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A normal hip joint is a ball and socket joint that normally fits firmly together at the upper end of the femur. There are ligaments and muscles that keep the ball and socket firmly in place. In babies and small children with developmental dysplasia of the joint, the joint becomes dislocated and the ball becomes loose in the socket.
Hip dysplasia usually is present at birth but it can develop at some time during the child’s first year. This is why doctors should check for it at every well baby visit up until a year of age. Babies who are tightly swaddled are at a greater risk of developing hip dysplasia after birth. Babies shouldn’t be swaddled with knees and hips straight.
In all cases of hip dysplasia, the socket or acetabulum is so shallow that the ball of the femur doesn’t fit well into the socket. The ligaments might be overly stretched. The degree of instability can vary from child to child. The most serious case is a complete dislocation of the joint. In a dislocatable condition, the joint can be dislocated on examination. In a subluxatable condition, which is the mildest case of hip dysplasia, the ball can be moved around within the socket but cannot be completely dislocated.
In the UK, about 1-2 babies per 1000 are born with hip dysplasia. It is a condition that runs in families. It can happen in either hip and is more prominent in the left hip and in girls. It is more prominent in first born children who were breech at the time of birth. If there are lower levels of amniotic fluid, then there is a greater chance of developing hip dysplasia.
Symptoms of hip dysplasia include having legs of different lengths, uneven skin folds noted on the thigh, decreased mobility on one side of the legs and limping or waddling when trying to walk.
The doctor’s examination is crucial to the diagnosis of hip dysplasia. The examination should begin at birth and continue through all baby’s visits to the doctor to the age of one. The exam involves pushing the knees above the level of the hips and abducting the hips. The doctor then tries to push the hips out of their proper position. If there is a palpable click, then hip dysplasia might occur. The diagnosis is confirmed by ultrasound in babies and by x-rays in older children. If the diagnosis is not made in a timely fashion, the baby might not walk well.
The treatment of hip dysplasia depends on its severity and when it is detected. When found at birth, for example, a harness or brace can be used to correct the dysplasia. If it is found at a later date, such as when the baby is walking, the treatment and outcome varies.
When a harness is used, the parents are trained as to how to use it and the child uses it for approximately 1-2 months until there is no longer any subluxation or dislocation.
At 1 month to 6 moths a harness is used but is used full time for 6 weeks and then part time for 6 weeks. If the hip doesn’t stay in place with the harness, a brace is used instead. It is made from material that is firmer than a harness and will keep the baby’s hips in normal position. In some cases, a spica cast is recommended to keep the bones in proper position. The procedure is done under general anaesthesia because it can be painful to put the bones in the proper position and keep them there until the cast is in place.
Babies from 6 months to 2 years need closed reduction and a spica cast placement is used. Skin traction is used to prepare the soft tissues before the cast placement. It can be done at home or at the hospital.
Surgical treatment is done in older children who don’t respond to closed reduction. The surgery shortens the femur so that the head of the femur fits the way it is supposed to in the acetabulum.
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