Signs and Causes Of Hip Dysplasia

hip dysplasia

You might have heard of ‘clicky hips’ but it’s likely that, unless your baby is diagnosed with the condition, you know little about it. Developmental dysplasia of the hip (DDH), to give it its proper name, requires treatment in one to two infants in every 1,000, but needn’t be debilitating if you can spot the signs early enough. Read on to find out what to look for.

What is hip dysplasia?
This is when the hip joint fails to develop properly, so the ball of the thighbone (the femoral head) does not fit snugly within the hip socket because the socket is too shallow. This means the joint is loose and, in severe cases, it can dislocate. It can happen in one or both hips, but is more common on the left. The condition is also known as congenital hip dislocation.

How do babies get it?
Position in the womb can be a factor, with babies born breech or weighing more than 11lb deemed to be more at risk. Research suggests the condition is more prevalent in girls (who are four to five times more likely to develop it), and in the children of mums with a reduced amniotic fluid volume during pregnancy, too. It is also thought some babies are more sensitive to the hormones produced during birth which allow the mum’s ligaments to stretch, causing excessive ligament laxity in the baby. Genetics play a factor as well – a child is roughly 12 times more likely to have it if there is a family history. In older babies, it’s thought an incorrect seating position, such as sitting for long periods with legs dangling loosely from a carrier, can trigger DDH, as it puts a strain on the hips. Swaddling babies too tightly can have a detrimental effect as well.

What are the signs?
✤ A doctor may detect a clunk or clicky hip during a newborn check-up.
✤ You may notice resistance in your baby’s hips when changing her nappy.
✤ The skin folds between her legs and body may not be equal on both sides.
✤ You may notice that she’s slightly dragging her leg while crawling.
✤One of your baby’s legs might be shorter than the other.

This list is not exhaustive, so if you have any concerns, consult a medical professional.

How is it tested for?
If your family has a history of the problem you may be offered an ultrasound scan within a few weeks of birth to determine whether your baby has the condition. Otherwise, at your regular newborn checkups (within the first 72 hours after birth and again at 6-8 weeks), a doctor will do a Barlow’s Test, which involves bending your baby’s knees and turning the thighs outwards, a bit like opening a book. If there’s a clunk or clicky hip (felt but not heard) they will refer you to an orthopaedic surgeon for a scan. This will also be recommended if your baby was born breech, you’ve had a multiple birth or your baby was born before 37 weeks.

If you haven’t been referred but are concerned, talk to your GP. But remember that a clicky hip can be normal at an
early age and may stabilise on its own by the six-week check.

What are the effects?
Midwife Nikki Khan says, “If hip dysplasia is not diagnosed and treated correctly, it’s possible your child may develop a limp, suffer from constant and/or debilitating pain, leading to
complicated treatment and impaired mobility later in life.”
The good news is, treatment should ensure your child has the
full range of mobility.

How is it treated?
“The earlier DDH is identified, the simpler and more effective the treatment is,. If the condition is picked up early, an orthopaedic specialist will usually start treatment before your baby is 3 months old.

✤ Non-surgical options A common intervention method is to use an orthopaedic device, such as the fabric Pavlik harness (or splint) which keeps legs in the ‘spread squat’ position. This keeps knees up a little higher than the hips and will promote the healthy development of the hip joint. This will be worn
constantly for several weeks, with only a healthcare professional able to make adjustments. You will be given advice on how to dress your baby and keep her clean during this time.
✤ Surgical options If your child is diagnosed after 6 months old, or the Pavlik harness doesn’t work, a surgical procedure called reduction will be carried out under general anaesthetic, which involves putting the femur back into the socket. Afterwards, a cast will be needed for at least six weeks and probably for an additional six weeks once checks of the hip have been made.

Can I lower the risk?
DDH can happen to any baby, but you can help avoid it with a few Simple precautions:
✤ When your baby is sitting, aim for the ‘M’ or ‘frog’ position (where her knees are higher up than her bottom and her legs are spread apart) to mimic the foetal position.
✤Opt for a carrier that does the same – keeping legs in-line or above the hips, rather than hanging loose.
✤ Choose a wider car seat so that your child’s legs aren’t forced together.
✤ Don’t swaddle your baby so tightly that her legs are straight and pressed together.

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