Hip Dysplasia - Infant and Paediatric

Hip dysplasia is a congenital and development disorder of the hip. Dr Balakumar consults newborn, infants, children, adolescents and adults with hip dysplasia.

Dysplasia refers to the growth disturbance that has occurred resulting in the abnormality. This growth disturbance simply put results in an underdeveloped hip joint. No one really knows why it happens although we know that genetics and environment certainly plays a role. The normal hip joint consists of the acetabulum (the socket) and the femoral head (the ball).

When the hip is underdeveloped it can result in varying degrees of severity. The most severe end of the spectrum is hip dislocation. This is when the ball is not in the socket and is sitting 100% away from where it is meant to be. This is usually a result of dysplasia, where the socket is so under-grown and flat that the ball slides out of it. The least severe end of the spectrum is dysplasia with no subluxation. In-between the two is hip dysplasia with subluxation.

Think of the normal hip like someone wearing a Vietnamese farmers hat on his or her head. The head represents the femoral head and the hat represents the acetabulum (socket). If it is slightly tilted the hat will feel unstable on the head and will need to be constantly re-adjusted analogous to the mechanical unstable nature of dysplasia. If the hat is sloped sideways on the person’s head it will slide of and completely fall off. This is analogous to a hip dislocation. When the hip is only dysplastic with no dislocation, the condition is dysplasia alone (the least severe of the spectrum).

Risk Factors

When diagnosed as a baby there are varying factors that may contribute to the dysplasia. First born children, girls, caesarian section, breech and family history are all strong factors associated with hip dysplasia. Infants are initially screened for hip dysplasia based on history and examination by their paediatrician/neonatologist and or maternal health nurse. Risk factors or examination findings may prompt your health practitioner to refer your child for an ultrasound and to an orthopaedic surgeon.

In some countries such as Austria and Sweden all babies are screened for hip dysplasia around age 6 weeks. This is because unless the hip is dislocated or subluxed, hip dysplasia can be completely asymptomatic in its early stages.

Treatment

When picked up in the first six months of life, hip dysplasia can be treated very effectively with brace treatment. When the diagnosis is made and your child is referred to Dr Balakumar, he will educate, prognosticate and treat the disease. The treatment can range from observation, bracing (most common), surgery and mechanical joint realignment procedure.

Early diagnosis is integral in treatment of the disease. Based on the severity of the dysplasia, all treatment of dysplasia relies on the 4 main principles.

1. Obtain reduction of the hip (with no soft tissue between the acetabulum and femoral head)
2. Maintain reduction of the hip (you will notice your practitioner performing stress maneouvres to check for this)
3. Encourage the growth of the socket to give a mechanically normal hip. Thereby preventing early osteoarthritis and early joint replacement
4. Serial review of the child and hip till skeletally mature to consider joint preservation options for a mechanically unfavourable hip.

• Dennis Brown abduction bar Dennis Brown abduction bar
• Dennis Brown abduction bar Dennis Brown abduction bar
• Dennis Brown abduction bar Dennis Brown abduction bar
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Early management usually involves using a Dennis Brown abduction bar, which is worn for either 24 hours a day (if the hip is dislocated) or 23 hours a day if the hip is only dysplastic. Sometimes other braces are used such as the Pavlick or Rhino cruiser. If brace treatment fails in the first 3-6 months it is either due to very strong genetic factors or soft tissue being trapped between the ball and socket. In these instances surgery is required.

Example of hip dysplasia and dislocation

An example of a dislocated hip diagnosed at 14 months requiring surgery

This patient then went onto to have a medial open reduction and an acetabuloplasty (“Dega”)

Even after the hip is treated with either a brace or surgery and the hip is considered normal, the hip is still susceptible to becoming dysplastic throughout growth.

Remember that dysplasia refers to a growth disturbance. So whilst there is growth left in the child, the hip can continue to under-grow. So even when the hip has normalised, Dr Balakumar will evaluate your child at 4-5 yearly reviews looking for “rebound” dysplasia.

If this is picked up even at an older age, the hip is still better treated with a joint preservation option rather than allowing the hip to become arthritic thus requiring total hip replacement.

See also:

• Hip Dysplasia in the Child, Adolescent and Adult