Hip dysplasia in children causes and treatment

The hip joint is one of the most important joints in the body, as it helps us move and walk with ease. However, in some cases, a developmental issue can occur in the joint from birth or due to other factors, which is known as hip dysplasia. This condition affects the stability and movement of the joint, and if left untreated, it can lead to pain, complications like osteoarthritis, or even the need for surgery in the future.

In this article, we will discuss the causes of hip dysplasia, its symptoms, and the different methods of diagnosis and treatment, whether through medication or surgery. Stay with us to learn all the details and how to manage this condition properly!

What is Developmental Hip Dysplasia?

Developmental hip dysplasia is a condition where the hip joint in a baby does not form properly. Just like car tires wear out quickly if they are misaligned, hip dysplasia prevents the joint from functioning correctly, leading to faster-than-normal wear and tear.

In a normal hip joint, the femoral head (the top part of the thigh bone) fits securely inside the hip socket. However, in a baby with hip dysplasia, the socket is too shallow, allowing the femoral head to move in and out either partially or completely.

Causes of Hip Dysplasia

Genetic Factors

A family history of hip dysplasia increases the risk.
Girls are more likely to develop the condition due to hormonal effects on the ligaments.

Fetal Position in the Womb

If the baby is in a breech position (head up, feet down) during pregnancy, it puts extra pressure on the hip joint, affecting its development.

Low Amniotic Fluid

Amniotic fluid allows the baby to move freely. If the fluid is too low, the baby's movement is restricted, which can impact hip development.

Firstborn Babies

The first baby often has less space in the womb, which can increase pressure on the hips.

Incorrect Swaddling

Proper swaddling is important, but if the baby's legs are tightly wrapped and kept straight, it can affect hip positioning and hinder normal development.

Bone Development Issues

Some babies may have naturally weak bones or ligaments, making the hip joint unstable.

Neuromuscular Disorders

Conditions like cerebral palsy can impact the development of joints and ligaments, increasing the risk of hip dysplasia.

Symptoms of Hip Dysplasia

In Newborns and Infants

Difference in leg lengths.
Difficulty moving one leg or reduced mobility.
A clicking or unstable feeling in the hip joint when moved.
Uneven thigh skin folds.
Delayed sitting or crawling due to joint weakness.

In Walking Children

Unsteady or limping gait.
Leaning more on one leg than the other.
Delayed walking compared to other children.

In Teenagers and Adults

Hip or thigh pain, especially with movement or prolonged walking.
Stiffness in the joint and difficulty moving the leg freely.
Clicking or popping sensations in the hip during movement.
Early-onset hip osteoarthritis if left untreated.

Diagnosis of Hip Dysplasia

Diagnosing hip dysplasia involves a series of tests, starting with a physical examination and progressing to imaging scans. Early detection is crucial, especially in newborns, to prevent complications.

1. Clinical Examination

This is the first step in diagnosing hip dysplasia, usually performed by a pediatrician or pediatric orthopedic specialist right after birth or during routine checkups.

Manual Examination Tests

Doctors perform specific movements to assess joint stability:

Ortolani Test
- The doctor gently moves the baby’s leg in a specific position.
- If the joint is partially dislocated, a clicking sound or sensation may be felt as the bone moves back into place.
Barlow Test
- The doctor applies gentle pressure on the hip to check if the joint moves out of its socket.
- If the bone easily shifts out of place, it indicates joint instability.

In mild cases, physical examination alone may not be enough to detect the issue, so imaging tests are needed.

2. Imaging Tests

Ultrasound (for babies under 6 months)

Widely used because it provides a clear image of the hip joint.
Helps identify a shallow socket or instability.
Completely safe since it doesn’t use radiation.

X-ray (for children over 6 months & adults)

Used once bones start hardening after 6 months.
Shows the shape and size of the hip socket and bone stability.
Useful for diagnosing late-stage cases or hip pain in adults.

MRI or CT Scan

Used in severe cases or after surgery to monitor the joint’s condition.

3. Continuous Clinical Follow-up

If a baby has risk factors (such as breech birth or a family history of hip dysplasia), the doctor may recommend follow-up checkups every 6 weeks and then every 3 months to ensure the hip joint is developing normally.

