Developmental Hip Dysplasia Information for Parents

What is developmental hip dysplasia?

Developmental hip dysplasia (DHD), also referred to as congenital hip dysplasia (CHD), is a medical term used to describe a problem with the development of one or both of a baby's hip joints. This disorder is either present at birth, or develops in the first few weeks or months of life. The hip joint consists of the socket in the hipbone or pelvis and the bony ball at the top of the thighbone (femur). In a normal hip, the ball of the femur and socket of the pelvis fit together well, and the joint is tight. In DHD, the ball and socket may fit loosely, the socket might be too shallow or the top of the femur might be positioned out of the socket of the pelvis.

Is DHD common?

DHD is somewhat common '" about 1.5% of all infants born in the United States have been diagnosed with some degree of hip dysplasia. Statistically, more girls than boys are affected. But, only about 12% all babies with DHD continue to have unstable hips past the age of 2 months, if treated as soon as possible. In most cases, DHD is resolved before the child is 6 months old if properly treated.

How is DHD caused?

The causes of DHD are not fully understood. However, there seems to be a genetic component (a family history of hip dysplasia) and/or a physical component (babies born in breech position or that have other orthopedic issues, such as clubfoot) that are known to cause DHD.

In some cultures where infant swaddling (tightly wrapping the baby in strips of cloth) or the use of cradle boards (which the baby is wrapped to) is common, there is an increased risk for DHD. The restriction of the movement of the baby's legs seems to cause DHD to develop as the baby grows.

What are the symptoms of DHD?

As a parent, you have the perfect opportunity to see how your baby moves. You might detect that something isn't quite right, but can't put your finger on it. Here's how you can tell if you should have your baby checked for DHD:

• Baby's feet and legs might be turned out farther than you think they should be.
• The folds of skin around your baby's groin area might look different on one side from the other (asymmetric). The folds of skin in this area should look more or less the same.
• Baby 'crab walks', or looks like their legs bend backward when they crawl on the floor.
• In toddlers or walking children, you may see limping, an odd gait, toe-walking or the baby's back may look severely curved, or 'swayed.'

If you believe that your baby might have DHD, schedule an appointment with your pediatrician so they can perform the necessary tests.

How does the doctor diagnose DHD?

A normal part of any post-natal or well-baby examination includes checking baby's hips. The doctor moves each leg around to feel for abnormalities in the hips. These specific movements, called Barlow and Ortolani tests, are painless and allow the doctor to check for potential problems, such as a loose joint, clicking, etc. If the doctor believes there might be an issue, further tests are required to be certain. X-Rays do not show these abnormalities in very young babies, so an ultrasound is usually needed, which shows the doctor whether the hip joint is formed correctly.

What treatments are available for DHD?

There are several different treatments that the doctor may prescribe depending on the age of the baby and the degree of DHD. The younger the child, the higher rate of success and less treatment time:

• Younger than 6 months:

If the baby is younger than 6 months of age, the doctor will usually prescribe a special brace called a Pavlik harness, which will keep the baby's hips in proper alignment, while allowing some freedom of movement.

• 6 months to 1 year:

Between 6 months and 1 year of age, the Pavlik harness is not as effective, so the baby will be fitted with a spica cast. The spica cast covers nearly the entire lower half of the baby's body and is more rigid than the Pavlik harness. It is fitted while the baby is under general anesthesia to allow muscles to relax, so the hips can be placed in a more natural alignment.

• One year of age and older:

Children over the age of 1 year will probably need surgery to correct the hip dysplasia permanently, although sometimes a brace or cast may help if the DHD is mild. The surgery is done under general anesthesia. The degree of hip dysplasia will determine what kind of surgery the baby requires. After surgery, a spica cast will be fitted, which will be worn throughout the rest of the treatment.

What is the chance of recovery for babies with DHD?

DHD is highly treatable. The prognosis or outcome of babies treated for DHD is very positive. Most babies with DHD recover fully with either brace or harness treatment alone. Surgical options for DHD have very high success rates. Talk to your pediatrician about DHD, treatment options and prognosis.

Sources:

Hip-baby.org

Familydoctor.org

Orthopedics.about.com

Turkish Journal of Pediatrics (turkishjournalpediatrics.org)