In the medical world, many terms are used for hip instability depending upon the time of occurrence and severity, these include Hip Dysplasia, Developmental Dislocation of the Hip (DDH), Hip Dislocation, Developmental Dysplasia of the Hip (DDH), Acetabular Dysplasia, and Congenital Dislocation of the Hip (CDH).
We care about your baby’s hip joint.
Facts about Hip Instability
Hip instability is the most common new-born abnormality.
1 in 10 infants are born with hip instability.
1 in 100 infants are treated for hip dysplasia.
1 in 500 infants are born with completely dislocated hips.
DDH is 12 times more likely if there is a family history
6 out of 10 cases of DDH occur in first born children
Girls are 4-5 times more likely to have hip dysplasia than boys
Breech babies have a higher risk for developing DDH
How is Hip Dysplasia Caused?
The exact causes of hip dislocation are still unknown. But hip dislocation often occurs at birth because the hip socket is shallower at that time. The hip joint’s flexibility is due to loose ligaments, causing the smooth passage of the baby through the birthing canal. After birth, the loose ligaments usually get tightened, and ultimately the hip joint becomes deeper during the first year of life naturally. But in some cases, the flexibility does not recover and results in dislocation of the hip joint leading to mild to severe hip dysplasia.
The hip joint is a ball and socket joint, and the bones of an infant’s hip joint are much softer than an adult hip joint, so it is easier for them to have misaligned or dislocated hip joined. Infant hip socket is soft and pliable cartilage, but an adult’s hip joined is formed of hard bones.
Sometimes, hip dislocation can also occur due to the following reasons:
Mother’s Hormonal Change at the time of Birth:
Another natural process in mothers at the time of birth is the release of certain hormones that causes an easier stretch of the ligaments in their birth canal to help the baby pass through it smoothly. Most infants don’t get affected by these hormones, but some babies are more sensitive and allow excessive ligament laxity. As girls have more ligament laxity than boys, they have a 4-5 times greater chance of developing hip dysplasia.
Hip Dysplasia due to Baby’s Position in the Womb:
Dysplasia from birth can be due to the baby’s position in the womb. The baby’s position in the womb exerts more pressure on the hip. In the womb, babies can be in two positions.
Breech Positioning: Baby’s breech positioning y in the womb enhances the chances of hip instability due to excessive pressure on the hip bone.
Normal Positioning: In normal positioning, usually, the pressure is on the left hip. Thus, the left hip bone has more chances of developing instability than the right one.
Acquired Hip Dysplasia due to Infant Positioning During the First Year of Life:
Swaddling is a traditional way of wrapping infants in blankets or clothes so that the movement of their limbs is strictly restricted. Improper swaddling is one of the biggest causes of developmental hip dysplasia. In the womb, the babies’ legs are bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket. When babies are swaddled, care should be taken to swaddle properly. There are many ways to swaddle babies by using blankets or commercial products designed for swaddling. In order for swaddling to allow healthy hip development, the legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints. Also called the M-position. The baby’s legs should not be tightly wrapped straight down and pressed together. Swaddling infants with the hips and knees in an extended position may increase the risk of hip dysplasia and dislocation.
The Occurrence Ratio of Hip Dysplasia:
Genetics plays a role in hip dysplasia but is not directly linked with it, but it has 12 times more chances of occurrence when there is a family history. If a child has hip dysplasia, the risk of another child developing hip dysplasia is 6% (1 in 17). And if a parent has hip dysplasia, the risk of a child having it is 12% (1 in 8). Furthermore, if a parent and a child have hip dysplasia, the risk of a subsequent child having hip dysplasia is 36% (1 in 3).
Additionally, girls, firstborns, breech position in the womb, and having someone in the family with the same condition increases the chances of developing hip dysplasia.
Symptoms of Hip Dysplasia:
The signs and symptoms of developmental dysplasia are often not clear because it doesn’t cause pain. So, it is hard to recognize them. But following are the signs that parents should notice in their baby:
Popping or clicking sound in the baby’s hip
Unequal length of both the legs
Not proper movement in one hip or leg
Not lined up skin folds under buttocks or on thighs
Difficulty (limp) in walking
Diagnosis of Hip Dysplasia:
Two tests are often performed
1. Ultrasound
Ultrasound is a non-invasive procedure and is usually preformed on babies under the age 6 months as their hip joint is still soft and cartilaginous, and may be more visible through ultrasound.
2. Xray scans
Xray scans may be preferred on babies older than 6 months. During this age their bones are hardened enough to be clearly visible on an X-ray scan.
Treatment of Hip Dysplasia:
A healthcare practitioner will recommend the treatment for the baby depending upon the dislocation’s severity. If you suspect any hip dysplasia in your baby contact your healthcare practitioner for further advise.
References:
International Hip Dysplasia Institute https://hipdysplasia.org
Ortolani M. Congenital hip dysplasia in the light of early and very early diagnosis. Clinical Orthopaedics and Related Research. 1976 Sep(119):6-10. PMID: 954324.
Weinstein, Stuart L. MD; Mubarak, Scott J. MD; Wenger, Dennis R. MD Developmental Hip Dysplasia and Dislocation, The Journal of Bone & Joint Surgery: September 2003 - Volume 85 - Issue 9 - p 1824-1832
Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clinical Orthopaedics and Related Research. 1987 Dec(225):62-76. PMID: 3315382.
Gala L, Clohisy JC, Beaulé PE. Hip Dysplasia in the Young Adult. J Bone Joint Surg Am. 2016 Jan 6;98(1):63-73. doi: 10.2106/JBJS.O.00109. PMID: 26738905.
Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014 Dec 22;111(51-52):884-90. doi: 10.3238/arztebl.2014.0884. PMID: 25597367; PMCID: PMC4298240.
Mechlenburg I, Søballe K, Lamm M, Stilling M. Hofteartrose [Hip dysplasia]. Ugeskr Laeger. 2014 Jul 21;176(30):1382-6. Danish. PMID: 25292227.
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