Here’s What You Need to Know for Infants, Babies and Older Children
June is International Hip Dysplasia Awareness month. Around the world, pediatric orthopedists and families are raising awareness of this common and preventable condition. That’s because early diagnosis and treatment are vitally important to avoid long-term complications throughout a child’s life.
What is Hip Dysplasia?
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. Although most children with hip dysplasia are born with this condition (one in every 100 babies), it may go undiagnosed because it is not obvious at birth, nor are there many signs or symptoms.
In addition to evidence of hip dysplasia in babies, one in every 1000 children are born with actual hip dislocation. For these reasons, your pediatrician should be hypervigilant about checking for this deformity during infants’ and young children’s routine exams. Steps Worldwide, an organization in the UK, recommends babies be checked for this condition at six to eight weeks old.
Symptoms and Risk Factors
At TPOC, the first signs of hip dysplasia we look for are hip pain, limping, or unequal leg lengths, but those may only present if the child’s hip is dislocated. Plus, these symptoms may not be evident until the child is a teenager or older. If your child presents with these symptoms, ask about X-rays or an ultrasound to diagnose the problem.
Even without symptoms, risk factors that pediatricians should be aware of are family history of hip dysplasia (a parent or sibling) and a breech birth (when the baby is positioned upside-down with buttocks or feet first during delivery). Dr. Scott Mubarak of Rady Children’s Specialists in San Diego contends that, “Fifteen to 20 percent of babies who are born breech have hip dysplasia. If your child was breech, 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.”
That early diagnosis and treatment is crucial to preventing hip problems later in life. Early intervention may enable non-surgical treatments (less invasive in nature) to be employed.
Early Non-surgical Treatment Options
In our practice, we pursue non-surgical treatment options first. For infants, we start with a Pavlik harness or brace that holds the child’s hip out to the side. The infant’s hip socket is still soft, so the harness helps the femur mold to the shape of the socket. We typically prescribe that babies wear the harness or brace full time for eight to 18 weeks. This early intervention achieves excellent results, with the hip dysplasia resolved in more than 90% of infants undergoing this treatment.
Early Surgical Options
For the child in that 10% who does not respond to the harness, surgery must be considered, with either an open reduction incision or closed reduction incision. In these surgeries, the pediatric surgeon pushes the child’s hip back into place or removes impediments to the correction.
In an open reduction incision, the pediatric orthopedic surgeon removes the contents in the side of the hip joint that have prevented the ball portion of the femur from properly fitting within the socket. With a closed reduction incision, the surgeon manipulates the ball to place it into the hip socket and stabilize it.
Treatments for Teens and Young Adults
If the child’s hip dysplasia is diagnosed later in life (teens or 20s), or if the first surgery was not successful (and the baby is at least six months old), we may recommend a Periacetabular Osteotomy (PAO), a specialized surgery which we perform. This is a hip preservation surgeryfor teenagers and young adults whose birth plates have closed. In PAO, we move the hip socket into a better position to alleviate the stress on it and to preserve the patient’s hip joint. PAO can help prevent advanced hip arthritis later in life and usually precludes the need for a total hip replacement.
Recovering from Hip Dysplasia Treatment
Recovery times vary depending on the treatment or surgery, and the patient’s age.
- Infants who undergo open or closed reduction surgery must wear a body cast (also called a spike cast) around their lower torso and extremities for 12 to 18 weeks. Older teenagers who undergo PAO don’t need a cast and will be walking within a few days. But they will require crutches for several months to make sure they don’t put too much weight on their hips and legs. Physical therapy will also be prescribed to improve strength and range of motion. Expect up to six months to achieve full recovery.
During this International Hip Dysplasia Awareness month — and throughout the year — the pediatric orthopedists at TPOC want parents to understand that with early diagnosis and treatment, hip dysplasia need not cause lifelong problems and pain. Pediatricians should consider the baby’s family history and the circumstances of their birth, 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.