A Focused Approach for Kids with Hip Dysplasia and Other Hip Disorders

Understanding Hip Dysplasia

Your child’s body has hundreds of bones. When two or more bones meet, they’re connected by a joint that helps the bones move painlessly and efficiently.

The hip joint—where the thigh bone meets the pelvis—is the largest “ball-and-socket” joint in the body:

• The ball (femoral head) is at the top of the thigh bone
• The socket (acetabulum) is a sac-like part of the pelvis

The ball fits into the socket and can rotate freely, allowing the hip to rotate, move backward, forward and from side-to-side . If your child has developmental dysplasia of the hip, his/her hip cannot form correctly — the socket becomes too shallow, and the ball doesn’t fit snugly inside. Hip dysplasia includes a range of disease severity. Some children with hip dysplasia have a mildly loose joint and others have femoral heads that remain entirely outside of the acetabulum.

Hip dysplasia in children occurs more often in the left hip. This is because a baby’s normal position in the womb puts more pressure on the left hip than on the right.

It is important to remember that dysplasia doesn’t need to be permanent. With the right treatment(s), your child’s hip can become stable and fully functioning.

Types of Hip Dysplasia

Hip dysplasia can be described in terms of its severity:

• Dislocated: This is the most severe type of dysplasia. It occurs when the ball is completely outside of the socket.
• Dislocatable: With this type of dysplasia, the ball is in the socket but can easily be pushed out.
• Subluxatable: This is a mild type of dysplasia where the ball is in the socket and is just loose. The bone can move around within the socket but doesn’t actually slip out of place.

Other Pediatric Hip Disorders

At LuskinOIC, our experts are specially trained to treat and diagnose a wide range of hip disorders, include these conditions and injuries:

Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease, often called Perthes, is a condition that causes a temporary disruption of the blood supply to the ball of the thigh bone (called the femoral head). This causes the bone to die and eventually remodel. The disease usually lasts between 18 and 36 months and is more common in children between the ages of 4 and 10.

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Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is a hip problem that begins when the top of the thighbone – the epiphysis – slips off the top of the thighbone, the femur. SCFE may develop in one or both legs. In many cases, this is a gradual process, but it can occur suddenly.

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Snapping Hip

Snapping hip is a condition in which the hip makes a popping noise and sensation when it is flexed and/or extended. It is common in athletes and dancers. It is normally not painful, but it can be irritating.

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Hip Fracture

A hip fracture is a break in the top of the thigh bone, also called the femur, or in the pelvis. Most hip fractures in children heal properly and in alignment when they are treated by an orthopaedic specialist. To avoid any long-term damage, hip fractures should be treated quickly and correctly.

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Common Symptoms

The symptoms of a child with hip dysplasia may include:

• Leg length differences
• Less flexibility or mobility in one leg
• Uneven or lopsided creases in the thigh or buttock
• Unusual walking such as walking on toes, limping or waddling
• Sway back (increased low back curve)

Diagnosing Hip Dysplasia

Sometimes, a doctor is able to diagnose dysplasia right after birth. However, it can take weeks, months or even years for signs to occur. Diagnosis generally begins with a physical exam.

During this exam, the physician may:

• Put your child’s hip into different positions, listening and feeling for “clunks” each time it’s moved.
• Move the hip into certain positions to determine if the hip can be moved in and out of the socket. This is sometimes startling to babies, and your child may cry, but it is not generally painful.
• Rotate and flex the legs to make sure the thighbones are positioned correctly within the hip sockets.

An ultrasound will be ordered if hip dysplasia is suspected and your child is 6 months old or younger. An X-ray will be ordered if hip dysplasia is suspected and your child is 6 months of age or older.

Our doctors and staff make sure your child gets the treatment they need

Treatment for hip dysplasia depends on your child’s age and the severity of his/her condition. Some children do not need any treatment. Your child’s doctor may choose to observe your baby’s hips through frequent check-ups as they develop to ensure that the joint forms normally with growth. In other cases, your child’s doctor may recommend non-surgical treatments or surgical treatments, which include:

Pavlik Harness

A Pavlik harness is a soft brace that is used to treat infants 6 months old or younger who have developmental dysplasia of the hip. The harness holds the ball of the joint in its socket , helping the socket deepen and ensuring the joint becomes more stable. The brace is typically worn 23-24 hours a day for 2-3 months. During this period, your child’s doctor will monitor your baby’s development through regular exams and ultrasounds. After your child is done wearing the brace, he/she will need to have ongoing check-ups for the next several years to continue to monitor the development of the hip joints.

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Rhino Bracing

Some babies’ hips do not respond well to the Pavlik harness. In this case, our doctors will recommend a different type of brace to be worn 23-24 hours a day, which has been shown to successfully treat hip dysplasia in some children who have not found success with the Pavlik harness.

Closed & Open Reduction Surgery

In a closed reduction, your doctor will inject contrast with a very fine needle into your baby’s hip to better view the joint. This is called an arthrogram. The arthrogram can guide your child’s doctor to set the ball back into the socket deeply.

If the arthrogram reveals that your child’s hip cannot be put back into place, your child’s surgeon will perform an open reduction surgery. In this surgery, your child’s surgeon will make an incision over the hip joint and reposition the joint to its proper place. This procedure may also include reshaping the hip socket, redirecting the femoral head.

After a closed or open reduction surgery, your child will be placed into a spica cast.

Spica Cast

A Spica cast is a body cast that extends from just under the armpits to the ankles. After your doctor has correctly set your child’s ball back into the socket, the Spica cast is used to hold the hip joint in the right position. The cast is typically worn for 3 months and is changed at the midpoint during that time.

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