How do you know if a baby has hip dysplasia?
The term developmental dysplasia of the hip refers to an orthopedic condition where the acetabulum, or roof of the hip, is out of place to varying degrees. Currently three have been identified:
- Total hip dislocation.
- Hip subluxation (one part inside and one part outside).
- Acetabular dysplasia (the acetabulum or roof of the hip is horizontal instead of being vertical). The latter condition is quite common in Mexico, especially affecting white people.
What causes hip dysplasia?
This condition is much more common in girls, with an incidence ratio of 8-to-1, than in boys. Hip dysplasia is known to be caused by several factors, and the genetic aspect is very relevant in this condition. Parents who suffer from or have developed hip dysplasia should have an ultrasound for their children before they are 3 months old, or an X-ray after the age of 3 months to rule out the condition.
Developmental dysplasia of the hip is more common in the first pregnancy, or if the mother had deficiency of amniotic fluid; or when the baby comes in breech presentation (sitting position), in which case there is clear indication to have an ultrasound to determine if the baby will have a hip problem in the future.
Of the 73% of cases with dysplasia, 67% corresponds to left hip dysplasia and only 6% to right hip dysplasia. The remaining 27% occurs on both hips, bilaterally. Hip dysplasia is the second leading cause of hospitalization in pediatric orthopedic hospitals, especially in Mexico.
In developed countries and where few children are born, part of the protocol at birth is to perform an ultrasound. This measure has had a favorable impact, since hip surgeries have not been performed in more than 12 years thanks to early diagnosis. Another country that implements this measure is Chile, because newborn children have X-rays to prevent this condition in the future.
How do you detect infantile hip dysplasia?
Roberto Galván-Lizárraga, M.D., chief of education and head of the hip clinic at Shriners Hospitals for Children — Mexico, says that it is possible to detect the condition when changing the patient's diaper, “When changing the child’s diaper it is possible to notice there is a limitation when spreading the child’s legs, that is, when performing an abduction, you will be able to notice a clicking sound, also called the Ortolani sign.
When this is on one side, we notice that the legs don’t spread well, or when lifting the lower limbs, we may observe an asymmetry of the folds of the legs and buttocks. The diagnosis may be confirmed by an ultrasound, which is highly effective before 3 months of age.
Unfortunately, when the patient arrives at The Mexico Shriners Hospital, the diagnosis is already evident, because the patient arrives limping, or walking with both legs spread like a “duckling.” This is when the dysplasia is on both sides.