Stages of Hip Dysplasia

Hip dysplasia progresses through different stages depending on the severity of the condition and the stability of the joint. Some mild cases improve on their own, while others may develop into a full dislocation if not treated in time.

Stage 1: Hip Instability

This is the earliest stage, where the hip joint is not fully stable but has not yet dislocated.
The ligaments holding the bone are slightly loose, making the bone move within the socket in an unstable way.
This condition is common in newborns, especially those born in a breech position.

Diagnosis:

Detected during newborn screening using the Ortolani and Barlow tests.

Treatment:

In many cases, the joint stabilizes naturally as the baby grows.
Some babies may require a Pavlik Harness to help keep the joint in place.

Stage 2: Mild Dysplasia

The hip socket (acetabulum) is shallower than normal but still holds the femoral head partially.
The bone remains in place but lacks strong stability, increasing the risk of early arthritis if left untreated.
This stage often goes unnoticed in infants but may cause hip pain in adults.

Diagnosis:

Ultrasound for infants.
X-ray for older children and adults.

Treatment:

If detected early, bracing is usually effective.
In some cases, physical therapy or corrective surgery may be needed in adults.

Stage 3: Subluxation (Partial Dislocation)

The femoral head is partially inside the hip socket but not securely positioned.
As the child grows, the bone may shift further until it fully dislocates.
At this stage, children may begin to show a limping gait, while adults may experience pain.

Diagnosis:

X-rays reveal that the bone is not in its normal position.

Treatment:

Braces or casts for young children.
Surgical intervention may be needed for adults.

Stage 4: Complete Dislocation

The femoral head is completely outside the hip socket.
If left untreated, the child will grow with an improperly formed joint, affecting their gait and increasing the risk of arthritis and joint inflammation.
In adults, complete dislocation causes severe pain, joint stiffness, and mobility issues.

Diagnosis:

X-ray clearly shows that the bone is entirely out of place.

Treatment:

In children, treatment may involve a cast or surgery to reposition the bone.
In adults, the primary solution is often a total hip replacement surgery.

Risks of Hip Dysplasia

If hip dysplasia is not treated early, it can lead to serious complications affecting movement, walking, and causing chronic pain. The more severe the condition and the later it is treated, the higher the risk of long-term problems.

1. Delayed Walking or Abnormal Gait

Children with advanced hip dysplasia may start walking later than their peers.
Even when they do walk, they may have a noticeable limp or lean toward one side due to joint imbalance.

How does this happen?

When the joint is unstable or the bone is out of place, the child compensates by altering their walking pattern, leading to unhealthy gait habits.

2. Leg Length Discrepancy

In severe cases, the affected leg may be shorter than the healthy one.
This occurs because the femoral head does not sit properly in the hip socket, affecting bone growth.
A difference in leg length can lead to body imbalance, causing back pain and knee strain over time.

How does this happen?

If the femoral head does not settle naturally in the socket, its growth is affected, leading to a shorter affected leg.

3. Early Hip Osteoarthritis

One of the most serious complications is early joint degeneration (osteoarthritis) due to abnormal joint use.
The patient may experience chronic pain and joint stiffness, making movement difficult over time.

How does this happen?

An unstable joint moves abnormally, increasing friction between the bones, which leads to cartilage wear and early arthritis.

4. Chronic Hip or Thigh Pain

Pain may start as mild discomfort and worsen over time, especially with movement or long walks.
In some cases, the pain may radiate to the lower back or knee due to body imbalance.

How does this happen?

When the joint is unstable, muscles and tendons overwork to compensate, leading to fatigue and persistent pain.

5. Stiffness and Limited Mobility

In severe cases, individuals may struggle to move their hip freely, affecting daily activities like sitting, running, or climbing stairs.

How does this happen?

Over time, joint weakness and increased friction lead to loss of flexibility, which may result in complete stiffness.

6. Need for Surgery in the Future

If left untreated, the condition often requires surgical intervention later in life.
In advanced cases, a total hip replacement may be the only solution, which is a major surgery.

