Congenital hip problems
The hip has two main components: the femoral head (the top of the thighbone known as “the ball”) and the acetabulum (the part of the pelvis called “the socket”). For the hip to be stable, the ball should sit securely in the socket. Some babies, however, are born with a socket too shallow to form a snug fit with the ball, which makes the hip vulnerable to dislocation. This is called developmental dysplasia of the hip (DDH).
Symptoms
Symptoms are not always present. In babies, symptoms may include:
- Limited flexibility and range of motion on one side of the body
- One leg shorter than the other
- One leg turns out more than the other
- Unequal folds of skin on the thigh
In toddlers, symptoms may include:
- Abnormal inward curve of the spine
- Limping
- Waddling
- Walking on the toes
Prevention
- In some cases, using a proper swaddling technique may prevent DDH from developing after birth. When swaddling your baby, leave enough room for small movements of the legs. The baby’s hips and knees should be bent slightly and pointed away from each other.
Risk factors
- Being a firstborn child
- Being female
- Breech (feet- or bottom-first) delivery
- Family history of DDH
- Improper swaddling after birth
- Increased elasticity of baby’s hip during labor in response to birth hormones
- Large birth weight
- Low levels of amniotic fluid in the womb
- Other congenital conditions, such as torticollis or flat head syndrome
Diagnosis
- Physical exam. The physician will manipulate the baby’s hip to assess stability and range of motion while listening for clicks and other sounds that may indicate the joint is loose or dislocated.
- Imaging exams. An ultrasound or X-ray of the hip can help confirm a diagnosis of DDH.
Treatment
- Watchful waiting. A mild case of DDH may resolve on its own in a few weeks.
- Bracing. For children ages 6 months or younger, use of a Pavlik harness brace keeps the ball of the hip in the socket for several weeks or months to support normal joint development.
- Surgery. If bracing is ineffective or the child is too old for it, surgery may be needed to properly position and stabilize the hip.
Follow-up care
- After surgery, a spica body cast will be worn for several months to keep the ball in the socket during healing.
- Follow physician instructions to maintain the child’s cast and keep him or her comfortable.
- The child’s physician will use physical exams and imaging moving forward to monitor and ensure the hip heals properly.