Developmental Dysplasia of the Hip
Developmental dysplasia of the hip (aka Congenital Hip Dysplasia) is generally identified in the newborn period. The term describes a spectrum of hip problems that ranges from mild movement of the femur (upper leg bone) in the acetabulum (cartilaginous lining of the hip) to complete dislocation of the femur from the acetabulum. The femur is dependent on the proper formation of the acetabulum to help keep the femur in a stable environment. Instability (movement or subluxation) in the hip of a newborn can lead to abnormal development of the hip joint.
Multiple factors may result in the development of an unstable hip joint. Children who have been in a breech position prior to delivery are at a higher risk of developing this condition. Low amniotic fluid (oligohydramnios) or a small uterus (in a first born child) may result in improper positioning of the femurs in respect to the hip joint.
First-born female newborns are more prone to developing this condition. It generally occurs in 0.5 2% of all live births. The presence of a breech position or a positive family history are other factors that will increase the risk.
Your child's health care provider will examine your infant at birth or at the two week visit for certain signs of a dysplastic hip. At times, the provider may identify a click with movement of the femur. This should not be mistaken for instability of the hip for 10% of normal newborns will have a click. As a child gets older, she or he may develop a limp, hip pain or, rarely, some degenerative disease in the hip if the condition is not treated properly.
The Ortalani and Barlow maneuvers will be done by your child's health practitioner to detect mild or significant subluxation of the hips. The symmetry of the gluteal fold (the fold of skin below each buttocks) is closely examined (although normal children can have an asymmetric fold). When your child's practitioner is suspicious of dyplasia, an ultrasound of the hips will be obtained to look for abnormalities of the hip as well as subluxation.
A Pavlik harness can be used to align the femur and acetabulum so that proper growth and development of the hip joint can take place. This harness is effective 95% of the time if it is used prior to 6 months of age. The harness bends the legs at the knee, as well as bends the hip at approximately 90 degrees, placing the femur in an ideal location within the acetabular space. The harness is worn 24 hours a day for a minimum of 6 weeks.
A plain x-ray of the hip may occasionally be required to monitor the progress of the hip.
In rare circumstances, a child will require surgery to repair the hip joint. Poor vascularization of the head of the femur is a rare complication.
American Academy of Pediatrics. Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip.
Reviewed by: Daniel J. Feiten MD
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