer needed, or until the child is old enough to remove the brace on her own.

Surgery and a Cast

Though most children with DDH do not require surgery, it is needed in some cases. Surgery is done for babies and toddlers while the hip is still developing. A child may need surgery for the following reasons:

• The femoral head cannot go into the hip socket because soft tissue is blocking it.
• The baby was born with teratologic hip dysplasia.
• Other treatments have not worked.
• Developmental dysplasia of the hip was diagnosed in an older child, and the bones in the hip joint have developed in the wrong shape and need to be corrected.

Some doctors use traction before surgery to relax a child’s muscles and tendons so that it is easier to put the femoral head inside the hip socket.

During surgery doctors use arthrography (an X-ray with dye injected into the joint) to learn more about the structure of the joint. Then they do the least invasive procedure to correct the hip joint. Surgeries that may be needed for DDH are listed below:

• Adductor Tenotomy: A small cut is made to a tendon to allow it to stretch enough for the doctor to do a reduction.
• Closed Reduction: The doctor puts the femoral head into the hip socket without opening up the hip socket.
• Open Reduction: The doctor must surgically open the hip socket.

After surgery, the child wears a body cast, called a Spica cast, to hold the hips in place. The length of time that the child wears 12-16 weeks.

If Your Child Has DDH

Caring for a baby or child who is undergoing treatment for DDH can be challenging. She may not fit into her car seat or stroller. And if your child is in a cast, then even simple daily tasks like diapering can be difficult at first. These organizations provide for support and resources for parents of children with DDH:

The hip-baby website offers information about medical treatment and practical advice for families at: http://www.hip-baby.org.

Shriners’ Hospitals offer free consultations or treatment for children diagnosed with DDH and other orthopedic problems.

Shriners’ Hospitals
P.O. Box 31356
Tampa, FL 33631
1-800-237-5055
http://www.shrinershq.org

Easter Seals can sometimes help locate car seats for children who cannot fit into a standard car seat.

Easter Seals
230 West Monroe Street, Suite 1800
Chicago, IL 60606
800-221-6827
http://www.easterseals.com/site/PageServer

Betsy Miller is a freelance writer who has written about a wide variety of topics from dental sealants to wireless technology. As an adult with DDH,she has a strong interest in this condition. Miller lives in Cupertino, California with her husband and two daughters.


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