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Hip Dysplasia & Other Hip Disorders

The human body has hundreds of bones. When two or more bones meet, they’re connected by a joint that helps the bones move.

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

  • 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 move backward, forward, or sideways.

When a child has dysplasia of the hip (also called developmental dislocation of the hip), her hip doesn’t form properly—the socket is too shallow and the ball can’t fit snugly inside. This can cause the hip to be loose and unstable, making it easier for her to dislocate her hip (move it out of place).

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.

Dysplasia doesn’t need to be permanent—with the right treatment, a child with dysplasia will probably be able to develop a stable, full-functioning hip.  

Types

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, but is very loose. The bone can move around within the socket, but doesn’t actually slip out of place.

Symptoms

It’s often easy to see that a child has dysplasia. The symptoms may include:

  • One leg longer than the other
  • Less flexibility or mobility in one leg
  • Uneven or lopsided creases in the thigh or buttock
  • Unusual walking (e.g., walking on her toes, limping, waddling)

Causes

Hip dysplasia can be a bit of a mystery—there are several different causes, and some cases have no known cause at all.

Certain factors can increase a child’s risk of developing dysplasia. These may include:

  • Sex: A girl is more likely to develop dysplasia than a boy.
  • Family history: Dysplasia tends to run in families.
  • Birth order: A firstborn may not have as much room to move around.
  • Birth position: A breech position—when a baby is delivered bottom-first rather than head-first—can cause the hips to stretch, leading to dysplasia.  
  • Exposure to hormones before birth: Hormones that are meant to relax a woman’s muscles and make birth easier can cause a baby’s joints to become too relaxed, making the baby prone to hip dislocation.

 

Although most cases of dysplasia are present at birth, it’s possible for a child to develop dysplasia if she has been swaddled too tightly.

 

Diagnosis

Sometimes, a physician 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 the child’s hip into different positions, listening and feeling for “clunks” each time it’s moved.
  • Move the hip to see if it can be dislocated or put back into place.
  • Rotate and flex the legs to make sure the thighbones are positioned correctly within the hip sockets.

The physician may also order imaging tests, like X-rays or ultrasounds, to see the dysplasia in more detail.

Prevention

While it’s difficult to prevent dysplasia in a newborn, there are ways to reduce the risk of a child developing dysplasia as she gets older:

  • Proper swaddling: If a baby is swaddled with her hips and knees in an extended position, she could develop dysplasia. Her legs should not be wrapped straight down—she should be able to bend her legs up and out at the hips.
  • Correct equipment: Wider car seats, or slings and harnesses that allow the legs to spread, help a child’s hips develop normally.

 

The OIC Hip Dysplasia Team

Medical services are provided based on the nature and severity of the condition.

Typical conditions treated at OIC include:

  • Congenital Coxa Vara
  • Legg Calve Perthes disease
  • Slipped capital femoral epiphysis
  • Developmental dysplasia of the hip
  • Fractures and post-traumatic hip abnormalities
  • Adolescent hip pain

 

Based on your child’s condition your team could include:

The Pediatric Orthopaedist specializes in the musculoskeletal system of children. They provide surgical interventions when necessary such as tendon lengthening.

The Pediatrician reviews medical issues and coordinates the general healthcare of the patient, in addition to working with the orthopaedic surgeon for pre-operative assessments if surgery is indicated and overseeing medical issues for hospitalized patients.

The Nurse Coordinator assists in making sure all medical orders are carried out, and provides case management and nursing assessment for the patient.

The Orthotist works with the team to prevent unequal or unbalanced muscle groups which can lead to deformities as the child grows.

You may also work with physical therapists who will help plan, develop, implement and monitor a physical therapy plan to help reduce pain, or improve or increase mobility.