It’s a standard practice to examine the hips of babies in the newborn nursery and at the pediatrician’s office. This is an exam to check for hip dysplasia. Doctors look for instability in the hips, if the legs are uneven lengths or have asymmetric range of motion.
Hip dysplasia is a condition where the hip sockets did not develop normally, are too shallow. If severe, the hips dislocate out of socket. The size of the baby, limited amniotic fluid in the womb and the amount of space inside the womb contribute to hip socket development. These factors affect the position that the baby’s hips are in during development.
High-risk babies should be screened with ultrasounds at six weeks old to see how the baby’s hips are developing. High risk factors include born in breech position, have a family history of hip problems or are female or first-born.
Signs of hip dysplasia
Hip dysplasia can affect one or both sides. A baby with hip dysplasia may have one leg that looks longer than the other. This can mean that the shorter side has a hip dislocation. Movement on the affected side may be restricted. Doctors also feel for a clunk or pop during the examination. Not all hip clicks mean dysplasia, but further tests like ultrasound and X-ray will help make a diagnosis.
It is best for the patient if diagnosed as an infant. However, signs may develop as children begin walking. “If the child gets to walking age they may walk with a waddling gait, or with arched back to compensate for hips that are dislocated,” said Dr. Rachel Randall, pediatric orthopedic surgeon with Marshfield Clinic Health System.
Early treatment improves outcomes
Treatments focus on bringing the hips into alignment so they go back into their sockets. Infants can wear a soft harness, called the Pavlik harness. This keeps the hips in a proper position to promote normal development. A hard brace is used if alignment isn’t corrected.
If the dysplasia isn’t corrected with these treatments there are more invasive options. A closed reduction is where the doctor manipulates the hip joint to get the ball back into socket while the child is under anesthesia. If successful, a spica cast, which is a hard cast that covers the legs to the waist, is applied. If the hip is not reducible, a surgeon would do an open reduction. This surgery moves the hip back into the socket, followed by a cast.
As the child grows, follow up will include X-rays to monitor growth. Later, as a toddler and into school age, surgeries can change the shape of the socket, but they get progressively more difficult to treat successfully. There are surgery options for young adults with too shallow hips sockets. This surgery changes the position of the socket within the pelvis to help reduce pain and prevent premature arthritis.
Long-term effects vary
The earlier the diagnosis, the better the results. If successfully treated, children will develop normally and have no pain or long-term problems. Diagnosis at a later age leads to a higher need for surgery to maintain normal hip anatomy into adulthood. If not treated, a person may experience pain and premature wear and tear. This may lead to early total hip replacement or hip resurfacing.
Generally, the goal of treating hip dysplasia is to prevent the need for a reconstructive hip procedure early in adulthood. “On the other hand, total hip replacements can be life-changing for patients who have daily pain and limited activities because of hip arthritis,” Randall said.