How does this happen?

If the joint continues to deteriorate without treatment, it reaches a stage where it can no longer function properly, making surgery necessary for pain relief and mobility improvement.

7. Spinal and Knee Problems

Hip dysplasia affects walking patterns, placing uneven pressure on the spine and knees.
Over time, this can lead to lower back pain or knee osteoarthritis due to improper joint use.

How does this happen?

An unbalanced walking style forces the body to compensate, putting extra strain on other joints.

Categories at Risk for Hip Dysplasia

Some babies are more likely to develop hip dysplasia due to certain risk factors. Here are the groups that need extra attention:

1. Newborns, Especially Girls

Newborns are the most vulnerable to hip dysplasia because their hip joints are still developing, making them more flexible than normal.

Girls are 4 to 6 times more likely to develop hip dysplasia than boys due to maternal hormones that increase ligament laxity.

Why Newborns?

Their bones and joints are not fully formed, so any looseness or minor issues can worsen over time if left untreated.
The baby’s position in the womb can affect hip stability.

2. Babies Born in the Breech Position

Babies born in the breech position (feet or bottom first instead of the head) have a higher risk of hip dysplasia.

This position puts abnormal pressure on the hip joint before birth, which can cause joint looseness or partial dislocation.

Why is Breech a Risk?

Uneven pressure on the hip joint can prevent proper socket formation.
Even if delivered via C-section, the risk remains.

3. Babies with a Family History of Hip Dysplasia

If a parent or sibling has had hip dysplasia, the baby’s risk is significantly higher.

Studies show a strong genetic link to the condition.

What to Do if There’s a Family History?

Early screening with ultrasound is recommended, even if no symptoms are present.
Regular check-ups with a pediatrician or orthopedic specialist are crucial.

4. Babies with a High Birth Weight

Babies born weighing more than 4 kg (8.8 lbs) are at higher risk.

Limited movement inside the womb due to size can affect hip joint development.

Solution?

If a baby has a high birth weight, a hip examination within the first few months is recommended.

5. Firstborn Babies

Firstborns have a higher likelihood of hip dysplasia compared to younger siblings.

This is because the mother’s uterus is tighter during the first pregnancy, leading to increased pressure on the baby’s hips.

How to Protect Firstborns?

Routine hip examination immediately after birth.
If there’s any concern, a hip ultrasound within the first 6 weeks is advised.

6. Twins or Multiple Births

Babies born as part of a twin or multiple pregnancy are at greater risk due to limited space in the womb.

Restricted movement can affect proper joint development.

What’s Recommended?

Every twin or multiple-birth baby should undergo a hip screening after birth.

7. Babies with Low Amniotic Fluid (Oligohydramnios)

Amniotic fluid allows the baby to move freely in the womb. When levels are too low, movement is restricted, which can affect hip development.

What to Do?

If oligohydramnios was detected during pregnancy, the baby must be checked for hip dysplasia after birth.

8. Babies Wrapped Too Tightly After Birth

Incorrect swaddling (wrapping a baby too tightly) increases the risk of hip dysplasia.

If the baby’s legs are tightly bound and can’t move freely, hip development can be affected.

How to Prevent This?

Use a safe swaddling technique that allows free leg movement.
Avoid wrapping the legs too straight or pulling them together too tightly.

Surgical Treatment for Hip Dysplasia

If hip dysplasia is not treated properly in the early stages or if the condition is severe, surgery becomes the main solution to restore the joint to its normal position and prevent complications such as pain, limping, and early arthritis.

The type of surgery depends on the patient’s age and the severity of the condition. There are different surgical options based on the degree of dysplasia and the patient’s age.

1. Closed Reduction – For Children Under 2 Years

This procedure is used for young children (6 months to 2 years) with complete or severe hip dislocation.

The surgeon repositions the femoral head into the hip socket without an open incision and then stabilizes it using a Spica Cast for about 3 months.

Procedure Steps:

The child is placed under general anesthesia to relax the muscles.
The doctor carefully manipulates the femoral head back into the hip socket.
If the bone stays in place, a Spica Cast is applied to keep the joint stable.

