DEVELOPMENTAL DYSPLASIA OF THE HIP
Developmental dysplasia of the hip (DDH) is a term that describes a spectrum of conditions relating to the stability of the hip joint in the infant or growing child. It may be used to describe everything from a complete hip dislocation to minor abnormalities in the formation of the hip joint that affect its stability.
Diagnosis/ What to look for:
In the newborn, the diagnosis is often made by the pediatrician during his or her first physical examination in the newborn nursery. If there is suspicion for DDH, the diagnosis is confirmed with an ultrasound.
In the toddler or older child, the diagnosis can be more difficult to make. The condition is not painful, but can cause the child to have a waddling gait or a limp. X-rays of the hips will be necessary if there is suspicion for DDH in the older child.
Your pediatric orthopedic surgeon will select the best treatment option for your child, based on the severity of the hip instability. The objectives in treatment are to reduce the hip joint (put it back into the socket) and hold it there as the child grows and develops. One of the most common treatments is the Pavlik Harness, which a device that uses straps around the shoulders, chest and legs to prevent the hips from dislocating (coming out of the socket). Surgery is occasionally necessary.
Legg-Calve-Perthes Disease (LCP) is a painful disorder involving the hip joint in children between the ages of 4 and 8. It is more common in boys than girls by a ratio of 4:1. One of the most controversial topics in pediatric orthopedics, there is still much debate about not only what causes LCP, but the best way to treat it.
Diagnosis/What to Look for:
Children with LCP most commonly present with limping. They usually do not complain of pain unless specifically questioned, and when they do have pain, it is usually activity related. The diagnosis is often made with just an X-ray, but on occasion an MRI or bone scan is necessary.
The goals in treating LCP are to prevent deformity, stop growth disturbance and prevent future problems. The best way to achieve these goals remains controversial and is very dependent on the severity of the condition and the age of the child. Often times brief periods of rest, NSAID’s and stretching are effective, but occasionally surgery is necessary.
SLIPPED CAPITAL FEMORAL EPIPHYSIS
Slipped Capital Femoral Epiphysis (SCFE) occurs when the growth plate of the proximal femur (the “ball” portion of the “ball-and-socket” hip joint) slips off of its location at the top of the bone. It occurs in adolescent boys and girls between the ages of 10 and 15 and has a higher incidence in children who are overweight.
Diagnosis/What to look for:
The most common symptoms of SCFE are groin or hip pain and limping. Up to 50% of patients however, may have no hip pain at all, and many (up to 40%) have only knee pain. The onset of symptoms is usually gradual, and is very rarely associated with a traumatic event. The diagnosis can usually be made with an x-ray of the hip, but in very mild cases (pre-slip) an MRI is necessary.
The goals in treatment of SCFE are to prevent further slippage and avoid the most feared complication, osteonecrosis (ON) of the femoral head. This occurs when the blood supply to the femoral head is disrupted, and as a result, a portion of it undergoes necrosis (dies). The best way to achieve both of these goals is urgent surgical stabilization.