Hip Dysplasia

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Hip Dysplasia is the medical name used to describe a problem with formation of the hip joint in children. The location of the problem can be either the ball of the hip joint, the socket of the hip joint, or both.

Historically, many doctors have called the problem congenital dysplasia of the hip, or CDH. More recently, the accepted terminology is developmental dysplasia of the hip, or DDH.

There may be no symptoms. Symptoms that may occur can include:

  • Different leg positions
  • Reduced movement on the side of the body affected by the dislocation
  • Shorter leg on the affected side
  • Uneven folds of thigh fat

  • After 3 months of age, the affected leg may turn outward or be shorter than the other leg.

    The exact cause of this disease is not easy to pin down, as there are thought to be several factors that contribute to developing this condition. It occurs in about 0.4% of all births, and is most common in first born girls. Some known risk factors for a child to have this disease include:
      * Children with a family history of hip dysplasia
      * Babies born in breech position
      * Babies born with other conditions that result in part from the in-utero position of the baby; for example, clubfoot and torticollis.
      * Lack of intrauterine fluid
    The treatment of hip dysplasia depends on the age of the child. The goal of treatment is to properly position the hip joint ("reduce" the hip). Once an adequate reduction is obtained, the doctor will hold the hip in that reduced position and allow the body to adapt to the new position. The younger the child, the better capacity to adapt the hip, and the better chance of full recovery. Over time, the body becomes less accommodating to repositioning of the hip joint. While treatment varies for each individual baby, a general outline follows:

  • . . . Birth to 6 months
    Generally in newborns, a hip dysplasia will reduce with the use of a special brace called a Pavlik harness. This brace holds the baby's hips in a position that keeps the joint reduced. Over time, the body adapts to the correct position, and the hip joint begins normal formation. About 90% of newborns with this disease treated in a Pavlik harness will recover fully. Many doctors will not initiate Pavlik harness treatment for several weeks after birth.

  • . . . 6 months to 1 year
    In older babies, Pavlik harness treatment may not be successful. In this case, your orthopedic surgeon will place the child under general anesthesia. This usually allows the hip to assume the proper position. Once in this position, the child will be placed in a spica cast. The cast is similar to the Pavlik harness, but allows less movement. This is needed in older children to better maintain position of the hip joint.

  • . . . Over age 1 year
    Children older than one year old often need surgery to reduce the hip joint into proper position. The body can form tissues that prevent from assuming its proper position, and surgery is needed to properly position the hip joint. Once this is done, the child will have a spica cast to hold the hip in the proper position.

  • The success of treatment depends on the age of the patient, and the adequacy of the reduction. In a newborn infant with a good reduction, there is a very good chance of full recovery. When treatment begins at older ages, the chance of full recovery decreases. Children who have persistent hip dysplasia have a chance of developing pain and early arthritis later in life. Surgery to cut and realign the bones, or a hip replacement, may be needed later in life.

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