What’s wrong with your child’s hip?
You take your infant daughter to the doctor for a wellness check. During the visit, the doctor does a physical exam. Afterward, she tells you that she thinks your daughter has hip dysplasia and recommends that she be treated. What exactly is hip dysplasia? How is it treated? Could it have been prevented?
Definition
When a hip socket doesn’t fully cover the ball portion of the upper thighbone (humerus), it’s known as hip dysplasia. The condition is usually present at birth because initially, the hip joint is made of soft cartilage that gradually hardens into bone. The ball and socket of the joint need to fit together well since they are molds for each other. If the ball isn’t securely in the socket, the socket doesn’t fully form around the ball, which means that it becomes too shallow. The hip joint can easily become partially or entirely dislocated if this occurs.
Hip dysplasia can result in the final months before birth because the womb can become so crowded that the hip joint ball moves out of the proper position. A few factors cause the reduced space within the womb, such as having a large baby, it being the mother’s first pregnancy, or the baby is in the breech position. While doctors check for signs of hip dysplasia shortly after birth and in subsequent well-baby checks, if the malformation is mild, it might not be noticed until the child is older or a teenager.
So, symptoms vary depending on the age of the individual. For infants, the usual sign is that one leg is longer than the other or one hip is less flexible during diaper changes than the other. As the child learns to walk, they may develop a limp. For teens, hip dysplasia results in painful conditions, like osteoarthritis or a hip labral tear (the labrum is the soft cartilage that outlines the socket portion of the hip—if it’s damaged, it can tear). This typically causes activity-related groin pain or the feeling of instability in the affected hip.
Besides the previously mentioned risk factors, others include a family history of hip dysplasia, being female, or swaddling the baby tightly with their hips and knees straight. Osteoarthritis is more likely to occur because of higher contact pressures over a smaller surface area of the socket, resulting in the smooth cartilage on the bones wearing away over time. The cartilage is supposed to help the bones glide against each other as the joint moves. When it isn’t present, the bones rub on each other, and this is known as osteoarthritis.
Treatment
Treatment for hip dysplasia depends on the person’s age and the extent of the hip damage. If the condition is discovered before six months of age, the doctor will want the child to wear a soft brace (Pavlik harness) to hold the ball portion of the joint firmly in its socket. This helps the socket mold to the shape of the ball. The brace will need to be worn for several months. If the child is older than six months, they’ll need to have bones moved into the proper position and then wear a full-body cast for several months to hold them there. Sometimes, the child needs surgery to fit the joint together correctly.
If the dysplasia is more severe, the position of the hip socket can be corrected via a procedure called a periacetabular osteotomy. During the surgery, the socket is cut free from the pelvis and then repositioned to match up better with the ball. Older individuals whose dysplasia has severely damaged their hips, causing arthritis, may need hip replacement surgery.
Prevention
Unfortunately, there isn’t much you can do to prevent hip dysplasia from happening. Instead, it’s vital to make sure you monitor your child for signs of the condition and report them as soon as possible to their doctor. Also, it’s essential that you take them for their well-checks as scheduled. By doing both of these, it’s possible to catch the condition early, which will reduce the likelihood of complications.
Hip dysplasia can be concerning for new parents. However, it can be corrected without causing a significant long-term impact. If you have any questions or concerns about hip dysplasia, please speak with your doctor. If you would like more information, please visit the International Hip Dysplasia Institute page at https://hipdysplasia.org/