Does Your Baby Have Healthy Hips? (Part 2)

hips

Last week, we began a two-part series that aims to educate parents about hip dysplasia, a common disorder that, if not addressed in early infancy, can lead to serious problems later in life. Our first post discussed what hip dysplasia is and the importance of early detection. This week’s will focus on treatment and prevention.

As a pediatric orthopedic surgeon, I spent 10 years of my career in Mexico City, where my practice was dedicated to hip dysplasia. I operated on about 250 kids a year, very successfully, but if the dysplasia had been detected in time, they wouldn’t have needed surgery in the first place.

Hip dysplasia is an under-diagnosed condition that, if left untreated, can lead to pain, degenerative arthritis, and the need for hip replacement early in adulthood. It occurs due to abnormal growth of the hip joint, resulting in a mismatch in the way the head, or “ball,” of the thighbone fits into the socket of the pelvic bone.

Many people with hip dysplasia are born with it, but it can also develop in babies that are frequently positioned with the legs extended and thighs pressed together, which increases pressure on the hips. Early detection—within the first few months of life—gives kids the best chance for effective and simple treatment.

Treatment for Hip Dysplasia
When looking for an orthopedic specialist to treat hip dysplasia, parents should seek someone who has specific pediatric orthopedic training in addition to orthopedic surgery training. A well-trained pediatric orthopedic surgeon should be able to diagnose and easily treat early-stage hip dysplasia.

Orthotic treatment. In babies younger than four months, treatment generally consists of a simple orthotic called a Pavlik Harness, or a similar device, which is worn for up to four months. The harness consists of two shoulder straps; a belt, which goes around the chest; and two boots that are strapped to the legs. The child can move freely within this soft brace, which positions the hip so components of its joint can develop normally. Parents may feel overwhelmed at first, but once they’ve learned how to use it, they find it very simple to employ. It takes less than a minute to put on, and you can change a diaper while the baby is wearing it.

Surgical treatment. If hip dysplasia is detected after four to six months, treatment becomes more complicated and may include either minimally invasive or open surgery to put the ball of the hip back into its socket. Following surgery, some children require a body cast to hold the hip in the corrected position while the joint heals. Surgical methods are effective, but do not produce good results as consistently as orthotic treatment applied to younger babies.

Tips for Healthy Hips
Hip dysplasia that develops before birth cannot be avoided, but hip-healthy practices can encourage normal joint development and prevent hip dysplasia in babies who were not born with it.
­– Avoid swaddling with the thighs together, a position that is harmful for the hips. They should be in the abducted position (with the legs open) and allowed to move freely.
– If you use a baby carrier, make sure it permits the hips to be wide open, and avoid any that tend to push the legs together and restrict movement. Any kind of baby carrier that allows free motion of the hips is generally considered healthy.
– Visit the International Hip Dysplasia Institute (IHDI) website (hipdysplasia.org), a valuable resource for parents to learn more about hip dysplasia, proper swaddling, and specific products that IHDI deems hip-healthy.

The Bottom Line
If your child does develop hip dysplasia, treating it early with non-surgical methods is ideal. Still, if it’s not caught in time for orthotics, surgery to correct the problem as a young child is better than no treatment at all. In Mexico City, I operated on a girl whose hip dysplasia had been missed until her grandmother noticed a slight limp when she began to walk. We fixed her hip and she has done very well. I recently received a video from the family of her tenth birthday party, and she was running and playing and jumping. She’s a thriving and healthy girl with a near-normal hip that likely will never need to be replaced.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Pablo G. Castañeda, MD, is the Division Chief of Pediatric Orthopaedic Surgery at Hassenfeld Children’s Hospital at NYU Langone.

Author: NYU Langone Medical Center

At the Hassenfeld Children’s Hospital of New York at NYU Langone, we understand that caring for infants, children, and teenagers is a special privilege. That’s why we partner with our young patients and their families to offer comprehensive inpatient and outpatient services and expertise. Our experts provide the best care possible for children with conditions ranging from minor illnesses to complex, more serious illnesses.