Healthy Hips for a Happy Healthy Baby

By Romel Bhanti, Orthotist Resident, Comprehensive Prosthetics and Orthotics

Developmental Dysplasia of the Hip, or DDH, is a condition characterized by an unstable hip joint. In general, this condition means that there is general instability, or looseness, of the hip joint and can therefore easily dislocate. DDH may also be referred to using the following terms: congenital dislocation of the hip (CDH), hip dysplasia, and developmental dislocation of the hip, acetabular dysplasia, hip dislocation, or loose hips. Although this condition is relatively painless in the early stages, if not treated properly it can lead to disabling conditions, such as arthritis, later in life. The good news is that the success rate with early diagnosis and proper treatment is very high and there are rarely long-term effects.

Approximately 1 out of 20 full-term babies has hip instability of some sort with approximately 3 out of every 1,000 infants requiring treatment. Girls are affected more often than boys and babies born in the breech position are more susceptible to DDH. Genetics also play a role in the likelihood of having a child with DDH. Normally there are not symptoms that are obvious to parents; however, if you notice any of the following it may be a sign of DDH and you should bring it to the attention of your doctor: legs held in unmatched positions, uneven fat folds on the thighs, or reduced movement on the affected side.

Diagnosis
The doctor will examine your child’s hips at the time of birth by moving your baby’s legs and looking for signs of instability. Your child’s hips should be examined at the follow-up appointments as they grow. In the case that there are signs of DDH in children younger than 4 months, your doctor may ask for an ultrasound to be taken of the hips. Children older than 4 months may have X-rays taken. The following are the four types of dysplasia listed from minor to severe:

• Subluxable: The head of the femur is partway out of the acetabulum (hip socket)
• Subluxed: The head of the femur is partway out of the socket in a resting position
• Dislocatable: The head of the femur can easily be fully dislocated; however, it is in the normal position at rest
• Dislocated: The head of the femur is completely out of the socket at rest.

Treatment
The type of treatment provided will depend on the age of the child; however, no matter the age of the child, the goal is always to place the head of the femur back into the acetabulum and keep it in place by providing stability. This process is known as reduction.

Children from birth to the age of 6 months may wear an orthotic device known as a Pavlik harness. This device is a soft strapping system that holds the head of the femur in the socket by positioning the legs away from the midline of the body and flexing the hips, which is a very stable position for the hip joint. The Pavlik harness is relatively non-restrictive and does allow the child to exercise his or her legs. This device will be fit by your doctor or an orthotist and you will be informed of the proper donning procedure at that time. This is a very simple treatment and works approximately 90 percent of the time. Early diagnosis is essential for success with the Pavlik harness.
    Children that are diagnosed after 6 months of age or have not had success with the Pavlik harness may require a body cast or more rigid orthotic device (brace) to hold the head of the femur in the acetabulum. Doctors may also choose to perform surgery to place the femur in the socket, known as open reduction. There are also cases when a tendon in the hip is tight and needs to be released in order to ensure that the hip is stable.

Early diagnosis and treatment are the keys to having a successful outcome when your child is diagnosed with DDH. The success rate is very high and there are rarely any long-term affects when treated early. Most children tolerate the Pavlik harness very well and are so young at the time of treatment that they have no recollection of the process as they grow.

Romel Bhanti is a Certified Prosthetist and Board Eligible Orthotist Resident at Comprehensive Prosthetics & Orthotics, Inc. (CPO). CPO provides patients throughout Illinois with prosthetic and orthotic devices and care, and also houses an on-site fabrication department where custom orthoses and prostheses are designed and created for each patient.

CPO can be reached by calling toll-free 888-676-2276. Visit the website at www.cpousa.com.

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