By Joshua Strassberg, MD, FAAOS
Hip dysplasia is a deformity in which the child’s hip socket doesn’t fully cover the ball portion of the femur or upper thigh bone, causing the hip joint to become partially or completely dislocated. Most children with hip dysplasia are born with this condition, but unless the child’s hip is dislocated, it may go undiagnosed because it is not obvious at birth, nor are there many signs or symptoms.
Risk factors that may suggest further examination by your child’s pediatrician include a family history (a parent or sibling) of hip dysplasia and a breach of birth. Note that if your first child is born female and breeches during delivery, one should assume the baby has hip dysplasia until proven otherwise.
Warning Signs of Hip Dysplasia
Hip dysplasia is far more common than many people think, with evidence of the deformity found in every one in 100 babies, while one in every thousand children are born with actual hip dislocation.
Therefore, your pediatrician should be hypervigilant during infants’ and young children’s routine exams, since the first signs of hip dysplasia in children (such as hip pain, limping, or unequal leg lengths) may only present if the child’s hip is actually dislocated—and these symptoms may not appear until the child is in their late teens, 20s or even 30s. If your child has these risk factors, your pediatrician may recommend an X-ray or ultrasound to ascertain whether hip dysplasia is present.
Early Intervention is Key
A key to preventing hip problems later in life—and a hip replacement—is to diagnose the deformity as early as possible so that treatment can begin as soon as possible. Early intervention may also mean that more conservative, non-surgical treatments, can be employed.
According to Scott Mubarak, MD, an orthopedic surgeon with Rady Children’s Specialists of San Diego, “Fifteen to 20 percent of babies who are born breach have hip dysplasia, so most pediatricians today know to screen for this condition. But if your child was breach, and your pediatrician does not refer you to a pediatric orthopedist within the first six weeks, parents should not hesitate to ask for a referral to one because early intervention is important to a good, non-surgical outcome.”
In our practice, we pursue non-surgical treatment options first. For infants, the first course of treatment is the use of a Pavlik harness or brace that holds the child’s hip out to the side. Because an infant’s hip socket is still soft, the harness can help the femur mold to the shape of the socket. Babies are typically required to wear the harness or brace full-time for eight to 18 weeks. More than 90% of infants undergoing this treatment will resolve their hip dysplasia, underscoring the benefits of early diagnosis and treatment.
“I always advise parents of the need to be patient about this form of treatment and give it the time it needs to work for long-term success,” Dr. Mubarak advised.
If a child does not respond to the harness, then a parent must consider certain hip dysplasia surgery treatments in which the pediatric surgeon pushes the child’s hip back into place or removes impediments to the correction.
- An open reduction incision allows the surgeon to remove the contents in the side of the hip joint that have prevented the ball from going where it should rest.
- With a closed reduction incision, the surgeon will manipulate the ball to get it into the hip socket with the goal of stabilizing the ball.
In the event that the child’s hip dysplasia is diagnosed later in life (teens or 20s), or if the first surgery was not successful, an orthopedist may recommend a Periacetabular Osteotomy (PAO), also called Ganz Osteotomy, a hip preservation surgery for teenagers and young adults whose birth plates have closed. In this procedure, the surgeon moves the acetabulum (hip socket) into a better position to alleviate the stress on and preserve the patient’s hip joint. PAO can help prevent your child from developing advanced arthritis in their hip and in most cases, preclude the need for a total hip replacement. Myself along with Dr. Sarah Stelma have undergone highly specialized training in this area, and we recommend waiting until the child is at least six months old before performing surgery.
Recovery times vary with the treatment or surgery, of course. Infants who undergo closed or open reduction surgery will wear a spike cast (a body cast) that fits around their lower torso and extremities for 12 to 18 weeks. Older teenagers who undergo PAO will not require a cast and will be able to walk within a few days of having surgery, but will require crutches for several months to make sure they aren’t putting too much weight on their hips and legs. They will also need physical therapy to improve their strength and range of motion. Full recovery can take up to six months.
Hip dysplasia is a difficult condition to live with, but with early diagnosis and treatment, it need not cause lifelong problems and pain. Pediatricians should consider the baby’s family history and the circumstances of their birth, as well as look for the signs of this deformity in babies and young children, and refer parents to a pediatric orthopedist trained in the surgical and non-surgical treatments that correct the dysplasia and preserve healthy hip joints.