Developmental hip dysplasia is a condition of the hip where the hip joint does not develop properly. The hip is a ball and socket joint. The socket, also known as the acetabulum, is part of the pelvis. The ball, or femoral head, is part of the femur. When the femoral head does not sit perfectly in the acetabulum, it causes developmental dysplasia of the hip or DDH.
What causes hip dysplasia in infants?
Normally, the femoral head sits snuggly in the acetabulum to form the hip joint. However, in developmental hip dysplasia, the socket portion of the joint is too shallow, which doesn’t allow the “ball” portion of the joint to fit properly. This leads to instability of the hip joint, and in more severe cases, can lead to congenital hipdislocation.
At the time of birth, the hip socket is as shallow as it ever will be. The shallow hip socket allows the hips to be more mobile and flexible, which helps the infant pass through the birth canal. Then, through the first year of life, as young children move through different positions and start to bear weight through the hips, the hip socket deepens. This makes the hip joint more stable and less flexible than at birth.
Hip instability is one of the most common abnormalities in infants. It is more common for girls to be diagnosed with hip dysplasia than boys, and it’s more common for the firstborn child to have developmental dysplasia. , also referred to as can be diagnosed in both hips, or just one. In cases where only one hip is involved, it is more common for the left hip to be involved. Although the exact cause of hip dysplasia is unknown, several contributing factors are widely accepted.
Genetics
Genetics can play a role in hip dysplasia, but it’s not a direct cause. If a parent or a sibling has been diagnosed with hip dysplasia, that child’s chances of being diagnosed increase compared to a child who do not have a parent or sibling with that diagnosis.
Position in the Womb
The position of a baby in the womb can place increased pressure on the hips, leading to the . Even in a normal position in the womb, more pressure is put on the left hip than the right, which might be a factor that contributes to the left hip being affected more often than the right. However, babies in the breech position are more at risk for hip instability and are more likely to be diagnosed with hip dysplasia. Additionally, if a child is a multiple, this puts them at greater risk of hip instability and hip dysplasia. The lack of room in the womb for movement, or poor positioning, can put added stress on the hips.
Positioning During First Year of Life
With a baby’s bones being soft and the hip socket being shallow at birth, the positioning of and movement allowed at the hips is extremely important in assuring proper hip development once the baby is born. The position to avoid is having the legs extended and tightly pressed together as if the child was standing. This places the front of the hip joint on stretch and may damage that part of the joint. It’s best to allow the hips some movement, even when swaddled, so that the child can bring the knees up toward their chest.
How can I strengthen my baby’s hips?
Physical therapy is an important component of treatment for hip dysplasia, especially after a period of time in a brace or spica cast. Strengthening core and hip muscles is imperative, but so is working on your child’s sense of joint position and movement, as well as overall coordination. This will help to progress gross motor skill acquisition after the brace is removed.
Position play and natural movements are the best options for strengthening hips in infants and toddlers. Depending on your child’s age, you can work with them in varied sitting positions, reaching in all directions for toys and maintaining their sitting balance. Ring sitting, side sitting, and figure 4 sitting are all great options. Playing on a child’s hands and knees is also great exercise for the hips and the core. This is beneficial because the child must use their core to stabilize their body for reaching, and they also utilize their hip muscles when reaching, rocking, and crawling. Lastly, tall kneeling is a challenging position that will help your child strengthen their core and hips. A child can place their hands on a surface and be in a tall kneeling position while playing at that surface with a toy, crayons, or puzzle.
Can hip dysplasia correct itself in babies?
All infants are screened within the first few days of life, and again around 6-8 weeks old. If at any point hip dysplasia is diagnosed, there is treatment available. The type of treatment will depend on the child’s age at diagnosis and the severity of hip displacement. The longer you wait for treatment, the higher the risk that your child may adopt a movement disorder or something similar later on.
Non-surgical options consist of different types of braces. A Pavlik harness is a soft brace that an infant wears constantly. It’s flexible and soft while holding the hips in appropriate alignment, which allows the hip joint to sit well in the socket. A fixed abduction brace may also be used, which provides less flexible positioning to the hips. Both brace options bring the hips into the optimal position to help relocate them and allow correct development of the socket.
Surgical options are also an option. A closed reduction procedure is when a orthopedic surgeon manually manipulates the ball back into the socket. This procedure is done when the child is under general anesthesia. An open reduction procedure is when a orthopedic surgeon makes a small incision in the groin area and removes any excess tissue that might be getting in the way of the ball sitting in the socket portion of the joint. There are also other surgical procedures that can be performed on either the ball end of the joint, the femoral head, or the socket portion of the joint, the acetabulum. Typically, after any surgical procedure, a hip spica brace is worn for around 12 weeks.
Regardless of treatment, physical therapy is an imperative step in the process to ensure that your child has the strength, coordination, and flexibility to acquire gross motor skills after hip dysplasia treatment.
Ivy Rehab for Kids Can Help
If you or your doctor are concerned about your child’s hip health, Ivy Rehab for Kids can help! A pediatric physical therapist can show you healthy and safe positions for your baby, activities to help strengthen their hips and core, and can help you make sure that they progress with crawling, walking, and running! Key signs and symptoms that can indicate possible hip dysplasia include:
- Asymmetry: differences in buttocks creases
- Hip clicks: hip clicking, popping, or snapping
- Decreased range of motion: difficulty spreading legs for diaper change
- Limping: obvious limping with walking
- Dragging leg: dragging of a leg when crawling
- Leg length: one leg seems longer than the other
Remember – these signs do not always mean that your infant has hip dysplasia. If you notice any of these signs, bring your concerns to your doctor or your physical therapist, and they will initiate proper testing to confirm a diagnosis. Visit our website for location information or to request an appointment online.
Article By: Jill Owen, DPT
*Information in this blog post obtained from the International Hip Dysplasia Institute.
Jill began her PT career 9 years ago. Jill loves working with the pediatric population and believes in the importance of providing quality treatment and education to patients and their families. She currently specializes in movement disorders, serial casting, torticollis, and developmental delay. Jill enjoys working with kids of all ages and abilities to reach their full potential and live their best lives! She currently treats patients at Ivy Rehab for Kids in Tecumseh, MI.
