Little children who begin to crawl or walk, parents should try observing whether they crawl using one leg more than the other, or when they walk their legs are not of equal length, or if one leg can rotate more than normal because if there is any irregularity, it should be consulted with a doctor, as there may be a risk of Developmental Dysplasia of the Hip (DDH).
Causes of Developmental Dysplasia of the Hip
Developmental Dysplasia of the Hip occurs in 1 in 1,000 newborns, and there’s a high chance of it affecting both sides, up to 20%. Causes include genetics and ethnicity, with certain ethnicities having a higher incidence of newborns with DDH such as Native Americans, Japanese, etc., and it’s less common in Chinese and Black people.
Other causes include environmental conditions in the womb or various risk factors that make the hip more likely to dislocate, such as the baby being the firstborn, female, breech birth, and family history of the condition. This might be explained by the uterus and vaginal canal not being fully expanded, which can compress the baby, breech births, babies with family history of this condition, mothers with less than usual amniotic fluid, large babies with heavy weight but small mothers, swaddling the newborn too tightly, and babies with abnormal foot or neck stiffness.
Risk Factors for Developmental Dysplasia of the Hip
How a baby is swaddled, carried, and their sleeping position significantly influences hip socket development. It’s found that the Native American and Ainu tribes of Japan, who swaddle their baby’s legs tightly in a straight position preventing movement, which contributes to dislocation. Whereas in China, where babies are swaddled with legs apart, DDH incident rate is much lower because the spread position helps the hip joint develop properly. In our culture, carrying a baby on the side is also beneficial because it promotes proper hip placement.
The treatment of Developmental Dysplasia of the Hip varies according to the severity of the condition and the age of the child.
- Newborn – 6 months: If detected at this stage, doctors will treat using a Pavlik Harness or a fiberglass cast similar to a turtle shell to position the femoral head within the socket normally and ensure proper joint development. This is worn all the time, with the duration dependent on the baby’s development.
- Over 6 months: If the initial treatment is unsuccessful, doctors may proceed with surgery to correctly position the hip joint, followed by a Hip Spica Cast, using X-ray, CT, or CAT SCAN, or MRI to observe.
- Over 1 year: At this stage, major surgery may be required to adjust and position the hip bone appropriately, with plates inserted for stability. After surgery, a cast is worn for several months with ongoing treatment.
- 14 years old and above – Adults with an intact hip joint: Treatment involves surgery at the hip socket or femur to maximize weight-bearing surface area, with the goal to delay joint degeneration.
- Middle-aged adults with advanced hip degeneration: Treatment involves hip replacement surgery.
Will a child with Developmental Dysplasia of the Hip be able to walk normally as they grow? Can it reoccur or affect adulthood?
If Developmental Dysplasia of the Hip is correctly treated, the child can return to normal just like other children, with a stable and strong hip joint without recurrence. However, untreated or incompletely treated children will continue to have problems including shortened leg length, limping, and may develop hip degeneration, causing pain when bearing weight in adulthood.
Preventing Developmental Dysplasia of the Hip
- Children who are at risk, firstborns, females, breech birth, premature rupture of membranes, should be specially examined by a pediatrician, possibly requiring a hip ultrasound or X-ray.
- Avoid swaddling the child too tightly. Proper swaddling techniques that allow leg bending and easy movement should be taught by doctors or nurses, not tight swaddling.
- Allow the child to sleep on their stomach or back, not on their side which can cause the hips to fold inward.
- Regularly observe any abnormalities in the child’s leg, skin folds, uneven leg length, outward-pointing legs, abnormal walking posture or limping without pain.
- Treating from a young age yields better results. Children with higher risk factors should be examined by a doctor for this condition from birth onwards. If parents suspect their child might have this condition, they should consult a doctor for a detailed examination.
- Parents should regularly check their child’s body, arms, and legs for any abnormalities, not underestimating any minor issues because it could lead to abnormal development and disabilities as they grow.
Early detection and treatment of Developmental Dysplasia of the Hip can lead to a complete recovery and normal development, but delayed diagnosis can result in lifelong complications such as limping or hip degeneration.
