Developmental dysplasia of the hip in children is an alteration of hip shape that may be present at birth or develop during the first year. Early diagnosis is essential, as treatment becomes more aggressive the older the child is. On the other hand, if diagnosed before the age of 6 months, the treatment success rate is high.
Developmental dysplasia of the hip: what is it and what does it cause?
Developmental dysplasia of the hip is one of the characteristic pathologies of pediatric orthopedics and traumatology. Throughout the years it has received different names, being more frequent congenital dislocation of the hip. However, as the problem is not always present at birth but can appear later with varying degrees of hip dysplasia without dislocation, the more appropriate name is developmental dysplasia of the hip.
It is an alteration of the shape of the hip that can be present at birth (most of the time) or occur as the child grows, usually during the first year of life. As a result of this altered shape, the head of the femur may eventually slip out of place. In less severe cases it can reach adulthood with an inadequate shape of the hip that will lead to a deterioration of the joint, with the passage of time, and the development of osteoarthritis. For these reasons it is very important to make a diagnosis as early as possible, since the sooner treatment is started, the simpler it is and the greater the chances of success.
In our society this pathology is not usually related to incorrect attitudes in the handling of babies. Hip dysplasia is more common in cultures that swaddle babies with both legs together, which is not common in our society. Baby carriers, which maintain the opposite posture with the hips open, have not been associated with an increased risk of developing hip dysplasia.
Diagnosing developmental dysplasia of the hip in children
To make the diagnosis, it is essential to examine the hips in all newborns by performing a series of maneuvers that indicate whether the hip is out of place or dislocated. These examinations should be repeated in all the baby’s health controls, at least until he/she reaches one year of age, since the problem does not appear at birth. From the age of three months, the sign that should make us suspect that a hip may be dislocated is the limitation of abduction, i.e., the affected hip does not open as well as the healthy one.
When the examination is abnormal, an ultrasound of the hips should be performed to confirm and assess the severity of the dysplasia, and an x-ray should be performed after six months of age. Ultrasonography is also performed (at around 6 weeks of life) in babies with normal examination who present some of what we call risk factors: direct family history of dysplasia, breech presentation in the third trimester of pregnancy, congenital muscular torticollis, alterations in the lower extremities, among others.
Treatment of developmental dysplasia of the hip in children
If hip dysplasia is diagnosed early, treatment is relatively simple. Different orthopedic devices are available for treatment: the Pavlik harness is the most widely used device and has a 95% success rate. The time of use depends on the severity of the dysplasia and the number of months of life the child has at the start of treatment, but the average is usually three months.
In cases where the harness is not effective (generally because there is some structure that does not allow the femoral head to enter its place) the treatment becomes more complex. It is necessary to resort to a closed reduction, which means a reduction of the hip under general anesthesia, and placement of a pelvic cast to keep it in position for at least 12 weeks. And, in some cases, open reduction, which consists of an operation, is necessary.
Treatments become more aggressive the older the child is. Hence the importance of early diagnosis. If it is diagnosed after six months, it is more likely that the latter treatments will have to be used.
On rare occasions the hip does not acquire the correct shape despite the previous treatments, or does not follow a correct development after them, so it is always necessary to control the development of the hips. Occasionally some surgeries are necessary throughout the child’s growth to change the improper shape.
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