You are a new mother, and have given birth to a lovely baby girl. You assume everything will be fine on routine health check up by the physician. Unfortunately, there is some problem on one side of the hip. Your baby’s leg appears to be outwards, and the folds of the skin in the thigh region don’t appear symmetrical on either side. On follow-up examinations, there is a diagnosis of ‘Developmental Dysplasia of the hip (DDH).’ However, being diagnosed early you get the assurance from your physician that the problem can be treated successfully.
Understanding DDH
DDH is a name given for a range of conditions that affect a child’s hip, mostly at birth (congenital) or develops as the child grows. The condition can vary from shallow hip sockets, making dislocation more probable (mild condition), to children born with the leg bones already out of the hip sockets (serious condition).
DDH has been observed to occur only once in every 1,000 live births and majorly affecting the girl child. The essential aspect here is to identify the problem in the beginning itself, so that treatment can be successful, thus avoiding future complications like abnormal gait or arthritis, as the child becomes an adult.
Routine screening
Following the baby’s birth, the pediatrician will conduct a neonatal check up to identify any problems associated with the hips. Regular check ups are done, as a hip problem cannot always be diagnosed at first. Simultaneously, a complete family history and prenatal history will be obtained to ascertain why the dysplasia occurred.
Factors influencing DDH
This condition is considered to be a ‘multifactorial trait’ as there are several factors that are responsible, both genetic and environmental in origin. There is a gender aspect with DDH affecting more females than males, especially first born female babies. Someone with this condition in the family also makes a baby more prone. During pregnancy, the position of the baby, especially breech presentation (buttocks facing the birth canal), less room for the baby or when there is less fluid in the womb all increase the chances of the baby to develop DDH. Some babies are sensitive to the mother’s hormones that relax her ligaments to allow the baby to pass through the birth canal.
Signs of DDH
In most cases, the infant will not show any signs of pain or discomfort when the doctor examines the hip area carefully. Usually, only one side (mostly left) is affected. An inability to move the thigh outward as far as possible, asymmetry in the folds of the fat in the groin and buttock region, shorter length of the affected leg and wider space between the limbs are signs of DDH in infants.
Examination is done by gently pushing and pulling the thigh bones to check how loose they are and whether the displacement from the socket is partial or complete.
When the results of a physical examination are unclear, or the baby is older than 3 months, imaging tests like an ultrasound (for babies below 4 months) or X-rays (for older children) are used to diagnose the condition. There are cases where symptoms can be silent and not detected at birth. Hence, multiple check ups are recommended till the child completes one year.
Treatment Approach
Treating DDH depends on the age and overall health of the infant, severity of the condition and the parent’s preference. A mild case can get resolved on its own in the first few weeks. In an infant upto 6 months of age, a Pavlik harness is used to keep the bone in the socket. This is worn full time for around 6 to 8 weeks and then reduced to 12 hours per day for another 6 weeks or till the X-ray or ultrasound tests show no signs of abnormality. If the Pavlik harness does not work, traction is applied for 10 to 14 days with the help of pulleys, strings, weights and a metal frame. This can be done at home or at the hospital depending on the circumstances.
In persistent cases, beyond 6 months of age, by the method of closed reduction, the bone is manually put back into place. This is done under anesthesia, in children younger than 18 months. Open reduction method is used in kids above 18 months old, where surgery is performed to realign the bone. Following successful surgery, a spica cast is put on the child for around 3 to 6 months to hold the hip in place and promote healing. The cast is changed from time to time to accommodate the child’s growth and ensure its rigidity. It is worn till there is normal placement of the hip. Following casting, a special brace along with physical therapy may be required to strengthen the leg muscles.
Future care
As a parent, do be vigilant when you take your infant for health check ups, especially when there is some history of DDH prevalent in the family. Do remember that DDH cannot be prevented, but diagnosing the condition early, and providing the appropriate treatment will help your child develop normally with no related problems. Majority of the children respond to non-surgical methods (Pavlik harness or traction) while around 1 in 20 babies may need a surgical procedure. It is best to start treatment immediately after birth, to avoid future complications, as your child grows older.
