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Hip Dysplasia

What Is Hip Dysplasia in Babies?

For babies who are born with hip dysplasia and for those who develop it in infancy, there is good news: Hip dysplasia can be effectively treated. While relatively rare, the condition can cause problems later in life, so it’s helpful for parents to know what hip dysplasia looks like, ways to prevent the condition and how it’s diagnosed and treated.

First, what is hip dysplasia? Also referred to as developmental dysplasia of the hip (DDH), it occurs when an abnormal formation of the hip socket causes the hip joint to become unstable or completely dislocated. For babies with DDH, the ball-shaped femoral head, which is normally held in a cup-shaped socket at the top of the thigh bone, is not in the proper place. This ultimately prevents normal development.

Fortunately, successful treatment of hip dysplasia in babies can help prevent joint health issues later in life—but treatment must be proactive. Here are DDH facts you need, from symptoms and diagnosis to prevention and treatment so you can make the best decisions for your child.

Symptoms: What does hip dysplasia look like in babies?

One of the challenges with diagnosing hip dysplasia in babies is that the symptoms can be difficult to spot. While the condition can lead to pain later in life if it’s not treated early on, infants and young children don’t experience pain from DDH.

So, what does hip dysplasia look like? The symptoms can range from mild to severe, but the most common include:

  • Leg length differences. The leg on the side of the body with DDH may look shorter than the other leg.
  • Restricted range of motion. The leg on the side with DDH may not spread as widely as the other leg, a symptom often discovered during diaper changes.
  • A noticeable “clunk.” This can be felt as the dislocated ball of the hip moves out of alignment, either during an examination with a health care provider or during diaper changes or other physical activity.
  •  Skin folds. The skin folds under the buttocks or on the thighs don’t line up.
  • Limping. A newly walking toddler may have a mild or pronounced limp, depending on the severity of the condition. They may also waddle when they walk, which could be a sign of DDH in both legs.

What causes hip dysplasia in babies

Hip dysplasia can occur before or after birth and affects one or both hips. Approximately 1 in 1,000 babies in the U.S. are born with the condition each year. While experts don’t fully understand what causes hip dysplasia in babies, a variety of factors can put a baby at greater risk for DDH. These typically include:

Genetics. A family history of DDH is a common risk factor. The risk of developing the condition goes up by 12% (1 in 8) if a parent had hip dysplasia when they were a child, and by >6% (1 in 17) if a sibling had DDH. If both a parent and child had hip dysplasia, the risk for other children in the family developing it is 36% or 1 in 3.

Breech birth. For a baby who presents breech (buttocks first) in the uterus, the risk of developing DDH is far greater than for a baby born headfirst.

Small uterus. A uterus that is too small for the fetus to move during pregnancy can cause more noticeable conditions in newborns like a head tilt or the turning in of the front of a foot. These visible abnormalities give health care providers a signal to check for hip dysplasia, which might not be detected that early otherwise.

Sex and birth order. Hip dysplasia is more common in girls than boys. It’s also seen more frequently in first-born children, which may be related to a smaller uterus.

Improper swaddling. While most babies with hip dysplasia are born with the condition, not all are. If a baby’s legs are maintained in a straightened position for extended periods, which can occur via improper swaddling, cartilage and bones can be damaged. This can lead to the development of DDH.

How is hip dysplasia typically diagnosed?

It’s helpful for parents to understand what hip dysplasia looks like in babies. Developmental dysplasia of the hip typically can be diagnosed during a physical exam. While babies usually are screened for DDH before they first leave the hospital, it may not be caught until signs are noticed later in infancy. If a baby shows signs of DDH or is at greater risk for it, their doctor may order an ultrasound or X-ray.

  • An ultrasound uses sound waves to make pictures of the baby’s hip joint. It’s used for babies under 6 months of age, because most of their hip joint is still soft cartilage and won’t be visible on an X-ray.
  • An X-ray is most often performed for babies older than 4 to 6 months as their bones have formed enough to be visible on an X-ray.

How can hip dysplasia in babies be prevented?

While congenital hip dysplasia can’t be prevented, there are two key things you can do after your baby is born to help prevent the development of hip dysplasia.

