Summary about Disease
Congenital hip dysplasia (CHD), also known as developmental dysplasia of the hip (DDH), is a condition where the hip joint doesn't form normally. The hip joint is a ball-and-socket joint, where the head of the femur (thigh bone) fits into the acetabulum (socket) of the pelvis. In DDH, the socket may be shallow, or the ligaments holding the joint together may be loose. This can allow the femoral head to partially or completely dislocate. The severity can range from mild instability to complete dislocation.
Symptoms
Symptoms can vary depending on the age of the individual and the severity of the dysplasia.
Infants:
Clicking or clunking sound or sensation when the hip is moved. (Note: This can also be present in normal infants, so further evaluation is needed).
Uneven skin folds on the thigh or buttocks.
One leg appears shorter than the other.
Limited range of motion in the hip.
When changing diapers, the legs may not open as wide.
Older Children/Adults:
Limping or waddling gait.
Pain in the hip, groin, thigh, or knee.
Unequal leg lengths.
Decreased range of motion.
Early-onset osteoarthritis.
Causes
The exact cause is not fully understood, but several factors can increase the risk:
Genetic Predisposition: A family history of DDH increases the risk.
Breech Presentation: Babies born breech (feet first) have a higher risk.
Firstborn Children: First pregnancies are associated with a higher incidence.
Oligohydramnios: Low amniotic fluid levels during pregnancy can restrict fetal movement and affect hip development.
Swaddling: Incorrect swaddling techniques that keep the baby's legs straight and together can increase the risk.
Hormonal Factors: Hormones released during pregnancy can cause ligament laxity in the baby.
Sex: Females are more commonly affected than males.
Medicine Used
There are no medications to correct the hip structure, but medications might be used for pain management, especially after surgery or in older individuals with osteoarthritis:
Pain relievers (Analgesics): Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be used for mild pain.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs): Prescription NSAIDs can help reduce inflammation and pain.
Corticosteroids: Injections of corticosteroids into the hip joint may be used to relieve pain and inflammation, but this is typically a temporary measure.
Is Communicable
No, congenital hip dysplasia is not communicable. It is a developmental condition, not an infectious disease.
Precautions
Proper Swaddling: Avoid tightly swaddling infants with their legs straight and together. Allow the legs to bend up and out in a "frog-like" position.
Early Screening: Follow recommended screening guidelines for infants.
Correct Car Seat Use: Use car seats that allow for proper hip positioning.
Avoid Hip Extension: Avoid positions or activities that force the hip into extension, especially in infants.
Prompt Treatment: Seek prompt medical attention and treatment if DDH is suspected.
How long does an outbreak last?
DDH is not an outbreak, it is a congenital condition. Untreated, the anatomical issues persist indefinitely. Treatment duration depends on the severity and the age at diagnosis, ranging from weeks to years involving casts, braces, or surgery, followed by rehabilitation.
How is it diagnosed?
Physical Examination: A doctor will perform a physical exam to check for hip instability, limited range of motion, and leg length discrepancy. The Ortolani and Barlow maneuvers are common tests used in infants.
Ultrasound: Ultrasound is the primary imaging method for infants because the hip is still cartilaginous.
X-rays: X-rays are used for older infants and children when the hip bones have started to ossify.
MRI: In some cases, MRI may be used to get a more detailed view of the hip joint.
Timeline of Symptoms
Prenatal: No symptoms are present before birth, but risk factors may be identified.
Newborn: Clicking/clunking during hip exam; uneven skin folds may be apparent soon after birth.
Infancy (0-6 months): Symptoms are often subtle; limited hip abduction might be noticeable.
Late Infancy/Toddlerhood (6-18 months): Limping or asymmetry in leg movement becomes more apparent.
Childhood: Limp, hip pain, decreased activity level.
Adulthood: Hip pain, early arthritis, limited mobility. Note that many cases are diagnosed and treated during infancy, preventing progression to later stages.
Important Considerations
Early diagnosis and treatment are crucial to prevent long-term complications, such as osteoarthritis and the need for hip replacement.
Treatment options vary depending on the age of the individual and the severity of the dysplasia.
Follow-up care is essential to monitor hip development and ensure treatment success.
Parental education and support are vital for adherence to treatment plans.
While treatment is often successful, some individuals may experience residual hip problems later in life.