Hip Dysplasia


Hip dysplasia is one of the most common orthopedic conditions that happen in infancy. About 1 in 100 infants are treated for hip dysplasia after birth. Yet most parents don't know much about it until it affects them. What is it? Why do kids get it? How can we prevent it?


What is Hip Dysplasia?

Hip dysplasia involves the head of the thigh bone (femur), a shallow hip socket (acetabulum), and loose ligaments in the joint. Naturally, all babies are born with shallow hip joints and there is more risk of that femur to slide around in that joint. When it slides around too much and becomes displaced or even dislocated, we call it hip dysplasia.


What are the Risk Factors?

  • Low amniotic fluid- this means that there is less space in the womb for the baby's legs to move freely, possibly causing positioning to cause hip dysplasia.

  • High birth weight- Same deal. Bigger babies=less space in the womb to move around.

  • Swaddling- Don't get me wrong, I LOVE SWADDLES! The key is to swaddle with the hips in mind! Swaddles that wrap the legs and hips really tight have the potential to cause hip dysplasia.

  • Breech- this is when the baby at time of birth has legs down and head up (usually the head is down during labor).

  • Genetic- studies have found that there is a genetic component to hip dysplasia, so if either parent had it, there is an increased chance of a child having it.

  • Twins- Twins take up a lot of space in mom's belly. And we know less room to move can cause abnormal positioning of the hips!

  • First born- Studies have shown that first born children have a higher risk of being diagnosed with hip dysplasia.

  • Female- Traditionally, females have more laxity in their ligaments (they are looser). This makes the joint even more unstable, increasing the risk for hip dysplasia.

  • Torticollis- It is not that torticollis directly causes hip dysplasia, per say, but there are studies that correlate the two diagnoses. It is understood that these two are probably correlated because of decreased space in the womb.

How to Prevent Hip Dysplasia

  • Swaddle loosely- DO NOT swaddle with legs straight and down. If anything, bring them up and out while swaddling, but keep in mind that we want them to move freely. Keep the swaddle by the legs loose while wrapping that baby up! It also may be helpful to only swaddle when needed (naps and bedtime).

  • No standing before babies are ready- babies are not meant to take weight through their legs until AT LEAST 7 months old. Babies start pulling to stand [on average] around 10 months, which is a more developmentally appropriate age to use standing devices, like an exersaucer.

  • No jumpers- I am begging you on this one!! Jumping creates A LOT of force through the hip joints. This will increase the risk of injury to the hip joint if babies are put in jumpers before their joints can support jumping. Kids learn to jump around the age of 2. At that point, they will not even fit into a jumper anymore, so you might as well just avoid adding it to your baby registry! (PLEASE)

  • Hip healthy baby wearing- I love and support baby wearing, as there are SO many benefits! When baby wearing, make sure the hips are in an "M" position, where knees are higher than hips and not dangling down. This ensures that the femur has great contact with the acetabulum.

  • Regular pediatrician visits- your pediatrician will screen for hip dysplasia if there are any concerns. Going to the pediatrician regularly will ensure that they are developing properly and if they are not, they will provide recommendations for intervention.


Treatment

If caught early enough, an orthosis will be used. Most commonly called the Pavlik Harness, this harness goes around the trunk (kind of like overalls) and wraps around each leg. It holds the legs in flexion, abduction, and external rotation, which is the optimal position for maintaining great contact between the femur and acetabulum.


For older kids or more severe cases, procedures may be performed. Closed reduction is when the orthopedic surgeon manipulates the joint back into place without surgery. Open reduction is used if a closed reduction procedure fails. This is when surgeons cut into the joint and place it back in socket, possibly also creating a deeper socket if necessary. With either, the kid is usually placed into a spica cast, which is the same positioning as a Pavlik harness, but made from cast material. It is stronger and ensures that the joints will not move during recovery.


Conclusion

I am hoping if anything, this post educates new parents about this very common orthopedic condition. Hip dysplasia cannot always be prevented, but knowing our resources and facts will help create some really strong hips!

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