Disadvantages:

Joint stiffness may occur after the cast is removed.
There is a chance of re-dislocation if the ligaments are too weak.

2. Open Reduction – For Children Over 2 Years

If non-surgical treatment fails or the condition is severe, an open surgery is performed to realign the joint and repair any issues in the ligaments or bones.

This procedure is mostly done for children aged 2 to 6 years.

Procedure Steps:

The surgeon makes a surgical incision in the hip area to directly access the joint.
Any tissues or obstructions preventing the bone from stabilizing are removed.
In some cases, bone or ligament adjustments are made to improve joint stability.
After surgery, the child is placed in a Spica Cast for 6 to 12 weeks, depending on the severity.

Disadvantages:

Longer recovery period compared to closed reduction.
Risk of joint stiffness or post-surgical infections.

3. Osteotomy – For Older Children and Teenagers

For children over 6 years old or those with severe hip deformities, osteotomy (bone reshaping surgery) is performed to improve hip stability.

This procedure is used when the hip socket is too shallow and cannot properly hold the femoral head.

Procedure Steps:

The surgeon makes an incision and reshapes the bone to improve joint stability.
The child may need internal fixation (plates, screws, or pins) to keep the bones in place.
Recovery is longer, and physical therapy may be required after surgery.

Types of Surgeries for Treating Hip Dysplasia

1. Bernese Periacetabular Osteotomy (PAO)

What is it?

This procedure involves cutting and repositioning the pelvic bone to deepen the hip socket, ensuring better stability for the femoral head.

When is it used?

It is used for severe cases of hip dysplasia, particularly in teenagers and young adults who have significant dysplasia but no arthritis.

2. Salter Osteotomy

What is it?

This involves cutting a part of the pelvic bone and repositioning it to adjust the angle of the hip socket, improving femoral head stability.

When is it used?

It is performed on children aged 2 to 6 years with hip dysplasia.

3. Dega Osteotomy

What is it?

This procedure modifies the shape of the hip socket to provide better support for the femoral head.

When is it used?

It is used for children with severe hip dislocation.

Disadvantages of These Procedures:

These surgeries are complex and require a long recovery period (3 to 6 months).
There is a risk of post-surgical pain or joint stiffness.

4. Total Hip Replacement – For Adults

What is it?

This surgery is performed for adults with severe arthritis due to untreated hip dysplasia.
The damaged hip joint is removed and replaced with an artificial joint.

Procedure Steps:

Removal of the damaged femoral head.
Insertion of a prosthetic joint made of metal or ceramic.
Reconstruction of the pelvic bone to stabilize the new joint.

Advantages of Surgery:

Eliminates chronic pain.
Improves walking and mobility.

Risks and Disadvantages:

The artificial joint has a lifespan of 15 to 20 years and may need replacement.
Possible complications include blood clots, infections, or joint dislocation.

Which Surgery is Suitable for Each Age Group?

Under 2 years: Closed reduction with a cast.
2 to 6 years: Open reduction or Salter Osteotomy.
6 to 18 years: Bone reshaping surgeries (PAO, Dega, or Bernese Osteotomy).
Over 18 years: Total hip replacement if severe arthritis is present.

Post-Surgery Recovery and Rehabilitation

After any hip dysplasia surgery, a recovery period is essential for the best outcome.

Post-Surgery Instructions:

Use of a cast or brace, depending on the procedure.
Physical therapy is crucial to prevent joint stiffness and strengthen muscles.
Regular follow-ups with X-rays to monitor healing.
Avoid putting weight on the joint during the early recovery phase.

Recovery Timeline:

Closed reduction: 6 to 12 weeks.
Open reduction: 3 to 4 months.
Osteotomy procedures: 4 to 6 months.
Total hip replacement: 6 months to 1 year.

Treatment of Hip Dysplasia with Medications

Medications are part of the treatment plan, but they do not fix the structural problem in the hip joint. Instead, they help with:

Reducing pain and improving comfort.
Decreasing inflammation in and around the joint.
Enhancing joint mobility and reducing stiffness.

The type of medication depends on the patient's age and severity of symptoms, and they are classified based on their purpose.

