Introduction
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What is developmental hip dysplasia?
Hip dysplasia is a condition affecting a baby’s hip joint. It may be called developmental hip dysplasia or developmental dysplasia of the hip (DDH). With this condition, the top of the thigh bone does not fit tightly into the hip socket. It may affect one or both hip joints. A baby may be born with it, or it may happen in the first year of life.
Typically, the thigh bone fits snugly into a cup-shaped socket in the pelvis and is held in place by muscles, tendons and ligaments. But with DDH, the hip socket may be too shallow or the tissues around the joint may be too loose.
In mild cases, the ligaments and other soft tissues are not tight. This lets the thigh bone move around more than usual in the hip socket. In more severe cases, the hip socket is more like a saucer than a deep cup. As a result, the ball at the top of the thigh bone may slide out of the hip socket.
It’s important to have DDH treated early. The longer it goes on, the more likely it is to cause long-term hip issues.
What causes DDH?
The exact cause of DDH is not known. But some things can raise your child’s chances of having it, including:
- A family history of DDH
- Being the firstborn child
- Being female
- Being born buttocks-first (breech position)
- Swaddling your baby’s legs too tightly
What are the symptoms?
DDH isn’t painful, and your baby may not have any obvious signs of a hip defect. Some babies with this condition may have:
- One leg that seems shorter than the other
- Extra folds of skin on the inside of the thighs
- A hip joint that moves differently than the other
A child who is walking may:
- Walk on the toes of one foot with the heel up off the floor
- Walk with a limp (or waddle if both hips are affected)
How is it diagnosed?
DDH is usually diagnosed during a newborn’s physical exam. A doctor will move the baby’s legs and look and listen for signs of a problem.
If your baby is older, your doctor may diagnose DDH during the physical exam at a well-baby checkup. But it may be more challenging to diagnose in a baby more than one to three months old because the only outward sign may be a hip joint that is less mobile or flexible than usual.
If the doctor suspects DDH but the results of a physical exam are not clear, your child might need to have an imaging test of the hip joint, such as an ultrasound or X-ray.
How is it treated?
Your child’s hip socket will not form and grow properly if the ball at the top of the thigh bone does not fit snugly in the joint. So treatment focuses on moving the thigh bone into its normal position and keeping it in place while the joint grows.
Your child may need:
- A Pavlik harness, which is typically tried first if your baby is younger than six months old. It holds your baby’s legs in a spread position with the hips bent. This harness can move the hips to their normal position most of the time.
- A hard cast, known as a spica cast, which is used for older babies. The cast keeps the hips in the proper position. It may have a bar between the legs to make it stronger.
Other forms of treatment that may be needed include:
- Braces or splints. These may be used instead of a Pavlik harness or spica cast, or they may be used after surgery.
- Surgery. In some cases, this may be needed to correct a problem in the thigh bone or hip socket. A child who has surgery will probably need to wear a spica cast to hold the hip joint in position until it heals.
- Physical therapy. A child who has been in a spica cast may need to do exercises to regain movement and build muscle strength in the legs.
If treatment works well, your child probably will not have any further hip problems, but you will need to get your child’s hips checked regularly to make sure they grow and develop properly.
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