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Hip Dysplasia: Causes, Symptoms, Risk factors, and Treatment

The hip joint is a ball and socket joint, between the pelvis and the upper part of the leg. Hip dysplasia (a.k.a: hip dislocation) is primarily due to the improper formation of the bones forming the hip joint (i.e. the head of the thigh bone and the acetabular cavity of the pelvis). This condition may lead to instability and partial or complete dislocation of the hip joint.

It is a common problem in the children, and is present since birth, in most of the cases. It may also develop in the adolescents or young adults. It occurs more frequently in girls than in the boys.

Hip dysplasia

What is Hip Dysplasia?

Any discrepancy in the formation of the upper thigh bone or the socket of the pelvic bone results in the formation of an unstable hip joint which leads to the condition called hip dysplasia.

The hip joint is the most prominent joints present in the human body. It is formed by the joining of the socket (acetabulum) of the pelvis and the head of the thigh bone (femur). A significant amount of the pressure of the human body is transmitted on these bony surfaces.

Causes of Hip Dysplasia:

Hip dysplasia can lead to congenital or developmental dislocation of the hip joint. Some of the common causes for hip dysplasia include:

  • The fetus is present in the breech position (the feet are located near the cervix and not the head) in the womb
  • Laxity in the structures (ligaments) surrounding the hip A discrepancy in the sizes between fetus and uterus of the mother
  • Untreated congenital hip dysplasia may develop into hip dysplasia in adolescents
  • Improper handling or carrying of the babies during infancy
  • The bent leg sitting (w-sitting) position of the babies for a prolonged duration
  • Automobile accidents or the fall from a great height

Symptoms of Hip Dysplasia:

Hip dysplasia may occur in one or both sides of the hip joints. Some of the common symptoms include:

  • Improper sitting of the babies
  • A click or popping sound at the hip
  • Pain in the leg, mostly seen in the adults
  • A leg-length discrepancy, one leg is shorter than the other leg
  • A decrease in the movements at the hip on the affected side
  • Limping off the leg during walking
  • Uneven skin folds near the thigh or buttocks

Risk Factors for Hip Dysplasia:

The factors that increase the risk of occurrence of hip dysplasia include:

  • A family history of the hip disorders
  • The lower level of amniotic fluid in the womb of the mother
  • The breech positioning of the child (legs facing the cervix)
  • Being the first child
  • Being a female child
  • Increased birth weight of the child
  • Prematurity
  • Twin or multiple babies
  • Maternal lifestyle habits like smoking
  • Use of anticonvulsant medications by the mother’s during pregnancy
  • Congenital foot deformities like clubfoot

Complications of Hip Dysplasia:

Hip dysplasia causes many complications as the hip joint is one of the primary weight- bearing joints of the body. Some of the common complications are:

  • Difficulty in walking independently
  • Recurrence of hip dislocation
  • The stiffness of the hip joint
  • Development of infections around the hip joint
  • Avascular necrosis of the femoral head (death of the bone tissue due to a decrease in the blood supply)

Diagnosis of Hip Dysplasia:

Physical examination and imaging studies are most important for the diagnosis of hip dysplasia.

Physical Examination:

The doctor will examine the hip movements of the newborn in the first health-checkup. If the child has certain risk factors for hip dysplasia, this physical evaluation will be done at regular intervals until the child attains adolescence.

Physical examination also includes observation for the leg length discrepancy and the walking pattern(gait) of the individual.

A detailed medical history of the patient consists of the presentation of the child during birth, the family history and the time of onset of the symptoms (since birth or in the adolescence).

X-rays:

An x-ray forms the first line of diagnosis in any hip dislocation case in the children and adults. X-helps to determine the following:

  • The size of the acetabulum or socket, shallow or deep
  • The severity of dysplasia, partial or complete dislocation
  • The type of hip displacement, upwards or downwards,

Ultrasound Study:

Ultrasonic sound waves are used to assess the infants’ (or adults) hip joints to have a clear view of the bones and the tissues(ligament) surrounding the joints.

Magnetic Resonance Imaging (MRI) Scans:

Powerful magnetic fields and radio waves are passed around the patient’s body to get more detailed cross-sectional images of the hip joint. Any death of the tissue (necrosis) and fragments of fractured bones are also visible on an MRI.

Treatment for Hip Dysplasia:

Treatment for hip dysplasia is variable, and it depends on the age of the patient and the severity of the dislocation. Treatment aims to allow for the free movement at the hip joint. Treatment includes:

Bracing:

If hip dysplasia is found in a child before the age of six weeks, supporting (bracing) of the hip joint of the child with Pavlik harness or brace is extremely helpful. The brace holds the head of the femur positioned in the socket of the acetabulum for a longer time. This process helps in the accommodation of the socket around the head of the femur.

In cases where dysplasia is severe and in children above six weeks of age, treatment is mostly performed by surgery.

Surgical Management:

Surgery is mainly performed to regain the stability and movement of the hip joints at the earliest. Some of the surgical procedures are explained here:

Reduction:

In this procedure, the doctor manipulates the (head) ball of the thigh bone in such a way that it fixes into the socket of the acetabulum, to stabilize the joint. It may be either an open or close reduction. Open reduction involves an incision into the groin to accurately place the hip joint in the socket of the pelvis. On the other hand, the closed reduction does not require any incisions on the affected area and is performed without opening of the internal tissues.

Bracing is done in the post-reduction procedure, to maintain the stability of the joint.

Osteotomy (bone surgery):

In this procedure, the doctors use metal screws or rods to reposition the bones at the joint and to reduce the instability of the hip joint. It is mostly performed with open reduction. It is also called as periacetabular osteotomy.

Hip Replacement Surgery:

This surgery involves replacing the damaged surfaces of the affected joints with metallic implants. It is done in patients with severe deterioration of the surfaces of the hip joint. This procedure is also called as arthroplasty.

Prevention of Hip Dysplasia:

Congenital hip dysplasia cannot be prevented. But, other types of dysplasia can be avoided by the following measures:

  • Positioning the baby carefully in a cloth, immediately after birth, by allowing the free movements of hands and legs
  • Holding the baby properly while lifting them
  • The teaching of the children to avoid W-sitting (cross sitting) position.

Hip dysplasia is a frequent condition in most of the children; early diagnosis and management are beneficial in avoiding complications like limping gait and death of the bone tissue (necrosis), which arises in the adulthood.

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