Are you worried about your little one's hips? Let's talk about hip dysplasia!

Just like the joy that comes to your mind when you look at a newborn baby, sometimes it's normal to feel scared even when you see something small, right? Especially when the doctor says that there is a slight difference or problem in the baby's hip bone, it makes your heart flutter. That's what this hip joint deformity, or as doctors call it (Hip Dysplasia) , is. Just think, even though this word is a little scary when you hear it, let's talk about it simply, in a way that you can understand.

What is this hip problem (Hip Dysplasia)? Simply put...

Simply put, (Hip Dysplasia) is a condition in which the bones in our hip joint do not fit together properly. Did you know, our hip joint is a very important joint. It is where our thigh bone (that is, the (Femur) ) connects to our hip bone (that is, the (Pelvis) ). This joint is formed like a ball being stuck in a cup. The ball-like part on the top of the thigh bone ( (Femoral Head) ) must fit perfectly into a cup-like socket on the hip bone ( (Acetabulum) ).

So, in someone with Hip Dysplasia, the ball and socket don't fit together properly. Maybe the socket isn't deep enough, or the shape of the ball is different. This is where the problems arise. When this doesn't fit properly, the cartilage around the joint (the cushion that protects the joint when two joints hit each other) can become damaged and worn down. That's when things like hip pain and stiffness come in. Also, the hip bone is more likely to dislocate.

This condition most often affects babies and young children . Sometimes doctors call it Congenital Hip Dysplasia or Developmental Dysplasia of the Hip (DDH) . These are all names for the same condition. However, sometimes the symptoms of this condition may not be apparent during childhood and may appear later in life.

If you have hip pain that doesn't go away in a few days, or if your baby seems to be in pain, or if one leg looks different than the other, you should definitely see a doctor.

Who is most affected by this condition? How common is it?

As it is known, in countries like America, about one in 1000 newborn babies has this condition (Hip Dysplasia) . This condition is also seen in Sri Lanka. That is why doctors specifically check the hip joint of babies as soon as they are born, and also in the clinics they give afterwards.

What are the symptoms? How do you recognize it?

The symptoms of hip dysplasia may change slightly with age.

Common symptoms (in adults and toddlers):

• Hip pain (often in the groin area).
• The hip feels loose and not strong enough.
• It looks like a limp when walking or moving.
• Leg length discrepancy (one leg appearing shorter or longer than the other).

These symptoms may vary for young babies who have not yet started walking:

• One leg appears to be turned outwards more than the other.
• Feeling as if one leg is shaking less than the other.
• Uneven skin folds on the thighs and buttocks. Imagine that when a mother bathes her baby, one leg looks a little more wrinkled than the other, or one leg looks a little more turned out than the other. These are the small signs that can be present.

At what age do babies start to show these symptoms?

Doctors often diagnose this condition in babies under 6 months old . Sometimes, it can be diagnosed right after the baby is born. Even if you don't notice much difference at home, the doctor will check the baby's hip joint at every clinic visit. So there's nothing to worry about.

Older children, young people, and sometimes adults can also experience this condition, but it is a little less common.

Why does this hip problem (Hip Dysplasia) occur? What are the causes?

Hip Dysplasia occurs when the femur ( thigh bone ) does not fit properly into the socket (acetabulum) of the hip bone. This can be caused by several factors:

• The hip socket is shallower than the pelvis .
• The head of the thigh bone ( Femoral Head ) has a different shape than normal.

For many people, this condition is congenital .

• This can happen due to pressure on the hip joints due to the baby's position during pregnancy .
• Also, this can be a genetic condition , meaning it can be inherited from parents to children.

What are the risk factors?

Anyone can develop this condition, and any baby can be born with it. However, some people are at a slightly higher risk:

• This condition is more common in girls than boys.
• This risk is higher for firstborn babies .
• Although this can affect both hips, the left hip is most commonly affected.

What other complications can this cause?

Adults and babies with hip dysplasia are at increased risk of hip dislocation . Usually, a hip dislocation occurs as a result of a major accident, such as a car accident or a fall from a height. However, with hip dysplasia, the hip joint is naturally weak, so it is more likely to happen. In addition, the muscles and ligaments around the hip may become loose.

Other complications that can be seen include:

• Hip Labral Tears: This is damage to the cartilage in the hip joint.
• Osteoarthritis: An arthritis condition that causes the joints to wear down over time.
• Unstable Hip Joints: Persistent pain caused by the hip joint not being properly aligned.

