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Developmental Dysplasis Of The Hip In Children

WHAT YOU SHOULD KNOW:

  • Developmental (de-vel-up-MEN-tal) dysplasia (dis-PLAY-zhah) of the hip, or DDH, is a condition that affects your child's hips and movements. Normally, the head of the femur (thigh bone) fits into the acetabulum (cup-shaped hip socket). Together with ligaments (connective tissues that hold the bones together), they form the hip joint. With DDH, the head of your child's femur does not fit correctly into the hip socket. The head may only be slightly out of place or may not be in the hip socket at all. Sometimes, DDH occurs when the ligaments of the hip joint are loose or stretched too much. Depending on how much the hip is affected, your child may have problems walking, standing, or moving normally.

  • Signs and symptoms include having hips that are unstable and pop in and out with movement. One of his legs may be shorter or longer than the other. The kneecaps may not be at the same level. Caregivers may do special movement tests, an ultrasound, or arthroscopy on your child's hip to diagnose DDH. Other tests, such as a bone x-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) test may also be used. Treatment of DDH depends on your child's age and how bad his hip deformity is. Treatment may include splints, casts, a closed reduction, traction, surgery, or braces. The earlier DDH is diagnosed and treated, the better your child's chance of having a full recovery.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

  • Treatment for developmental dysplasia of the hip may cause unwanted side effects. Your child's treatment may cause him to have rashes, pressure sores, or nerve damage. He may bleed, get an infection, or get blood clots if he has surgery. Occasionally, avascular necrosis may occur when there is a brief or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the hip bone or joint to break easily.

  • If DDH is not treated, your child may have problems walking normally. He may also have life-long problems, such as hip or leg pain, and arthritis (swelling of joints). His legs may be of an unequal length as he grows up. Your child's health, quality of life, and ability to function may decrease without treatment. If not treated early, your child's hips may no longer heal correctly, even if surgery was done. Ask your caregiver if you are worried or have questions about your child's condition, medicine, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

Activity:

Your child may need to rest in bed for a while so his hips can heal. As his pain decreases, your child may be allowed by his caregivers to start moving or walking. This will make his bones heal faster and will prevent him from getting skin sores or infections.

Emotional support:

Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.

IV:

An IV is a small tube placed in your child's vein. Caregivers use the IV to give your child medicine or liquids.

Medicines:

Your child may need any of the following:

  • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

  • Anti-nausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or taking pain medication.

  • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.

Overhead trapeze:

This is a special piece of equipment. Your child may have it if he is old enough to move himself in bed. It may be used while he is in traction, a spica cast, or a splint. A metal triangle-shaped grab bar is hung on the over-the-bed frame of his hospital bed. Caregivers will teach him how to safely use the trapeze to move and change positions while in bed.

Tests:

Your child may have any of the following:

  • Arthrography: An arthrography is an x-ray of your child's hip joint using dye. The dye helps your child's caregiver to better see the hip joint and the area around it.

  • Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.

  • Bone x-rays: Your child may have x-rays of his hips, thighs, or legs taken.

  • Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your child's hips. It will look at your child's bones, muscles, blood vessels, and organs in the hip and abdominal area. Your child may be given dye by mouth or in an IV before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if he is allergic to shellfish, or has other allergies or medical conditions.

  • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your child's hips. During an MRI, pictures are taken of his bones, abdominal or pelvic (hip) organs, or blood vessels. He will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.

  • Ultrasound: This is a test which uses sound waves to look at your child's hips. Pictures of your child's hips, other organs, or blood vessels will show up on a TV-like screen.

Treatment options:

Your child may need one or more of the following:

  • Splints: Your child may need a special splint with many straps. This is called a Pavlik harness and it holds the hip in place. This harness makes the head of the femur fit correctly into the hip socket. Your baby's legs may move a little when he is strapped. After a few months of wearing the harness, your baby's DDH may be slowly corrected.

  • Cast: If your child is already walking when diagnosed with DDH, a special spica cast may be needed. Caregivers may place him in a cast that covers him from the chest down to the legs or knees. These will prevent his hips from moving and allow proper healing.

  • Closed reduction: Caregivers may realign a deformed bone or bring the hip joint back to its normal position. This is done by moving the hips and femur without opening the skin.

  • Traction: Traction pulls on the hip or thigh bones to pull them back into place. A pin may be put in your child's bone or cast, and hooked to ropes and a pulley. Weight is hung on the rope to help stretch the soft tissues around the hip bones. This helps the hip fit into the hip socket.

  • Surgery and braces: Surgery and braces may also be used to fix and correct your child's hip problem. They may also prevent or decrease movement problems.

  • Rehabilitation: This is a program that helps your child improve his normal range of motion and strength. A physical therapist or an occupational therapist may exercise his hips, thighs, legs, feet, and arms. These exercises may help improve and maintain functions that are important to daily living, such as self-care.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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