1. Pain Relievers and Anti-Inflammatory Drugs (NSAIDs)

What are they?

These drugs help reduce pain and swelling in the hip joint caused by friction or inflammation.

When are they used?

They are especially useful for adults suffering from chronic pain due to osteoarthritis or joint wear.

Commonly used medications:

Ibuprofen (e.g., Brufen)
Diclofenac (e.g., Voltaren)
Naproxen (e.g., Naprosyn)
Celecoxib (e.g., Celebrex)

How do they work?

Reduce inflammation in the joint and surrounding ligaments.
Alleviate pain during walking or movement.

Side effects:

May cause stomach issues like acid reflux or gastritis.
Should be taken with food to protect the stomach.
Long-term use may affect the kidneys or liver.

2. Mild Pain Relievers (For Infants and Children)

What are they?

If a child experiences pain due to wearing a cast or post-surgery, doctors may prescribe safe pain relievers for children.

Commonly used medications:

Paracetamol (e.g., Panadol, Adol)
Ibuprofen (small doses for children over 6 months old)

Benefits:

Reduces pain without causing stomach issues like NSAIDs.
Safe for children when used at the correct dose.

Drawbacks:

Less effective than NSAIDs.
Does not treat the underlying problem but helps relieve discomfort.

3. Muscle Relaxants

What are they?

In some cases, especially in adults or post-surgery, hip and thigh muscles may spasm, causing additional pain. These medications help reduce muscle spasms and improve mobility.

Commonly used medications:

Baclofen (e.g., Lioresal)
Tizanidine (e.g., Zanax, Sirdalud)

How do they work?

Relax muscles around the joint, reducing pain and improving comfort during movement.

Side effects:

May cause dizziness or drowsiness, so they are best taken before bed.
In some cases, they may cause muscle weakness.

4. Corticosteroid Injections

What are they?

These injections are used for adults experiencing severe pain due to joint inflammation or early arthritis.
They help relieve pain and inflammation for weeks or months.

Common injections:

Depo-Medrol (Methylprednisolone)
Kenalog (Triamcinolone)
Betamethasone (e.g., Betazone)

How do they work?

Reduce inflammation inside the joint and decrease swelling.
Improve mobility and allow pain-free walking for an extended period.

Drawbacks:

Temporary effect (only lasts for a few months).
Frequent use can weaken bones or cause joint deterioration over time.

5. Platelet-Rich Plasma (PRP) Injections

Who can benefit from PRP injections?

Used for patients with mild joint wear or inflammation.
Helps stimulate tissue healing and reduce pain.

How do they work?

Plasma is extracted from the patient’s own blood and injected into the joint.
Promotes cartilage repair and reduces inflammation.

Advantages:

Safe since it is derived from the patient’s own blood.
May delay the need for surgery in some cases.

Disadvantages:

Not all patients respond effectively.
Temporary effect, requiring repeated injections over time.

6. Nutritional Supplements for Joint Support

Some supplements can help strengthen cartilage and improve joint flexibility, but they do not replace primary treatment.

Common supplements:

Glucosamine and Chondroitin (e.g., Move Free)
Vitamin D (important for bone health)
Calcium (supports bone and joint strength)

Are they effective?

They may help slow joint degeneration but cannot reverse damage.
More effective in early-stage hip dysplasia or as supportive therapy.

They may help reduce joint deterioration and delay arthritis.

Their effect is slow and appears over the long term.

Drawbacks:

Do not repair existing damage, but they may help with future joint protection.

Which Doctor Should You See for Hip Dysplasia?

1. Orthopedic Surgeon

The specialist in diagnosing and treating bone and joint problems.
Responsible for medical, rehabilitative, or surgical treatments.

2. Pediatric Orthopedic Surgeon

Specializes in treating hip dysplasia in infants and children.
Provides early intervention to correct the condition before complications develop.

3. Physiotherapist

Helps improve mobility and strengthen surrounding muscles after treatment or surgery.

If the condition is advanced or requires surgery, it is best to consult an orthopedic surgeon specialized in joint replacement or corrective hip surgeries.