Your baby’s hips will be checked as part of the newborn physical screening examination within 72 hours of being born and again at six to eight weeks of age.
The examination involves gently moving your baby’s hip joints to check if there are any problems, especially a condition called hip dysplasia but this should not cause them any discomfort.
But what exactly is hip dysplasia and how does it occur. Here are some take-home points on the condition.
What is hip dysplasia?
This is a condition characterised by a relatively shallow hip acetabulum (cup) in comparison to the femoral head (ball). This may lead to subluxation (malalignment) of the joint and in extreme cases dislocation.
How does it present?
This problem usually presents painlessly, so a high index of clinical suspicion is needed. When the hip begins to dislocate, there is stiffness and pain on attempted separating of the legs.
At this point, an X-ray of the pelvis will give a clear diagnosis. If the child is yet to attain months of age, an ultrasound scan is used to assess the hip joint.
What causes hip dysplasia and what are the risk factors?
It is not known what causes hip dysplasia but it is thought to occur in the womb as the child is growing. There is a hereditary component to the condition.
For good development of the hip, the femoral head should be located well within the acetabulum and any impediment to this may be considered a risk factor.
This includes a first-born child (because of a smaller womb applying abnormal pressure to the growing limbs), breech position and female gender (more laxity in soft tissues).
How common is it?
We may not have data on this condition locally but worldwide, the incidence is about one in 1,000 births.
However, it is more common in certain communities than in others. Thankfully, perhaps because of the way babies are carried, it is relatively rare in Africa.
Are there tell signs or this problem that parents can be on the lookout for?
If there is a relative in the family with a history of hip dysplasia, the parents should have a high index of suspicion and mention this to their healthcare professional.
Any clicking or clunking of the hip should be evaluated. If the legs appear to be of unequal length this should prompt a visit to the doctor.
Most commonly though, it is one-sided stiffness of the hip, e.g. when changing nappies, that leads to parents seeking medical attention.
How is this problem treated and what is involved in the treatment?
If the problem is diagnosed in the first few weeks of life, it is usually treated in a device called a Pavlik harness, which keeps the hips flexed and spread, in an ideal position, for about six weeks.
If found after a few months, a “rhino cruiser”, or hip brace is used until the hips are normal. If not diagnosed in the first year of life, then often an operation to better place the hip is required.
If left unmanaged, what risks can occur in the long term?
If left unmanaged, the hip may dislocate leading to stiffness, pain, limb length inequality and overall disability.
Even if the hip does not dislocate, because the ball and socket are not ideally placed in hip dysplasia, degenerative changes start to take place early in adult life leading to arthritis.
Can it be diagnosed prenatally?
Hip dysplasia cannot be diagnosed prenatally reliably, but this is not required since if picked up in the first weeks of life, treatment is straightforward and effective.
What are some of the coping tips once diagnosed?
The disease is treatable. The earlier it is diagnosed, the better the outcome.
Parents, especially of children with risk factors, should get in touch with their family doctor soon and organise an appointment for history to be taken and an examination to be conducted.
If there are any concerns, then a referral should be made to a paediatric orthopaedic surgeon.
Dr Baraza is a Consultant Paediatric Orthopaedic Surgeon at Aga Khan University Hospital, Nairobi.