Hip Dysplasia The term hip dysplasia has been used to describe a variety of hip problems in infants, children and adults. Hip disorders that are often associated with hip dysplasia include:
Congenital Hip Dislocation- The hip is dislocated at birth.
Acetabular Dysplasia - The hip socket is too shallow, so the hip is unstable. Henry Ford is the only health system in Michigan with doctors specially trained to perform a periacetabular osteotomy – a state-of-the-art surgical procedure to stabilize this type of hip dysplasia among adolescents and adults.
Developmental Dysplasia or Dislocation of the Hip (DDH)- Abnormal formation of the hip joint in which the ball at the top of the thighbone (femoral head) is not stable in the socket (acetabulum).
Although the exact cause of hip dysplasia is not known, the condition tends to run in families and is more common among girls, firstborn infants and breech babies.
There are generally no symptoms of dislocated hips in young children. You should contact your pediatrician or a pediatric orthopaedist if your child has:
Legs of different lengths
Uneven thigh skin folds
Less mobility or flexibility on one side
Limping
Pediatricians screen for hip dysplasia at a newborn’s first exam and at every well-baby checkup. Treatment of hip dysplasia is easier and safer the earlier the diagnosis is made. Treatment methods depend upon the child’s age.
Newborn: An unstable hip recognized at birth is treated with a Pavlik harness which has replaced the casts, pillows and splints used in the past. The harness has straps that allow the baby to move about freely while holding the hip in place and preventing movements that would make the condition worse. Worn for 1-2 months, this device is effective in up to 97 percent of cases.
1-6 months : Treatment to reposition the hip ball in the socket uses a harness or similar device. The method is usually successful. If it is not, the joint may be manipulated back into the socket without surgery and maintained with a body cast.
6 months-2 years: Manipulation of the joint into the socket or surgery is the major method of treatment. Either way, the child will require a body cast.
After 2 years: Deformities may become severe and require surgery to realign the hip. This is followed by a body cast and/or brace to keep the hipbone in the joint. X-rays and continuous monitoring are needed following treatment until the child’s growth is complete.
If dysplasia is treated early enough, a child usually returns to normal hip joint function and has no further problems. Untreated hip dysplasia can lead to arthritis and pain for adults (see Adult Hip Dysplasia), requiring more extensive treatment.
Slipped Capital Femoral Epiphysis The femoral epiphysis is the head of the femur that forms part of the hip joint. It is separated from the main part of the thigh bone by cartilage while the bone is still in the process of growing. In adolescents, the capital femoral epiphysis may slip, causing pain and loss of range of motion. Slipping of the upper femoral epiphysis most often occurs in children between 10 and 16 years of age and is more common in boys than girls.
The onset of this condition may be one of three types:
Acute Slip:Sudden onset, sometimes after trauma.
Chronic Slip: This is gradual, with slowly increasing symptoms over a period of weeks or even months. In chronic slipping, there may be no history of trauma and the symptoms are often quite mild, amounting only to aching, fatigue, a feeling of stiffness after standing or walking, and a limp.
Acute Slip Superimposed on a Chronic Slip
Since the pain of a slipped capital femoral epiphysis frequently is felt in the knee, early diagnosis may be missed. The symptoms may be attributed to "growing pains" or muscle strain. It is important for a pediatric orthopaedist to examine the condition.
The degree of slipping and the duration of symptoms will help to determine the course of treatment. In general, a single screw is used to stablize the upper end of the thighbone. This is inserted at surgery through a tiny incision and most patients are able to walk immediately following surgery. Children who have extensive deformity of the upper end of the thigh bone may require reconstructive surgery.
Legg-Calve’-Perthes disease
Legg-Calve’-Perthes disease (LCPD) is a condition in which the upper end of the thighbone (femoral head) deteriorates from a lack of blood supply. It eventually becomes brittle and may collapse, leading to deformity and arthritis. The cause of LCPD is not known, and boys get LCPD four times more often than girls.
With LCPD, a child’s pain often is felt first in the knee or thigh and may build slowly over several months. A child may lose the ability to rotate his or her hip and also may develop a limp. The treatment of LCPD depends on the age of the child and the extent of involvement of the head of the femur.
If a child has LCPD, the sooner he or she gets diagnosed, the better the options for treatment. Using x-rays, a pediatric orthopaedist may decide to prescribe exercises, leg braces or surgery for treatment. With treatment, children under age six have a better chance of recovery from LCPD than those who have completed, or nearly completed, their growth. The goal of treatment is to keep the head of the thighbone covered by the socket to prevent deformity.
Bone lengthening/shortening The Henry Ford pediatric orthopaedics division offers surgical treatment for unequal leg lengths that may be caused by:
Neurologic disorders
Hip conditions such as Legg-Calve’-Perthes disease
Previous injuries or bone fractures that may result in a shortened or angled limb
Birth defects or congenital deformities of bones and joints
Potential surgical procedures include lengthening the shorter leg, shortening the longer leg or limiting growth of a normal leg to allow a short leg to grow to a matching length.
