Hip dysplasia in infants occurs when the hip joint has not formed correctly, and as a result, the thighbone remains loose in the socket. Because the hip is a ball-and-socket joint, it’s important that the joint forms correctly with the ball of the thighbone, firmly fitting into the hip socket. If the ball is loose within the socket as commonly presented with a diagnosis of hip dysplasia, the hip will easily dislocate and may cause additional problems later in life, such as osteoarthritis.
While the exact cause of hip dysplasia is not known, it is widely considered to be developmental. Most diagnoses of the condition occur at birth, right after birth or during childhood. It is important to note that when family history of hip dysplasia is present, it is 12 times more likely to occur.
Additionally, how a baby is positioned in the womb may increase the likelihood of developing hip dysplasia. A breech birth, where the baby’s feet are positioned upward, may increase the instances of hip instability versus a normal birth position. Fetal crowding may also impact the hip position in the womb and negatively impact hip development. Firstborn female infants are more likely to develop hip dysplasia as they have more flexible ligaments than male infants. Swaddling of infants may also worsen hip dysplasia if there is restricted leg movement due to too-tight swaddling.
There are several signs to look for in order to determine the presence of hip dysplasia in infants and young children:
With children of walking age, a waddling walk may indicate the presence of hip dysplasia if only one hip is affected. When the dysplasia is symmetrical and present in both hips, it is more difficult to detect.
Hip dysplasia is typically diagnosed with a hip exam during routine well-baby checks by a pediatrician. If the pediatrician suspects hip dysplasia after examination, additional imaging in the form of X-rays or an ultrasound will be utilized to confirm.
Treatment of hip dysplasia depends upon the severity of the condition and the age of the child. For newborns and babies under 6 months of age, the most likely treatment is the use of a Pavlik harness. The Pavlik harness stabilizes the hip bone within the joint socket until the ligaments and the socket become stronger and more stable. Treatment with the harness will usually last from one to two months, depending upon the severity of the dysplasia. The harness holds the hip in the proper position while the legs can move freely. The main complication with the Pavlik harness is skin irritation around the straps.
A closed reduction may be required in older babies if treatment with the Pavlik harness is unsuccessful. In this procedure, completed under general anesthesia, the thighbone will be moved into the proper position by a physician and a body cast will be used to stabilize the joint. The main complication with the use of a body cast is a slight delay in walking. Once the cast is removed, development proceeds normally.
Open surgery is another treatment option if it is determined that the closed reduction did not put the thighbone in the appropriate position. In some cases, the thighbone may need to be shortened so that it fits correctly within the joint. X-rays may be taken during the surgery to verify placement within the joint. Once the surgery is completed, the child will be fitted with a cast for two to three months to maintain proper hip position.
Resolving hip dysplasia in older children and young adults will require surgery, which will attempt to preserve the hip joint and reduce pain within the joint. Hip-preserving surgery focuses on realignment of the hip socket so that the ball fits firmly within the joint. Screws will be placed within the socket to hold the ball in place until it heals. This type of surgery is beneficial for younger patients and those who have not had extensive cartilage loss.
Joint replacement surgery utilizes artificial means to replace or repair the damaged hip joint. This can be in the form of hip joint resurfacing for younger patients or a total hip replacement in more severe dysplasia cases.
If hip dysplasia in babies is identified and treated early, the likelihood of additional surgeries or treatment is rare. Success in surgical treatments may also vary, depending upon the severity of the dysplasia. Some patients will require only one surgical procedure while others may require several along with regular monitoring of the area. Without early treatment, hip dysplasia can cause extreme pain and early-onset arthritis later in life and may even require hip replacement surgery.
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Children's Memorial Hermann Hospital
Houston, TX 77030
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