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Paediatric Newborn Hip Dysplasia
Paediatric Newborn Hip Dysplasia
Newborn Hip Dysplasia (Developmental Dysplasia of the Hip – DDH)
Developmental dysplasia of the hip (DDH) is a condition in newborns in which the hip joint is not correctly formed. In DDH, the ball at the top of the thigh bone (femoral head) is not securely held in the socket of the hip, which can lead to instability, dislocation, or improper development as the child grows.
Early diagnosis and treatment are crucial for proper hip function and preventing long-term complications. Treatment is generally conservative with the use of a Pavlik harness, but surgery may be necessary if the dysplasia is associated with dislocation of the hip.
When detected early, DDH has an excellent prognosis. Most babies treated in the first few months of life go on to have normal hip function without long-term complications.
Symptoms
In newborns, DDH may not always present clear symptoms, but some signs that may indicate a problem include:
Uneven Skin Folds
Asymmetrical creases in the skin of the thighs or buttocks.
Limited Hip Movement
Difficulty or reduced range of motion when moving one leg compared to the other.
Limb Length Discrepancy
One leg may appear shorter than the other.
Hip Clicks
A clicking or popping sound may be heard when moving the baby’s hips.
Unstable Hip Joint
In more severe cases, the hip joint may appear dislocated or be easy to dislocate.
Causes
The exact cause of DDH is not fully understood, but several factors increase the risk:
- Breech Position: Babies delivered in a breech position (feet or buttocks first) have a higher risk.
- Family History: A family history of hip dysplasia increases the likelihood of the condition.
- Firstborn Babies: Firstborn children have a slightly higher risk of developing DDH.
- Tight Uterus: A lack of space in the womb, often seen with larger babies or multiple pregnancies, can prevent proper hip development.
Risk Factors
Certain factors increase the likelihood of DDH in newborns:
- Breech presentation during birth
- Female sex (girls are more commonly affected)
- Family history of hip dysplasia or other skeletal disorders
- Firstborn status
- Oligohydramnios, a condition where there is low amniotic fluid in the womb
Diagnosis
DDH is typically diagnosed during routine newborn screenings.
- Physical Examination: The Ortolani and Barlow tests, which check for hip instability, are performed on newborns.
- Ultrasound: For babies younger than six months, an ultrasound can provide a clearer image of the hip joint’s development.
- X-rays: For older infants, X-rays can help confirm a diagnosis when the bones have begun to harden.
Rehabilitation
Following treatment, whether surgical or non-surgical, rehabilitation is important to ensure the hip continues to develop normally.
- Physical Therapy: Once the baby’s hips are stable, gentle exercises may be recommended to improve joint mobility and strengthen the surrounding muscles.
- Follow-up Care: Regular check-ups with an orthopaedic specialist will monitor the hip’s development. Imaging, such as X-rays, may be used to ensure the joint is healing correctly.
Complications
Without treatment, DDH can lead to complications later in life, such as:
- Hip Arthritis: Early onset of arthritis in the hip due to abnormal wear on the joint.
- Limping: A noticeable limp may develop due to leg length discrepancy or instability.
- Chronic Hip Pain: Persistent pain can result from improper joint function.
- Decreased Mobility: As the child grows, untreated DDH can lead to reduced range of motion in the affected hip.
When To See A Doctor
Routine newborn checkups will screen for hip dysplasia, but if parents notice any of the signs mentioned earlier or have concerns about their child’s leg or hip development, they should consult their paediatrician or an orthopaedic specialist.
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