Developmental Hip Dysplasia is a condition that affects approximately 1 in 2000 babies. Although not overly common, it is a condition that can be easily treated if spotted early. So, here’s everything you need to know.
If you’ve been keeping up with one of our favourite celebrity mums, Millie Mackintosh, you’ll have seen her Instagram post detailing her daughter Sienna’s recent Developmental Hip Dysplasia diagnosis.
In an emotional post Millie explained that following a routine 6-week scan, one of Sienna’s hips appeared to be slightly under developed – this was later confirmed as a case of Developmental Hip Dysplasia.
We caught up with Mr Robert Hill, Consultant Orthopaedic Surgeon at The Portland Hospital, Part of HCA UK, to talk us through the condition and how best to treat Hip Dysplasia in babies.
What is Developmental Hip Dysplasia?
According to Mr Hill, developmental dysplasia of the hip (DDH) is a fairly uncommon but important condition of where the hip joint is underdeveloped, which affects the ball and socket joint of the hip. There are sometimes abnormalities present with the joint, too.
There is a spectrum of abnormality ranging from a shallow socket (acetabulum) with the ball (femoral head) in the correct place, to a completely dislocated ball that will not reduce back into the correct position. The treatment required depends on the severity of the condition – but more on that later.
How can you diagnose it?
The condition is present at birth but can deteriorate if not picked up and treated. On average about 1 in 2000 babies will have this condition but there are risk factors that greatly increase the risk.
If a baby has any of these risk factors the hips need to be checked by an ultrasound scan by 6 weeks of age. All babies, irrespective of risk factors, should have their hips checked after birth by a doctor or experienced nurse or physiotherapist.
What causes DDH? What are the risk factors?
There are several ‘risk factors’ which are considered as components to developmental hip dysplasia in babies.
- Family history – there is a genetic component to hip dysplasia and if a parent, sibling or even a grandparent has had the condition the risk is increased.
- Breech birth or breech presentation – the abnormal position of the legs makes dysplasia more likely.
- Moulding deformities elsewhere – i.e. a foot deformity or torticollis may increase the risk of hip dysplasia.
Additionally, Hip Dysplasia is found to be more common in girls, and there is also a possible increase in risk for first borns (but these are not major risk factors and would not normally trigger an ultrasound scan).
According to Mr Hill, dysplasia of the hip or dislocation can be a feature of a generalised syndrome, although in the vast majority of cases DDH is isolated, that is, there is nothing else wrong with the baby.
How to spot the signs of Developmental Hip Dysplasia
This can be difficult in babies and very young children but as the child gets older the signs become more obvious. That’s why identification of risk factors is important at an early stage.
When a doctor examines a baby after birth he or she will be checking to see if there is abnormal restriction of movement in the hip and a “clunk” which is often easier to feel than hear – this is caused by the femoral head moving in and out of the socket.
Depending on the age a parent may spot some of these signs:-
- Its difficult to open the legs to put on as nappy
- Or there is a difference in difficulty between the left and right leg
- There is a click or clunk on moving the leg
- One leg is shorter or there is an extra skin crease in the thigh
- After walking the child has a limp or if both hips are affected a waddling gait
How to treat Hip Dysplasia in babies
There are a number of factors that can determine how to treat developmental hip dysplasia in babies and children. This includes the age of the child and the severity of the DDH.
Although just a guide, Mr Hill suggests the following:
From birth to about three or four months of age the vast majority of patients can be successfully treated with a harness such as the Pavlik harness or a splint. This can be difficult for parents to accept, there will be a few sleepless nights and they may not be able to bathe the baby. However, it is an efficient method of treatment and parents will need to persevere and take a long term view.
The harness should be checked regularly and progress monitored by an ultrasound scan. The treatment time with the harness is about 10 weeks. There then has to be follow up appointments to check the hip continues to develop normally.
For children over the age of four months, at diagnosis or in cases where harness treatment failed, a manipulation under anaesthetic, possibly with a tendon release and a plaster cast (hip spica) may be needed.
After age 1, open surgery to reduce the femoral head into the acetabulum is more likely to be required – sometimes with bony surgery to correct any abnormal shape of the acetabulum or upper femur.
This is complicated, there is the risk of complications such as joint stiffness and the older the child the more likely it is that bony surgery is required. Sometimes secondary operations are needed if the hip does not develop properly.
The earlier the treatment starts the better the outcome.
Is it painful?
The condition itself is not a painful condition, although treatment and the harnesses may cause some discomfort for baby.
What happens if DDH goes untreated?
As Mr Hill explains, this is a simple question but in a way its difficult to answer.
There are consequences from the condition and from treatment. It is much easier to treat hip dysplasia if its picked up early, treatment is simpler and surgery may not be required.
However, the older the child the more complex the treatment and the more likely surgery will be needed. After the age of seven years or so there is a strong case for not treating bilateral complete dislocation of the hip and for a unilateral dislocation after age 9. This is because of the risks and complications associated with surgery. It is well documented in some ethnic communities such as North American Indians (who have a high genetic risk of hip dysplasia) that bilateral hip dislocation causes little in the way of symptoms apart from a waddling gait and relatively normal function can be expected.
Its actually worse to have a hip that is half in and half out with a shallow socket because these patients will get arthritis quite early maybe in the late teens.
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