1. Learn proper swaddling techniques.

While parents swaddle babies to make them feel secure, quiet them from crying or help them sleep, swaddling a baby’s legs too tightly can lead to hip dysplasia. Your health care provider can demonstrate proper swaddling techniques, but in general, babies need room to wiggle. Swaddling them in a way that allows their legs to bend up and out at the hips is key for achieving normal hip-joint development.

2. Use an inward-facing baby carrier.

The popularity of attachment parenting techniques has led to an increase in baby-wearing and related carriers. Beyond attachment benefits, baby wearing also can help reduce the risk of DDH when done properly. This can be achieved by using an inward-facing carrier that keeps the baby’s legs in an M-position or spread-squat. In this position, the thighs spread across the parent’s torso and the hips are bent just enough that the knees are slightly above the buttocks and thighs are supported. The International Hip Dysplasia Institute recommends using an inward-facing carrier from birth to at least 6 months to encourage healthy hip development.

How is hip dysplasia in babies treated?

The goal of treatment for hip dysplasia in babies is to get the ball of the hip in the socket and keep it there, so the joint can grow normally. Treatment is typically provided by a pediatric orthopedic surgeon and can vary based on the severity of the condition and other factors, including age. Treatment options include bracing, closed reduction and casting, or an open reduction (surgery) and casting.

Bracing

Bracing is the most common treatment method for babies younger than 6 months. It involves using a brace called a Pavlik harness that pulls the baby’s legs into a position that guides the ball of the hip joint into the socket. Treatment generally takes 6 to 12 weeks, with checkups and ultrasounds every 1 to 3 weeks to ensure progress and adjust the harness as needed. The harness is often enough to correct the dislocation without further treatment.

Closed reduction and casting

A closed reduction (manually moving the ball back into the socket) and casting are a secondary option if the harness isn’t able tocan’t keep the ball of the hip in the socket or if treatment begins after 6 months of age. The procedure is performed under general anesthesia, allowing the surgeon to inject contrast dye into the joint to see the cartilage part of the ball and then move the infant’s thighbone so the ball goes back into place in the socket. To hold the hip in place while it develops properly, the baby is placed in a hip spica cast for 2 to 4 months.

Surgery and casting

An open reduction (surgery) and casting may be needed if the closed reduction was not successful or treatment began when the child was older than 18 months. During an open reduction, the surgeon makes an incision, moves muscles out of the way to get a better view of the hip joint and puts the ball back into place. Stitches are placed under the skin to close the incision and won’t need to be removed. To hold the hip in place while it develops properly, the child is placed in a hip spica cast for 6 to 12 weeks. For children older than 18 months the surgeon may also perform a procedure on the pelvic bone to deepen a shallow hip socket.

While there are always risks associated with any surgical procedure—including infection, bleeding, or anesthesia complications—they are minimal for DDH treatments. The biggest risk with a hip dysplasia diagnosis is doing nothing. If left untreated, babies with hip dysplasia are at a high risk of developing osteoarthritis later in life. In fact, some research suggests that up to 50% of hip replacements due to osteoarthritis may have first been caused by a pediatric hip condition—most likely dysplasia.

What is the long-term outlook for hip dysplasia in babies?

In most cases, the prognosis for hip dysplasia in babies is very favorable—especially when the condition is treated early in infancy and a Pavlik harness or closed reduction is successful. Children who require open reduction surgery likely will not achieve normal hip development and may have hip problems as they get older, including needing a total hip replacement.

Overall, though, the earlier the treatment occurs, the better the outcome. And follow-up visits are just as critical. Children who had hip dysplasia as infants should have regular checkups with their orthopedic specialist through ages 16 to 18 to help ensure their hip continues to develop normally.

Get help for hip dysplasia

Rady Children’s Hospital-San Diego is committed to providing comprehensive care for hip conditions starting from infancy. Our program is led by experienced orthopedic surgeons and utilizes advanced office-based ultrasound analysis for accurate diagnosis and effective treatment of hip dysplasia.

Our Hip Center is renowned for its pioneering work in developing harnesses for hip problems in babies. As a result, we have established one of the largest Pavlik harness treatment programs in the world. In addition to offering specialized orthopedic surgery for hip preservation, our Center provides:

  • Access to and referral for advanced imaging studies
  • Parent and patient education
  • Expert consultation on the development and progression of all childhood hip conditions
  • Physical therapy and rehabilitation services

For more information about our diagnosis and treatment options, please contact us at 800-788-9029. We are here to support you and your child.