Hip Developmental dysplasia is actually a medical term for looseness or instability of the hip joint especially in a newly born or infants. Hip Dysplasia, dislocation or DDH are all the same and can be harrowing for both the child and the parents.
Usually the joint is in a normal state but has some instability associated to it. Understanding the nature of this problem would make us firstly delve deeper into the anatomy of the hip joint.
The hip area is usually conjoined by ligaments into a ball and socket setting. The round ball part is femoral head, forming the top part of the thigh bone and the socket is acetabulum, a main part of the pelvis.
The hip joint is structured by the perfect placing of the ball and the socket. DDH is generally found in newborn but it can also gradually develop during the first year of the child.
Scientific researches and medical advancement has proven that infants with slightly swaddled legs and have straightened knees or legs are prone to DDH.
Types of Hip Developmental Dysplasia:
Usually the disease has certain variations and the severity is also variable –
- The mildest case, known as ‘subluxatable’ where he femur head is wobbly in the socket but would not dislocate anyways.
- In some cases the femur gets embedded in the acetabulum but can run the risk of being dislocated any time. This is generally called ‘dislocatable’ type which involves the potential danger of being pushed out from the socket.
- The most severe form of ‘Hip Developmental dysplasia’is called ‘dislocated’ sort as here the femur becomes completely detached from the socket area.
It has been evidenced that out of 1,000 babies 1 to 2 are born with this disease.
Causes of Hip Developmental Dysplasia:
There are various inherent and intrinsic factors that contribute to the causation of this disease. It is mainly seen in the girl child, in majority.
It primarily is caused by heredity and can occur in any of the hips. Despite that the left hip is generally more affected. It is majorly seen in:
- The first child.
- Breech position tends to make babies prone to DDH a lot. The feet part is down and the shoulder area is up, which results in thorough screening and scanning of the female fetuses.
- Even siblings and parents having such a problem can run the risk of this disease.
- Extremely low levels of amniotic fluid are one of the prime causes.
- Multiple births by the mother or anteceding twins
- Premature babies run the highest risk of DDH, especially when the child is delivered before 37 months.
Indicative Symptoms of Hip Developmental Dysplasia:
Any newborn usually does not undergo any painful phase even when they have DDH. Just after the birth, the first medical examination would reveal the Dysplasia problem.
Usually a check is performed by a gentle twisting of the knees and thighs of the little baby, positioned outwardly to detect any unease or certain obstruction.
If the hip area somewhat shows a certain glitch then the medical examiner would immediately grasp the problem and advise further checkups. Some other signs of Hip Developmental Dysplasia are-
- The skin area especially between the body and legs might be unequal and can vary.
- The femur might seem to be too short on one of the two sides. Though skin folds are not the most authentic way to detect DDH as it can be just another normal thing. So a thorough checkup is always recommended for the right diagnosis.
- Instability of the hips area.
- Waddling or one leg slightly being dragged after the other one while crawling.
Some of the major points to be considered while grasping the symptoms are given below-
- The baby should be put out of the diaper and should be in a calm state. A thorough examination of any symptoms within 24 hours of birth is ideal.
- A regular interval at 6-week, followed by 6 months and thereafter 9 months is ideal. After that another session of detection can be performed while the child can walk.
- In case of children who have attained the age of walking, a slightly limping way of the manner of walking is bound to be medically inquired. In some instances the child tends to walk on its toes and it always does not imply that the walking would be delayed due to the presence of DDH.
Initially after diagnosing the symptoms the doctor advises to return for another session of checkups.
The main cause behind this suggestion is that at the time of birth usually the hips of the babies remain on the softer side and within 2 months of time span they become more firm and stable.
In case of subluxed or dislocated hips, relocation is very much possible and can be stabilized to normalcy effectively. After understanding the symptoms an ultrasound scan can be done around the age of 4 to 6 months.
This absolutely pain-free test is fabulous to grasp the symptoms that crop up. However, when a child exceeds the 4-6 months age limit, the X-Ray diagnosis is very useful.
The measurements taken on the X-Ray of the pelvis area as well as the femur would successfully determine DDH presence.
Treatments of Hip Developmental Dysplasia:
Treatment becomes a very vital thing for generally treating Hip Developmental Dysplasia as if it is left untreated DDH can become dangerous and can permanently damage the head of the femur, resulting in not normal way of hip development.
Initially the treatment should be made earliest possible in order to avoid any long running negative impact on the child. The more delay one makes in treatment the more one would pose risk to the recovery process.
