What is Hip Dysplasia?

Hip Dysplasia also called Developmental Dysplasia of Hip (DDH) or Congenital Dislocation of Hip is a condition where the head of the thigh bone does not fit properly into the cavity of the hip bone of babies. Sometimes, hip dysplasia may begin while the baby is in the womb, while sometimes it develops after birth while the child is growing, often in the first year of life. This condition may be found in one or both hips, but is seen more commonly to affect the left hip.

What causes Hip Dysplasia?

Normally, the rounded head of the thigh bone sits snugly in the cup shaped socket of the hip bone. In children who have hip dysplasia, the hip socket is too shallow, resulting in the femoral head not being held tightly enough. This leads to looseness of the hip joint where the ball like head of the thigh bone is partially or completely out of the cup like socket of the hip bone.

The below factors may predispose a baby to be born with hip dysplasia:
• Girls
• First born babies
• Being in the upside down position in the last month
  of pregnancy
• first after 28 weeks of pregnancy
• Either of the child’s parents or siblings having a history of hip problems in their childhood
• Being a part of a twin / triplet
• Having low levels of the fluid in the womb

What are the signs of Hip Dysplasia?

Babies with Congenital dislocation of the hip usually do not have any pain, making this condition less obvious to parents.

Children with hip dysplasia can have the below signs:

• The baby’s hip can have a clicking or popping that may be audible or may be felt
• The baby’s skin folds under the buttocks or on the thighs are unequal
•  The baby’s legs are not of equal length

Which doctor can treat Hip Dysplasia?

Your regular paediatrician is qualified to identify and catch the development of hip dysplasia. If your paediatrician suspects this condition, they may refer your baby to a Paediatric Orthopaedic Surgeon
or a Paediatric Hip Specialist.

How is Hip Dysplasia diagnosed?

Hip dysplasia that is apparent since birth gets detected at the first examination that is done by the paediatrician after birth. You may notice your paediatrician gently moving your baby’s hip joints to check for problems. Many times, babies are born with hips that are loose due to laxity of the tissues that join the bones. In such cases, this hip laxity gets better on it’s own by 4 to 6 weeks of age. This is not true hip dysplasia. If the laxity persists beyond 4 to 6 weeks of age, treatment may be needed. If your paediatric doctor feels that your baby’s hips may have an issue, they will advise a sonography of the hip between 4 to 6 weeks of age.

Occasionally, hip dysplasia may become noticeable much later. You may notice that one leg:

• is dragging while crawling
• appears shorter than the other
• doesn’t move out as much as the other to the side
• is limping while starting to walk

In babies who are older than 4 to 6 months of age, an XRay may be advised, as their bones are formed enough to be now seen on an XRay.

How is Congenital Dislocation of Hip treated?

There are multiple treatment options for Congenital Dislocation of Hip, depending on the type and severity:

1. Pavlik’s Harness

If your baby is diagnosed early, a brace called Pavlik harness may be prescribed. This brace helps to ensure that your baby’s hips stay in a stable position and develop normally. This positioning device has to be kept on continuously initially. Later on, your Paediatric Hip Specialist will advise you to
remove it for short periods for a while, after which it can be done away with permanently. The treatment often lasts for 1 to 3 months with regular visits to the Paediatric Hip Specialist for
adjustment in the brace, if needed.

2. Surgery

For babies who get diagnosed after they are 6 months old or if the Pavlik harness did not help,
surgery is advised. Surgery may be reduction surgery or reduction with a bone surgery called osteotomy. In reduction surgery, the head of the thigh bone is placed in the hip socket. This is followed by a period of at least 3 – 4 months of wearing a plaster. Bone surgery called osteotomy
may be needed in children with bone deformities or to deepen a very shallow hip socket or to shorten a thigh bone, especially in older children.

What are the long term effects of Hip Dysplasia?

Most babies who are treated for congenital dislocation of hip grow into healthy children and adults with no hip problems. If the congenital dislocation of the hip is untreated, the hip joint does not grow well which can lead to pain while walking and even hip arthritis at a young age.

How can Hip dysplasia be prevented?

Most of the times, hip dysplasia cannot be prevented. However it has been found that tightly wrapping a baby can have an effect on the development of hip dysplasia. Hence one should remember to wrap or swaddle the baby such that their legs and hips are free to move about.

Early diagnosis is the most important part of the treatment of Hip Dysplasia. If you suspect that your baby may have congenital dislocation of the hip, please get in touch with your nearest Paediatric Hip Specialist. Dr. Mandar Agashe, Paediatric Orthopaedic surgeon and Paediatric Hip Specialist in Mumbai. On account of his training at the International Hip Centre at Rady Children’s Hospital, San Diego, USA, Dr. Mandar Agashe is highly experienced in treating hip dysplasia. He can be reached via email at contactus@agashehospital.com or via phone at 9867539883 at Agashe Hospital.