HIP DYSPLASIA (Congenital Hip Luxation)
Approximately 1% of white newborn children present hip dysplasia. The incidence among Chinese, Korean and black children is smaller.
It is four times more frequent in girls, and the left side is the most frequently affected (60%).
Factors: first pregnancy, female baby, clunes, torticollis, varus foot, family tendency.
There are many theories that try to clarify the causes; some emphasize on an anomalous position of the baby during intrauterine life. Other theories talk about ligament laxity or about initial dysplasia of a part of the hip (acetabulum), which is the first expression of hip luxation. Many authors believe in the first two as the strongest, and one can complement the other.
Quite often, the newborn baby has certain instability in the area of the hips and in most cases it is solved spontaneously during the first days.
During the neonatal check-up the pediatrician makes certain movements with the baby’s legs and hips (Ortholani and Barlow), he measures the child’s inferior limbs, compares their shape and associates the background mentioned (clunes, sex of the baby, etc.) to reach the clinical diagnosis of Hip Dysplasia.
Associated with the physical examination and according to the clinical findings, the pediatrician can request radiological studies (the hips echography is quite specific for a diagnosis during the first days or months of life).
Hips radiographs can be useful. There are specialists who think that until the fourth month many doubts may arise about this kind of studies because before that age the secondary centre of ossification of the head of the femur is not completely developed.
A normal radiograph taken before the fourth month of life may suggest the existence of such pathology.
Therefore, the hips echography is an excellent diagnosis method during that period of time.
What may happen if this problem is not treated?
There may be future complications such as: osteoarthritis, pain, abnormal walking, the baby’s inferior limbs may be different in size, etc.
There are no doubts about the importance of making an early diagnosis and starting the treatment fast, which will be decided by the specialist in children’s traumatology.
During the first six months of life and in the case of children who show the above mentioned characteristics, the treatment consists in reducing the head of the femur to the interior of the acetabulum by means of Pavlik's hardness, an innocuous method well tolerated by babies. The duration of this treatment varies but about six weeks are enough to obtain a good response.
In the case of older children, special plasters and even traumatologic surgery are applied to if needed.
The most important thing is to know that an early diagnosis, made during the neonatal stage or the first months of life can prevent more uncomfortable and difficult treatments than the simple Pavlik's hardness.
Pediatricians look forward to the moment when health insurance will cover echographs without obstacles. Many of us consider those studies should be done on all newborn babies as a routine, like we do as regards blood tests to detect hypothyroidism and phenylketonuria, for instance.