Developmental Dysplasis Of The Hip In Children

GENERAL INFORMATION:

What is developmental dysplasia of the hip?

• 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 all 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.
  
  
• DDH affects every child differently. Depending on how much the hip is affected, your child may have problems walking, standing, or moving normally. DDH can happen in one or both of your child's hips. Some children have signs of DDH from birth, while others have signs after a few weeks or months. The younger your child is when diagnosed and treated, the fewer hip and movement problems he will have growing up.

What causes developmental dysplasia of the hip? The following may cause or increase your child's risks of having DDH:

• Breech delivery: Baby's buttocks (bottom) or feet come out of the vagina (birth canal) first instead of his head.
  
  
• Genetics: DDH is more common among girls and firstborn children. Having a family member with DDH or other hip problems may increase your child's chances of having DDH.
  
  
• Hormones: Certain hormones (body chemicals) of the mother during pregnancy may cause the baby's hip joint to become loose.
  
  
• Others: Having bone and muscle problems, such as a foot deformity, may also increase the risk of having DDH.

What are the signs and symptoms of developmental dysplasia of the hip? The hips of children with DDH are usually unstable and pop in and out with movement. Your child may have any of the following:

• Extra folds or wrinkles on the thigh.
  
  
• Kneecaps that are not at the same level.
  
  
• One leg is shorter or longer than the other.
  
  
• Pops and clicks may be heard or felt when your child moves his hips.
  
  
• Problems crawling, walking, or moving his hips, thigh, or legs. These may include:
  
  
  • Crawling or walking with one leg dragging behind.
    
    
  • Standing and walking with one foot on tiptoes with the heel up off the floor.
    
    
  • Walking with a limp or swaying his body from one side to another.
    
    
  • Waddling (walking in short steps) or with a duck-like gait.

How is developmental dysplasia of the hip diagnosed? Your child's caregiver will take his and your health history. This may include details of your pregnancy or if other family members have DDH or hip problems. He may also do special movement tests by gently moving your baby's hips sideways. Your child may also need any of the following:

• Ultrasound: This test uses sound waves to show pictures of your baby inside your womb or after he is born. Pictures of your baby will appear on a TV-like screen. Caregivers can learn the age or position of your baby and how well he is growing. Caregivers can also check if your baby has organ, blood vessel, or bone problems, such as DDH.
  
  
• 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.
  
  
• Bone x-rays: Your child may need to have x-rays of his hips. Caregivers use these pictures to see if your child's hipbone is in the right place or not.
  
  
• 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 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.

How is developmental dysplasia of the hip treated? Treatment of DDH depends on your child's age and how bad the deformity is. It aims to put the head of the femur back into the hip socket. This will allow the hip to develop normally and make your child walk or move correctly. Your child may have any 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.

Where can I get support and more information? Accepting that your child has DDH may be hard. You, your family, and those close to you may feel scared, sad, or angry. These are normal feelings. Talk to your child's caregivers, your family, or friends about your feelings. You may also want to join a support group. This is a group of people whose children may also have DDH. Ask your caregiver for the names and numbers of support groups near you. You may also want to contact the following organizations for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.org/
  

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village, IL 60007-1098
  Phone: 1-847-434-4000
  Web Address: http://www.aap.org
  

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

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