What Is Developmental Dysplasia of the Hip?

Developmental Dysplasia of the Hip or Congenital Hip Dysplasia (CHD) is an abnormal or delayed development of the hip joint, causing a dislocation between the socket and thigh bone. This condition appears in around 1.5 per 1,000 births with girls being 8 times more likely to be affected. In normal circumstances, the femur should fit securely into its respective hip socket (the acetabulum). But sometimes during gestation or shortly after birth this connection becomes misaligned due to excess movement in the joint; usually leading to an upward displacement of the femur from out of its corresponding hip socket.

Developmental Dysplasia of the Hip can cause life-long physical issues, such as leg and hip pain, an awkward gait, restricted range of motion in the legs, unequal length between the limbs or even early onset arthritis. Being a firstborn child with female gender increases one’s risk factor for CHD; furthermore breech delivery as well as family history may play a role too. Therefore, it is essential to detect this condition at an early stage, so that any joint development difficulties can be addressed promptly and prevent long-term complications from arising.

If you think your child might have developmental dysplasia of the hip/hip dysplasia, it’s important to get medical attention right away because this condition can lead to severe problems if left untreated.

It is important to note that most infants treated for developmental dysplasia of the hip develop into active, healthy kids and have no future hip problems.

 

Can a Chiropractor help with Developmental Dysplasia of the Hip?

Chiropractors are trained to recognize warning signs that could indicate the presence of a condition, such as: 

-A discrepancy in leg length

-An unevenness at the thigh skin folds

-Restricted mobility or range of motion when bending the hip due to muscle tightness and tension  

-The distinctive ‘waddle’ gait associated with this ailment   

-The clunking sound emitted from within the affected hip upon walking.

As part of the six post-natal check ups your newborn should receive in their first year, Chiropractors can perform simple assessments for hip problems. If any issues are identified, chiropractic adjustments can help bring the joint back to ideal working order and condition. Additionally, strengthening exercises, pain management techniques and functional activities will be carried out by a chiropractor while they can also provide take home exercises that could supplement treatment from the comfort of one’s own living space.

What are the risk factors associated with Developmental Dysplasia of the Hip?

The cause of developmental dysplasia of the hip is mostly unknown, but there are many contributing factors, usually both genetic and environmental. There are a number of risk factors that have been associated with Developmental Dysplasia of the Hip (DDH), including:

• •   Use of forceps during delivery  

• •   Family history of DDH

• •   Being born a female

• •   Breech position delivery

• •   Tight swaddling of an infant’s legs

• •   Oligohydramnios or low amniotic fluid during pregnancy 

• •   Being born twins, triplets, etc.

• •   First-born babies are at greater risk of dislocation of the hipOther factors 

• •   Having flexible ligaments

• • The presence of other conditions
    • •  infant torticollis, clubfoot malformation, congenital conditions, metatarsus adductus, etc. 

It is important to note that even in the presence of the aforementioned factors, DDH may not develop, but it is critical to have your child diagnosed further should they be present. Early detection and treatment are critical to avoid more invasive procedures discussed at the end of this article. 

What Happens in a Hip With Developmental Dysplasia?

Our hips have a remarkable ball and socket system that allows us to move in all directions, from the front, back and side-to-side when walking or running. The ball part of the joint usually sits inside a socket forming part of the pelvic bone. The ball moves around in different directions inside the socket and usually stays put in normally developing children. Unfortunately, with developmental dysplasia of the hip (DDH), this joint does not form correctly which results in an incorrectly positioned ball within a shallow socket. When this occurs, there is too much space between your baby’s thigh bone and pelvis. This additional space causes his or her thigh bone to slip out of place when he or she moves around in the womb, or during and after birth.

Unless these issues are quickly treated, they can result in severe pain while walking, and can cause arthritis at a young age. Both of these conditions can cause immense suffering for those affected.

What are the Symptoms of Developmental Dysplasia of the Hip?

Developmental dysplasia of the hip rarely causes pain in babies, but can be very difficult to diagnose without an exam. Parents should pay particular attention to the following signs and symptoms:

• • One hip/leg moves differently or has a different range of motion

• • A popping or clicking that is heard from the hip area

• • A limp when first starting to walk 

• • The folds of skin under the thighs or buttocks do not line up

• •  A difference in leg length 

How Is Developmental Dysplasia of the Hip Diagnosed?

Before three months of age, your chiropractor that specializes in treating infants and children will perform two physical exams to test for DDH. 

• • In the Ortolani test, your child’s pediatrician or chiropractor will apply upward force as they move your child’s hip away from the body (abduction).

• • In the Barlow test, your child’s pediatrician or chiropractor will apply downward force as they move your child’s hip across the body (adduction).

Once diagnosed, they will work closely with your pediatrician or pediatric orthopedic doctor to come up with the best treatment plan and physical therapy regimen.

How Is Developmental Dysplasia of the Hip Treated?

Getting the ball of the hip into the socket and keeping it there, so that it develops normally will be the main objective of treatment. 

Your doctor will choose the treatment based on the child’s age, and the options include:

• •   bracing as through a Pavlik Harness

• •   a closed reduction with casting

• •   an open reduction/surgery and casting

Pavlik Harness bracing

If the baby is younger than 6 months old, the use of a soft brace is usually the best route. The brace most often used is a Pavlik harness. Utilizing a shoulder harness that attaches to foot stirrups, the Pavlik harness puts the baby’s legs into a position which guides the ball of the hip joint into alignment with the socket.

The normal amount of time in a Pavlik harness will be from 6 to 12 weeks. Utilizing a Pavlik harness usually means that most babies will not require further treatment.

If for some reason the harness does not realign the ball and socket joint, doctors may perform one of the following:

• • a closed reduction/manually moving the ball back into the socket, and casting
    • • Used when a baby commences treatment after age 6 months.

• • an open reduction/surgery and casting
    • • Used when a baby commences treatment after age 18 months.

What is the long term prognosis for Children with Developmental Dysplasia of the Hip?

If treatment is sought early, then the long term prognosis for Children with Developmental Dysplasia of the Hip is a healthy one. Most infants identified and treated within the first two weeks of life have healthy hips as adults, with very few experiencing any pain or disability associated with the hip joint. However, treatment for infants can be time consuming and complex, involving specialized equipment, so it’s important to consult a doctor as soon as possible if you suspect DDH is present. Early diagnosis and treatment are key to achieving a healthy long-term prognosis for these children.