The primary aim of the treatment is to relocate the head part of femur into acetabulum. After this process the basic structure of the hip part gradually results in a steady development of the hip joint.
The age of the little one is the main determining factor for determining the nature of treatment.
Non-surgical treatments generally are best suited if the treatments are started before attaining 7 months of age. Some of the most commonly effective treatments are as follows-
This fabric splint harness device is practically used to contain the hips in a very correct position to make it rapidly regain shape. Doctors recommend this method of treatment when the child is generally of 6 months age or below.
The time-span of using it on the kid varies from 1 and a half months to 6 months of part-time usage in young ones. The elder ones usually need to wear them on for longer time span to cure the problem.
While wearing a Pavlik Harness the child must be constantly scrutinized over the ultrasound scan to note the changes and the improvements. The harness acts like a force to keep the legs bent, pointing outwards so that the movements of the child are restricted.
It simply does not allow one to straighten the legs or somehow turn any of the leg inwards. The harness can be magnificently adjusted with the growth of the child and the rate of improvement.
It does not impede your child’s normal growth.In case of Subluxation the harness works for 90% of the babies.
However the severe one can be 80% effectively treated. Despite these the harness can create a tendency of avascular necrosis which can be the result of abnormal positioning.
This basically is a problem regarding the bone tissue where the femur is overtly pressurized by unwanted pressure on the bone. However the harness cannot be randomly removed by any layman and should always be removed after talking to a doctor.
The harness has to be constantly adjusted as the baby would grow. A careful parent must be aware of certain facts while the kid is on Pavlik Harness treatment-
- Changing the clothes of the baby without tampering the position of the harness.
- Cleaning of the harness is also important as gentle detergents or brushes are deal for this task.
- Never should the baby be allowed to sleep sideways, always lay them on their back for effectiveness.
- The baby oft skin might become sore from the straps so any soft yet hygienic material, wrapped around the harness strap would do the trick of securing any friction.
- When to remove for short spans and when to remove it forever are to be strictly understood. Engaging the child in swimming while the harness has been taken off is also a great way to make the process of recovery faster.
Closed Reduction and Hip Spica
This process of treatment is specially designed for children above 6 months. It is also advised when the Pavlik Harness does not fructify at all. In this circumstance the child is induced with anesthesia.
While making them anaesthetized the doctor effectively positions the hip in the desired and normal way. To secure its position the area is plastered or a special cast is done to maintain it.
A CT scan or even an MRI would be done soon after the plastering to ensure the success of the positioning. The cast is kept around 3 months or so, to ensure the full eradication of DDH. This does not imply any major cuts on the body.
An utter failure of all of the above ways can lead to an ‘open reduction’ recovery process. It can be used for much older children after a late detection of DDH too.
This surgical way involves a relaxation of the tendons surrounding the hip area and thus obliterates and significantly wipes out any impediment in the path which hinders free movement of the hips. As soon as the bones are set properly the joints get strengthened and sturdier.
Various other types of surgery
Generally dysplasia of hip is resolved and successfully treated within 18 months or one and half years of age, yet after that any sort of remedy is hard to find. In such cases the some parts of the joint and bone area are removed in order to place the hips in the correct state.
If left Untreated, What Can be the Outcome-
If a child does suffer from DDH and is not at all cured then there might develop a propensity of suffering from arthritis in the hip-joint.
Then the treatment becomes even more difficult and thus a steep decrement of the chances of recovery occurs. This dimming chances lead to even more carelessness yet one must remember that treatment any time is better than a total lack of it.
Prevention of Hip Developmental Dysplasia-
One would always try to seek a prevention of any disease yet the blatant truth is that DDH does not have any such prevention methods. The baby is prone to more flexibility while it’s born, though for a short time.
In spite of that one mustn’t allow the baby to keep their legs straightened for a long stretch of time or should not indulge in any joining of the two legs constantly in a tight position.
Usually such behavior of the baby might cause an unnatural hip formation and can eventually hinder the normal formation. Ensure that the child is freely able to kick and does not have any constraints while trying to move their knees or hips, before the firming of bones.
Hip Developmental Dysplasia is not an uncommon problem and if your child has this ailment as well just ensure the best treatment and postures. It is totally curable at an early stage and does not pose other health hazards if diagnosed properly.
Even a matured child can be treated successfully and instances of full recovery are ample. DDH should not be ignored or taken casually by any parent as it might permanently damage your child’s skeletal structure.
Therefore by fully grasping the causes, symptoms and the treatment procedure, Hip Developmental Dysplasia can be ably wiped out.