Hip Dysplasia

What is hip dysplasia?

Hip dysplasia occurs when the hip joint does not develop properly. The hip is a ball-and-socket joint. Normally, the "ball," or top of the thigh bone, fits securely into the hip socket. In children with hip dysplasia, the hip socket is too shallow, causing the thigh bone to slip either partially or completely out of the socket. This can range from a mild abnormality to a dislocated hip. Some children are born with hip dysplasia, known as developmental dysplasia of the hip (DDH), and others develop it as they grow.

What are the signs and symptoms of hip dysplasia?

Severe cases of DDH are usually diagnosed soon after birth during a routine physical exam. Ultrasound testing may be performed to help diagnose hip dysplasia in newborns up to 6 months of age. Symptoms in children with mild hip dysplasia may not be noticeable until they grow and become more active. In these cases, the instability of the hip joint can cause damage to the cartilage in the joint, which will become increasingly painful over time.

Symptoms of hip dysplasia in infants can include:

• One leg that appears shorter than the other
• A popping sensation when moving the hip, which may occur during diaper changing

Symptoms of hip dysplasia in teens and young adults can include:

• A clicking sound in the hip
• Knee pain
• A limp
• Hip or groin pain

What causes hip dysplasia?

Experts do not know the exact cause, but there are several factors that may increase a child’s risk of hip dysplasia:

• A family history of hip dysplasia
• Gender—girls are two to four times more likely than boys to have hip dysplasia
• Birth order — the uterus may be tighter for first born babies which can affect the development of the hip
• Breech position during pregnancy
• Tight swaddling of the legs in a straight position

How is hip dysplasia treated?

Treatment of hip dysplasia depends on your child's age and the severity of their condition. Early treatment can help reduce your child's risk of pain and loss of function later in life. Your pediatric orthopedic provider at Arkansas Children's is experienced in hip dysplasia and will work with you to come up with the best treatment plan for your child.

• Non-surgical hip dysplasia treatment in infants:
  • Babies 3 months or younger that have a relatively stable hip may not need any treatment. Your baby's provider will monitor their hip joint to make sure it develops properly.
  • A Pavlik harness may be used to treat hip dysplasia in younger infants. The harness holds the hip in place, while still allowing for some leg movement. Typically, the harness must be worn 24/7 for several weeks. Your baby's provider may do exams during and after treatment to check the development of the hip joint.
  • If treatment using a Pavlik harness does not work, your baby's provider may suggest an abduction brace. Abduction braces are more rigid than Pavlik harnesses and can be used on older infants. If treatment still is unsuccessful, your baby may need surgery.

   

• Surgical hip dysplasia treatment in infants:
  • Closed reduction: In this procedure, the hip joint is set in place under anesthesia followed by application of a spica cast to hold the hip in place. The cast typically starts at the chest and extends down to the ankle of the affected leg. Most babies wear the spica cast for about 3 to 6 months. The cast may be changed as your baby grows.
  • Open reduction: If closed reduction is not successful, your provider may recommend open reduction surgery. In this procedure, the surgeon makes an incision in the hip to visualize and reposition the joint. The procedure may vary slightly depending on your child’s specific condition. Your baby will need to wear a spica cast during the healing process.
    
    
• Treatment options for teens and young adults:
  • Many cases of mild to moderate hip dysplasia in adolescents and young adults can be treated with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs). If pain continues, your doctor may recommend surgery.
  • Surgery to treat hip dysplasia in adolescents and young adults is called periacetabular osteotomy. The goal of this procedure is to reduce pain and improve hip function.