Paediatric Hip Dysplasia

Overview of Paediatric Hip Dysplasia in India

The phrase “Hip Dysplasia” is the name given to the medical term that describes an insufficient covering of the hip socket by the ball part of the upper thighbone, resulting in the possibility of the hip joint being partially or completely dislocated. In most cases, individuals experiencing Hip Dysplasia will have been born with it.

After the birth of a child, a health care professional will evaluate him/her for possible Hip Dysplasia or deformity. If detected in early infancy, a defect may be treated effectively with a soft brace.

Sometimes, mild deformity (Hip Dysplasia) does not produce symptoms until adolescence or early adulthood; thereafter, osteoarthritis and chondromalacia occur because of damage to the cartilage lining of the joint and/or damage to the soft cartilage (labral) lining of the socket housing the ball on the upper thighbone. Labral tears occur from injury at the time of hip joint replacement surgery.

A surgical procedure may be required for children and young adults to realign bones into their proper positions for the purposes of ensuring a normal range of motion of the hip joint.

What Is Hip Dysplasia?

When the bones in your hip joint don't align properly, this condition is known as hip dysplasia.

Although hip dysplasia is mostly seen in babies and toddlers, mild cases may not present until later in adulthood. Congenital and developmental dysplasia of the hip (DDH) are the terms given to describe hip dysplasia that is present at birth. All three of these terms refer to the same medical diagnosis.

Your hip joint is the articulation of two bones: the femur and the pelvis. If you have had any experience with hip dysplasia, the round ball at the upper part of the femur (the femoral head) does not have a good fit within the cup-shaped socket of the pelvis, called the acetabulum.

As a result of this poor fit, the cartilage (the protective cushion) can be severely damaged, and patients/alcoholics who suffer from hip dysplasia are significantly more likely to suffer both from pain and stiffness, as well as more frequent dislocations of the hip joint.

What Causes Paediatric Hip Dysplasia?

There may be a few reasons why a child ends up with DDH; it’s not just one thing or whatever. Some factors include, for example, babies who are in the womb in a breech position. Those are the babies that are buttock side down, instead of head side down.

Also, a small or tight uterus (womb) can matter, because there is less room for the fetus to move around. This is often noticed in first-born babies and in babies whose mothers had low amniotic fluid levels during pregnancy.

Sometimes children are born with other related conditions, like metatarsus adductus and torticollis, and they seem to show a higher risk of DDH too.

There can also be a genetic side to it, because it may run in families.

And after birth, babies who are swaddled really tightly, with their legs together and hips and knees kept straight, are more likely to develop DDH. Even when swaddled, babies still need room to move, not just rigid positioning all the time.

Types of Paediatric Hip Dysplasia:

Hip dysplasia is kind of a spectrum of conditions that go from oddly formed hip bones to a hip that is fully dislocated, so it’s not just one thing and not always the same.

Dysplasia: the socket section of the hip joint is shallow or otherwise weirdly shaped, but the ball part still stays within that socket.

Subluxation: the ball can actually slide in and then out of the hip joint. This may show up during a physical exam, often as a hip “clunk”. Sometimes only part of the ball is inside the hip socket, like it’s not completely seated.

Dislocation: the ball part of the joint ends up completely outside the socket. A brand new, false socket may form, and it might not be tied to the original socket at all. If there is no false socket, then the ball is basically not anchored to one specific spot in the hip, and it can drift around within a certain radius of where the original socket used to be.

Procedure:

Nonsurgical Treatments

Nonsurgical​‍​‌‍​‍‌​‍​‌‍​‍‌ procedures target the positioning of the femoral head further along the socket to stimulate the typical growth of the hip. If hip dysplasia is identified timely, it can usually be managed effectively through nonsurgical methods.

Observation

It is possible that some newborns might naturally overcome their hip dysplasia condition. A wait-and-see approach might be adequate to find out if the disorder improves spontaneously within the first two to six weeks after delivery.

Bracing

A few kinds of braces come in handy in the treatment of hip dysplasia in infants by holding their hips in a certain fixed position (like a frog’s legs), which naturally helps in the better development of the hip joint. Typically, these braces are used round the clock for several weeks; however, sometimes they may be worn only during sleep or can be removed for bathing:

Between six weeks and six months of age, a Pavlik harness is generally the first choice. This complete harness secures itself around the baby’s shoulders and waist, and is considered one of the most successful nonsurgical methods in orthopaedics.

The rhino brace is suitable for kids from three to 24 months. It does not cover the waist and upper body but limits the movement of the hips. It is sometimes employed if the Pavlik harness does not yield ​‍​‌‍​‍‌​‍​‌‍​‍‌results.

Closed reduction and casting

A surgeon puts the ball back into place during a procedure, then puts a spica cast over the area to keep it in place while the child is under anesthesia. The alignment will be confirmed with imaging. A spica cast will be worn for a period of time and can be replaced while wearing a cast and braces after using a cast for hip alignment. In general, closed reduction and casting can be considered for a younger child who did not receive a brace and was greater than 6 months old. A brace is used after the leg is cast to help continue with alignment.

Hip Dysplasia Surgery

Surgical intervention may be indicated for older children and adults who either have not had success with nonsurgical management or have been diagnosed later in life. Surgical management typically includes repositioning the ball in the socket, realigning either the ball or the socket, or a combination of both.

There are multiple types of surgical techniques to correct hip dysplasia; however, there are multiple techniques addressed at once in one surgical procedure. The surgical technique(s) selected will depend on the age, skeletal maturity, health of the hip joints, and the patient's anticipated activities postoperatively.

Open reduction

If a closed reduction doesn’t work or if the child is more than 12 months old, an open reduction can be performed by making a small incision and then removing any tissue that is sort of in the way, preventing the ball from sitting properly inside the socket.

Hip tenotomy

When tight tendons are the main reason the ball can’t settle into the socket securely, these tendons can be lengthened during this step. The idea is to make room so the hip mechanics can work in a more balanced way, without everything feeling overly tight.

Osteotomy

This procedure is basically about cutting and then reshaping parts of the hip bone anatomy. Exactly how it’s done depends on which bone structures need to be changed. For instance:

• The hip socket may be deepened or redirected depending on how severe the dysplasia is, and also on the child’s age.
• The ball can be rotated or shortened so it fits better within the socket, and stays more stable once the joint is in place.