Developmental Dysplasia of the Hip: Causes, Symptoms, and Treatment
Key takeaways:
Hip dysplasia is a medical condition in which the hip joint doesn’t form properly. Some children are born with an underdeveloped hip joint, while others develop hip dysplasia as they get older.
Hip dysplasia can affect one or both of a child’s hip joints. Without treatment, hip dysplasia can lead to pain with walking, limited movement, and hip arthritis.
Hip dysplasia can be treated with bracing, casting, or surgery. Children who start treatment earlier have better long-term outcomes, such as less pain, better hip movement, and less trouble walking.
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If you have a baby or toddler, regular check-ups are a part of your everyday life. You may have noticed that your child’s pediatrician checks their hips at every visit. And you may have wondered why it’s so important.
The answer may surprise you. Some children have underdeveloped hip joints. This can lead to long-term pain, trouble walking, and early arthritis. This is called developmental dysplasia of the hip. Developmental dysplasia of the hip is a common problem and catching it early can save your child’s hip. Here’s what you should know about this common childhood hip condition.
What causes developmental dysplasia of the hip?
It’s not clear why some children have developmental dysplasia of the hip. The hip joint, like all joints, starts to develop during pregnancy. But the hip continues to develop during infancy and early toddlerhood.
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Experts know that during hip development the hip bones must stay in close contact. This contact ensures the hip joint forms the right way. Several things can interfere with this close contact and possibly increase the risk of hip dysplasia.
For example, during pregnancy, exposure to the hormone estrogen can make the ligaments that support the hip looser. This looseness or laxity sometimes interferes with proper positioning for normal hip development. But all babies are exposed to estrogen during pregnancy and yet not all of them develop hip dysplasia. So, while estrogen plays a role, it’s not the direct cause of the condition.
Experts are still trying to work out the exact combination of things that leads to developmental dysplasia of the hip. But it’s clear that some things increase a child’s risk of developing hip dysplasia. Being on the lookout for these things can help caregivers and healthcare professionals spot children who have hip dysplasia sooner.
What are the risk factors for developmental dysplasia of the hip?
Children at higher risk for developmental dysplasia of the hip include:
Girls: Female infants and toddlers are four times more likely to develop hip dysplasia than males.
Breech babies: A breech birth happens when the baby has a bottom-first position. Breech positions can keep the hips in the wrong alignment for proper hip development. Babies who are in a breech position during the last weeks of a pregnancy are three times more likely to develop hip dysplasia.
Those with a family history: Research shows infants with a sibling or parent who had hip dysplasia have a higher chance of developing it, too.
Certain swaddling techniques also increase the risk of hip problems. Swaddling can keep the hips in a position that interferes with good hip development. So if you swaddle your baby, make sure the swaddle isn’t too tight around the hips. Your baby should be able to move their legs freely. You can learn more about hip-healthy swaddling from the International Hip Dysplasia Institute.
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Why is hip dysplasia a problem?
Hip dysplasia is a problem because it means the hip joint hasn’t developed completely. Without a properly formed hip joint, people aren’t able to move as they should. They can have trouble with everyday tasks like walking, running, and climbing stairs.
Without treatment, people with developmental dysplasia of the hip face a lifetime of movement problems and pain. Over time, the impact of everyday movement wears away at the hip joint. People can develop severe pain and early arthritis. They often need hip replacements, usually before they’re 50 years old, which is quite early. And since hip replacements don’t last forever, many people need more than one.
What are the symptoms of developmental dysplasia of the hip?
Most children with developmental dysplasia of the hip don’t have any symptoms. Pain and trouble with movement take years to develop. That’s why healthcare professionals check a child’s hips at each visit.
But as your child starts to stand and walk, you may notice subtle signs of hip dysplasia. These include:
Your child seems to move one leg more than the other.
Your child’s hip seems to pop or click when they move.
Your child’s legs look like they’re different lengths.
The way your child walks seems different or off.
If you have concerns about how your child walks or moves, talk with their pediatrician. Even with careful monitoring, developmental dysplasia of the hip can be missed on a physical exam. As a parent or caregiver, you know your child best and what you see can be the first (and only) clue that something is going on.
How is developmental dysplasia of the hip diagnosed?
Developmental dysplasia of the hip can be diagnosed by physical examination, imaging studies, or a combination of both.
Healthcare professionals use several maneuvers to see how the hips are developing. You may have noticed your child’s pediatrician positioning and moving your child’s hips during their exam. These maneuvers are the primary screening tool to diagnose hip dysplasia. That’s because any trained healthcare professional can do them without any extra equipment or resources.
If your child’s pediatrician notices anything unusual, they might get an imaging study like an X-ray or ultrasound of your child’s hips. A hip ultrasound can find signs of developmental dysplasia of the hip until a baby is about 4 to 6 months old. After that, a hip X-ray can help to diagnose the condition.
Children who are at high risk for developmental dysplasia of the hip will often have a hip ultrasound when they’re 4 to 6 months old, even if their physical exams are normal. This adds an extra layer of protection and confirms that the child’s hips are forming properly.
How do you treat developmental dysplasia of the hip?
Pediatric orthopedic surgeons treat developmental dysplasia of the hip with bracing, casting, or surgery.
Bracing: A Pavlik harness is a special hip brace that can treat hip dysplasia in babies who are younger than 6 months. The brace holds the hip in the correct position so it can form the right way. Most children need to wear this brace for 6 to 12 weeks.
Closed reduction and casting: Closed reduction and casting involves putting the hip in the proper position and then casting the joint in place. This is used for children older than 6 months and in cases where bracing didn't work. The cast remains in place for 3 to 4 months.
Open reduction: Open reduction is a surgical procedure. It’s used in cases of severe hip dysplasia and in toddlers older than 18 months. It can also be used when casting or bracing hasn’t worked. During open reduction, the surgeon makes a small incision in the hip and puts the bones of the hip joint in the proper position. They confirm proper alignment with an X-ray and then place a cast over the hip.
The exact treatment your child will need depends on their age and their degree of hip development. Children who have less developed hips and children who are older often need more invasive treatment options. Children who receive early treatment for developmental dysplasia of the hip can avoid later complications like pain and early arthritis.
But sometimes, even with treatment, the hip stops developing. So children with developmental dysplasia of the hip need to be followed by an orthopedic surgeon for several years to make sure their hip continues to develop correctly.
The bottom line
The hip joint allows people to walk, run, and move. The hip joint starts to develop during pregnancy but isn’t completely formed until toddlerhood. When the hip doesn’t develop correctly, children can have trouble moving and develop early, painful hip arthritis. This condition is called developmental dysplasia of the hip. Developmental dysplasia of the hip can be detected on physical examination and by imaging studies like X-rays and ultrasounds. Treatment for developmental dysplasia of the hip includes bracing, casting, and surgery in more advanced cases.
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References
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