Developmental Dysplasia of the Hip (DDH)
The hip is a ball and socket joint. The ball portion is the round part of the proximal femur (thigh bone), while the socket portion is curved portion of the pelvis at the hip. In Infants and young children if the joint does not form normally, it is called hip dysplasia. (DDH). Although DDH most commonly presents at birth it can also develop during the first year of a child’s life. All children’s hips are screened by their pediatrician. If they find an abnormality or if your child is at risk for hip dysplasia, they will order an ultrasound of your child’s hip. Based on their exam finding or the ultrasound they will refer you to a pediatric Orthopedic Surgeon.
Treatment will depend on the age of your child and the severity of the hip dysplasia. Most children are successfully treated with a brace (Pavlik Harness). In some cases, children may require treatment with a cast or even surgery. The goal of the treatment is to allow the hip to develop normally and prevent hip problems as an adolescent or young adult.
Developmental dysplasia of the hip (DDH) is a childhood condition caused by abnormal development of one or both hip joints. In DDH, the top of the thighbone (femur) does not fit securely into the hip socket (acetabulum). This allows the thighbone to either partially or completely slip out of the socket (dislocate).
Legg-Calve-Perthes disease (LCPD)
Legg-Calve-Perthes disease (LCPD) is a disorder of the upper part of the thighbone (head of the femur) that causes breakdown of the head of the femur. This is followed by new bone formation.
LCPD develops because of loss of blood flow to the head of the femur. This causes breakdown (avascular necrosis) and deformity of the femur where it connects with the hip socket. The bone reforms in the hip area when the blood supply returns to normal. During this time, the femur is soft and may easily fracture and collapse. The head of the femur heals in an abnormal shape and does not fit properly into the hip socket, causing stiffness and pain.
The cause of LCPD is unknown. It occurs most often in children ages 3 to 12. Boys are affected about 4 to 5 times as often as girls. Usually only one hip is affected, although it is possible to have LCPD in both hips.
Symptoms include pain, limping or an uneven gait, decreased movement, loss of height, and loss of muscle mass in the thigh. Treatment depends on the severity of symptoms but may include physical therapy, a brace or cast, or surgery. Occasionally the disease heals on its own without treatment.
Slipped capital femoral epiphysis
A slipped capital femoral epiphysis occurs when the upper end of the thighbone (femur) slips at the area where the bone is growing (growth plate or physis) and does not fit in the hip socket correctly. The condition is most common in teenagers.
Rapid growth and a hormone imbalance during adolescence may cause the femur to slip.
Symptoms usually begin about 8 to 16 years of age, and they may begin earlier in girls than in boys.
Symptoms may be triggered by growing or gaining weight quickly. Symptoms may include:
- Hip tenderness and decreased movement during the early stages of the condition.
- Increased pain when the toes are turned in toward midline (internal rotation of the hip).
- Mild discomfort in the groin, thigh, or knee while walking or running. Rest relieves this discomfort.
- Stiffness and a limp, especially when the person is tired.
- Knee pain.
- Muscle spasms.
- Mild to severe pain.
Treatment to prevent further slippage and reduce complications of the condition often involves surgery to secure the growth plate (physis) with a single screw or with pins. A slipped capital femoral epiphysis may lead to early degenerative arthritis of the hip if it is not detected early and treated properly.
Hip Programs at Renown Children's Hospital
- Ultrasound screening
- Pavlik harness
- Abduction bracing
- Closed reduction casting
- Surgical open reduction
- Pelvic and femoral osteotomies