Childhood Hip Problems

Developmental Dysplasia

What is Developmental Dysplasia?

Developmental dysplasia of the hip (DDH) or Hip dysplasia is a condition which is seen in infants and young children because of developmental problems in the hip joint. The femur (thighbone) partially or completely slips out of the hip socket causing dislocation at the hip joint. It is most common in the first-born baby with a family history of the disorder.

Causes of Developmental Dysplasia

The exact cause for hip dysplasia is not known. Genetic factors play an important role in causing this birth defect. DDH can be mild or severe and can affect one or both hips. It is more common in girls and usually affects the left hip. DDH does not cause any pain and so the condition may not be noticed until the child starts to walk.

Symptoms of Developmental Dysplasia

The common symptoms of hip dysplasia include:

• Position of the legs may differ (dislocated hip may cause leg on that side to turn outwards)
• Restricted movement on the side of hip dislocation
• The leg may appear shorter on the side where hip is dislocated
• Skin folds of fat on the thigh or buttocks may appear uneven.

In a normal hip, the head of the femur (thighbone) fits well into the socket (acetabulum) whereas in hip dysplasia, the socket and femoral head are not congruent because of their abnormal development.

Diagnosis of Developmental Dysplasia

During hip examination, the doctor may also look for the difference in range of motion of the hip, presence of uneven skin folds around the thigh and difference in leg length from side to side. In infants less than 6 months, an ultrasound may be advised to confirm the diagnosis.

Treatments for Developmental Dysplasia

The treatment for DDH depends on both the age of the child and severity of the condition. The aim of treatment is to keep the femoral head in good contact with the acetabulum so that the hip can develop normally. A Pavlik harness may be used to keep the hip in flexion and abduction may be advised. Only when conventional treatment is not effective, surgery to put the hip back into place may be advised.

Legg-Calve-Perthes Disease

What is Legg-Calve-Perthes-Disease?

Legg-Calve-Perthes Disease (LCPD) or Perthes disease is a disorder of the hip that affects children, usually between the ages of 4 and 10. It usually involves one hip, although it can occur on both sides in some children. It occurs more commonly in boys than girls.

Causes of Legg-Calve-Perthes-Disease

The cause of Legg-Calve-Perthes Disease is not clearly known. It may occur due to inadequate blood supply to the ball of the hip joint (the femoral head) which leads to death of the bone. Over the course of several months, the blood supply returns to the bone tissue and new bone cells gradually replace the dead bone over 2 - 3 years.

Symptoms of Legg-Calve-Perthes-Disease

Some signs and symptoms of Perthes disease include:

• Walking with a limp (painless limp)
• Pain or stiffness in the hip, groin, thigh or knee
• Shortening of leg or unequal leg length
• Wasting of thigh muscles

Diagnosis of Legg-Calve-Perthes-Disease

Your doctor will make a diagnosis based on your child’s signs and symptoms, a thorough physical examination, imaging studies such as X-ray of the hip, and magnetic resonance imaging (MRI) scan.

Treatments for Legg-Calve-Perthes-Disease

The goal of treatment for Perthes disease is to keep the femoral head snug in the socket portion of the joint. Non-surgical treatment options may include rest, activity restrictions, anti-inflammatory medications, casting or bracing, and physical therapy. If non-surgical treatments don't work, your child may need surgery. Surgery involves lengthening a groin muscle or reshaping the pelvis (osteotomy) depending on the severity of the condition and the shape of the femoral head.