Dr. James Engels, chief of pediatric orthopaedics, explains infant hip dysplasia - from risk factors to recovery.
Newborns receive lots of screenings before they leave the hospital so doctors can start caring for any concerns right away. One of the many conditions healthcare providers look for is developmental dysplasia of the hip, or hip dysplasia.
Dysplasia means the hip socket is shallow or abnormally formed, allowing the ball-shaped head of the thigh bone, or femur, to slip out of place. The ligaments that normally stabilize the hip are often loose as well.
A child with dysplasia could have a hip that is:
- Shallow but not loose and the head of the femur remains in the socket
- Shallow and unstable, or loose, but does not dislocate (called subluxation)
- Shallow and does dislocate
- Dislocated but reducible (femur head can be placed back into the hip but is unstable and will re-dislocate)
- Dislocated and not reducible
What causes hip dysplasia?
Baby being in a sustained breech position (bottom down instead of head down in the womb) later in pregnancy is a primary risk factor. This is because the legs are folded up which can push the hip out of its natural alignment.
Females and first-born babies also tend to be at higher risk for hip dysplasia. Female fetuses are more responsive to the hormones responsible for loosening mom’s ligaments in preparation for delivery, while firstborn babies are often more restricted in a uterus that hasn’t been stretched from previous pregnancies.
Family history plays a role as well, though the precise genetic factors are still being studied.
How to know if your baby has hip dysplasia
Hip dysplasia is often detected right after birth, but sometimes symptoms aren’t noticeable until a bit later. The earlier hip dysplasia is detected, the better the chances of correcting it without surgery. That’s why the pediatrician will continue assessing hip development at well-baby visits until your child starts walking.
During these assessments, they’re looking for the following:
- Asymmetrical creases on the thighs or buttocks
- One leg shorter than the other
- Popping or clicking when moving the hip
- Tight hip adductors (inner thigh muscles)
- Wider than normal space between the legs
If they notice any of these signs, they’ll refer you to a pediatric orthopaedic specialist. Based on their assessment, they may order an ultrasound to take a closer look at the hip and surrounding structures to determine the presence of hip dysplasia and the need for treatment. This is typically performed 4-6 weeks after birth. The timing may need to be adjusted if the infant is premature.
Tried and true treatments for your child’s hip dysplasia
Treatment usually involves bracing or casting for a few months to keep the hip in place while it continues to develop.
- The Pavlik harness is very effective and the most common treatment for infants under 6 months old. This soft brace keeps baby’s knees bent and spread apart to hold the hips in a position that promotes normal development.
- Older and more active babies may need a more rigid device, called a hip abduction brace. There are many great options that can hold the hips in specific positioning and alignment.
- Surgery is usually needed only for children diagnosed with a dislocated hip after 6 months or those whose hips don't respond to bracing.
During treatment, additional hip ultrasounds are used to monitor the baby’s response to treatment.
Taking these steps during infancy are often successful and help prevent further pain, dislocation and other issues down the road.