Therefore, a doctor will advise you on how to avoid accidents and reduce your risk of hip dislocation.

How do you diagnose this exactly?

A doctor will diagnose hip dysplasia through a physical exam and some imaging tests . You will need to tell your doctor when you first started feeling pain in your hip and whether the pain gets worse when you do anything.

Your baby will be checked by your doctor for signs of hip dysplasia immediately after birth and at every clinic visit thereafter.

What tests do doctors use to diagnose this?

These tests can be used to take pictures of your (or your child's) hips:

• Ultrasound scan: This is the first thing done for a baby.
• Hip X-rays: For older children and adults.
• CT Scan (Computed Tomography - CT scan): In some special cases.

What are the treatments?

A doctor may recommend treatments for hip dysplasia to reduce pain and protect the hip joint. The most commonly used treatments are:

• Wearing a brace/harness: Young babies may need to wear a special brace or harness to help keep their hip joint in the correct position. Think of it like a Pavlik Harness . This helps the hip joint to form properly as the baby grows. Especially if this treatment is started on babies under 6 months old , the condition often improves on its own. You will need to wear this brace for several months.
• Physical Therapy: A physical therapist will teach you special stretches and exercises to strengthen the muscles around your hip and increase the flexibility of the joint.
• Hip Dysplasia Surgery: If other treatments don't work, your doctor may recommend surgery. The main surgeries for hip dysplasia are Hip Osteotomy (which involves reshaping the bones) and Hip Arthroscopy (which involves inserting a camera through a small incision to repair damage inside the joint). In severe cases, especially with osteoarthritis , a hip replacement (Arthroplasty) may be necessary. Your surgeon will explain to you what type of surgery you (or your child) will need and what to expect.

Is there a way to prevent this?

Actually, there is nothing you can do to prevent your child from being born with Hip Dysplasia . And you can't prevent it from developing either. It happens when the hip joint doesn't form properly. That means it's not something that's caused by a parent's negligence. So don't worry about it.

However, you can ask your doctor for advice on how to protect your baby's hip joints as they develop. For example, be aware of things like swaddling your baby so that there is no pressure on the hips and that the legs can be freely positioned.

How is the recovery after this situation? (Outlook)

This is the most important thing. For most babies, if this condition (Hip Dysplasia) is recognized and treated early, there will be no long-term effects. In most cases, they will have to wear the brace for a few months to allow the hips to adjust properly. After that, they can live without any problems or complications. If they get treatment for this when they are young, they may not even remember it when they are older!

Even adults can return to their normal activities after treatment, once the doctor gives permission.

When should you see a doctor?

• If you have hip pain that doesn't go away even after a few days of rest.
• If your child seems to have any symptoms of Hip Dysplasia (as mentioned earlier, differences in the legs, differences in wrinkles, etc.).

Do you need to go to the Emergency Treatment Unit (ETU) ?

Yes, if you think you or your child has a dislocated hip , go to the emergency room immediately . Never try to put a joint back into place yourself. Keep the joint as still as possible and get to a hospital as soon as possible.

What are the important questions to ask the doctor?

When you see a doctor, it's important to ask all your questions. Here are some examples:

• Does my child have Hip Dysplasia or another congenital hip problem?
• How often should I have my child's hips checked?
• What kind of treatment do I/my child need for Hip Dysplasia ?
• Will I/my child need surgery?

Is it good to walk when you have Hip Dysplasia?

Adults with hip dysplasia can walk and move normally. However, your doctor or physical therapist can tell you how much walking you need to do or other exercises to keep your hips strong and flexible. However, don't overdo it . Don't force yourself to move or exercise until you feel pain. Ask your doctor how much and what kind of exercise is safe for you.

Finally, things to remember (Take-Home Message)

It's normal to feel scared when you learn that your baby has a congenital health condition that you can't prevent. However, Hip Dysplasia is a very treatable condition. Especially for young babies. Many children will need to wear a brace for a few months, but once the hip joint is properly aligned, it will heal without any long-term effects.

Therefore, without worrying, follow the doctor's instructions carefully. Don't miss your baby's clinics. Then, even if there is a situation like this, you can quickly recognize it and start the necessary treatment.

Ask your doctor about the signs of hip dysplasia to look out for at home. They will check your baby's hips at every clinic to make sure this condition is identified and treated as soon as possible.

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