Pediatric Hip Disorders

Hip dysplasia refers to a condition affecting the hip joint, sometimes causing the loss of function. Several terms are commonly used to describe hip dysplasia:

• Acetabular dysplasia: The hip socket is too shallow, making the ball-and-socket hip joint unstable.
• Congenital hip dislocation: The hip is dislocated at birth.
• Developmental dysplasia or dislocation of the hip (DDH): involves abnormal formation of the hip joint in which the ball of the hip is not stable in the hip socket.

Risk factors and symptoms of hip dysplasia

Although the exact cause of hip dysplasia is not known, this disorder tends to run in families and is more common among girls, firstborn infants and breech babies – those born in a feet-first position. Generally, there are no symptoms from dislocated hips in young children. But children should be examined by a pediatrician or a pediatric orthopedic specialist if they experience any of these symptoms:

• Legs of different lengths
• Uneven thigh skin folds
• Less mobility or flexibility on one side
• Limping

Treatment for hip dysplasia

Pediatricians screen for hip dysplasia at a newborn's first exam and at every checkup. Early diagnosis is important to make treatment easier and safer for children. Treatment methods depend on the child's age:

• Newborn: We treat an unstable hip with a Pavlik harness. The harness has straps that allow the baby to move about freely while holding the hip in place and preventing movements that would make the condition worse. Worn for one to three months, this device has a success rate between 80 and 95 percent, depending on the child’s condition.
• One month – two years: If the Pavlik harness isn’t successful, then we may manipulate the joint back into the socket without surgery and maintain it with a body cast. These closed treatment methods are most often successful, but occasionally surgical hip relocation is necessary later on.
• After two years: Deformities may become severe, and your child will require surgery to realign the hip. We follow this surgery with a body cast and/or brace to keep the hip in the joint. No matter what procedure we perform, we’ll continuously monitor your child’s hip development to ensure that it is healing normally and rule out further reconstruction. Corrective reconstruction of the hip and/or pelvis can help prevent the need for hip replacement later in life.

A child has the best chance of developing a normal, properly functioning hip joint when hip dysplasia is treated early. Untreated or partially treated hip dysplasia can lead to arthritis and hip pain in adolescents and adults.

When one leg is shorter than the other, it is called leg length discrepancy (LLD). In children, this can result from a congenital condition – one that is present from birth. It can also happen after an injury, or due to neuromuscular disorders like cerebral palsy. Those with LLD tend to lean to one side when walking. LLD can cause problems in a child’s gait and posture, leading to other conditions like scoliosis – a spinal deformity.

Children with LLD will need corrective surgery. We offer several surgical treatments, such as:

• Lengthening the shorter leg
• Shortening the longer leg
• Limiting growth of the longer leg to allow the shorter one to grow to a matching length

Recovery time after these procedures varies depending on the kind of procedure we perform. It’s common for children to experience muscle weakness and the loss of function for two or more months. We’ll work with you and your child to make sure you understand what this surgery will entail and how to make the recovery as smooth as possible.

Legg-Calves-Perthese disease (LCPD) involves the upper end of the thighbone (femoral head) becoming weaker from a lack of blood supply. The femoral head eventually becomes brittle and may collapse, leading to deformity and arthritis. The cause of LCPD is not known, though boys develop LCPD four times more often than girls.

Symptoms of LCPD

A child with LCPD often first feels pain in the knee or thigh. The pain may build slowly over several months. The child may lose the ability to rotate the hip, and develop a limp.

Treatment for LCPD

The goal of LCPD treatment is to keep the head of the thighbone covered by the socket to prevent deformity and to encourage the femoral head to grow again. Treatment depends on the child's age and the extent of degeneration in the femoral head. The sooner a child with LCPD is diagnosed, the better the treatment options are. These may include exercises, leg braces or surgery.

Children under 6 years old have a better chance of recovery from LCPD than older children who have completed, or nearly completed, their growth.

The femoral epiphysis is the head of the femur that forms part of the hip joint. It is separated from the main part of the thighbone by cartilage while the bone is still in the process of growing. In adolescents, the capital femoral epiphysis may slip off the thighbone, causing pain and loss of range of motion. This condition most often occurs in children between 10 and 16 years old and is more common in boys than girls.

Symptoms of SCFE

This hip disorder can have different symptoms depending on its type:

• Acute slip: a sudden onset of pain and loss of function, sometimes after trauma.
• Chronic slip: gradual, with slowly increasing symptoms over a period of weeks or even months. In chronic slipping, there may be no history of trauma and the symptoms are often quite mild, amounting only to aching, fatigue, a feeling of stiffness after standing or walking, knee discomfort, and a limp.
• Acute slip superimposed on a chronic slip: a sudden onset of pain and loss of function that follows weeks or months of knee discomfort or a limp.

Since the pain of a slipped capital femoral epiphysis is frequently felt in the knee, parents often miss the chance for an early diagnosis of their child’s SCFE. Symptoms of this hip disorder may be attributed to "growing pains" or muscle strain. It is important for a pediatric orthopedic to examine children, adolescents and young adults with these symptoms before they become worse.

Treatment of SCFE

The degree of slipping and the duration of symptoms will help to determine how we treat this hip disorder. We generally use a single screw to stabilize the upper end of the femur -- the epiphysis. We use a tiny incision to insert this screw surgically, and most patients are able to walk immediately following surgery. Children who have extensive deformity of the upper end of the thigh bone may require reconstructive surgery.

We treat a number of other hip disorders in youth and adolescents, including:

• Acetabular dysplasia
• Acetabular fracture
• Acetabular labral tears
• Avascular necrosis
• Bursitis of the hip
• Complex sports hernias and groin injuries
• Femoral acetabular impingement
• Post-traumatic joint disease
• Synovial diseases (such as pigmented villonodular synovitis and synovial chondromatosis)