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Hip dysplasia treatable:

Early diagnosis gives best opportunity for effective treatment

Congenital hip problems, called developmental dysplasia of the hip, affect about one in 1,000 people, more than three-quarters of them girls. Treatment for hip dysplasia varies according to the age of a child (or adult) when the problem is diagnosed and the type of hip problem that occurs.

Health care providers check for signs of hip dysplasia in infants by manually testing hip motion.

Females are more frequently affected, than males, said F. Stig Jacobsen, M.D., a pediatric orthopaedic surgeon at Marshfield Clinic Marshfield Center. In addition to being female, people who are born breech, first-born children, people of some races (Native Americans have a high incidence of hip dysplasia, as do Caucasians) and those with a family history of hip dysplasia have a higher incidence of developmental hip dysplasia than the rest of the population. In fact, one study indicates that a first-born girl with a family history of hip dysplasia has a one in 15 chance of having hip problems.

Hip dysplasia is often diagnosed shortly after a child is born. By testing the hip motion, a physician can feel whether the hip joint is stable, Dr. Jacobsen said.

However, even if a hip socket appears to have a problem at birth, the problem could resolve by itself with a few months. Conversely, hip testing is part of well-child visits for the first year or more of life because hip problems may appear after several months, as well. Research is not clear whether the problems discovered later are new or were merely masked at birth, Dr. Jacobsen said.

In addition to physical manipulation, physicians use X-rays and ultrasound scans to confirm diagnosis of a developmental hip problem and to plan treatment. “In some countries, ultrasound images are part of a ‘well-child’ check,” Dr. Jacobsen said. “Here we have found that ultrasound points out a high percentage of false positive cases and is not worth the increased cost. Physically checking every newborn’s hips is an effective first diagnosis, combined with ultrasound of children in high risk groups.”

In a baby with hip dysplasia, the first line of treatment is a harness, called a Pavlik harness. “Children who are diagnosed early may wear the harness full-time for six weeks or longer,” Dr. Jacobsen said. “Children, once the harness is properly fitted, do well, but parents sometimes remove the harness and fail to put it back on. They think it is uncomfortable for the child. In fact, children adjust to the harness quickly and do not appear to experience discomfort.” At any time, Dr. Jacobsen has two or three patients using the Pavlik harness, he said.

The harness holds the child’s hips at a specific position, pulling the ball of the hip into its correct position. “When the ball is in the rest of the joint will usually develop normally.” As a first-line of treatment, the Pavlik harness is less disruptive and invasive than other treatments. If the Pavlik harness fails to correct the problem, or if the dysplasia is diagnosed too late to use the harness, other options are available, including traction, surgery and casting (with legs in the same position as with the Pavlik harness). Often the treatments are used together or in sequence.

Children diagnosed with developmental dysplasia of the hip must be followed for as long as they are growing, Dr. Jacobsen said. For boys, that is until about age 16 and to about age 14 for girls. “Additional problems can occur in the joint as children grow,” he said. “We watch carefully for signs of problems so they can be corrected as soon as possible.”

Developmental hip dysplasia can cause pain, reduced function or a limp. If dysplasia occurs in both legs, it is more difficult to diagnose because those physical manifestations are less easily seen.

However, proper and early diagnosis is crucial to effective treatment, Dr. Jacobsen said.

As children grow, the treatment options become more limited but are usually successful, he said. It is crucial to treat hip dysplasia as early as possible to prevent long-term complications. “Some children have hip pain and that may be caused by dysplasia,” he said. “A great deal of arthritis pain may be linked back to hip dysplasia. If we treat the problem early, we can possibly prevent or delay those complications later on.”

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