What is developmental hip dysplasia? DDH is one of the most common congenital conditions but maybe one you haven’t heard of, until now?
According to the International Hip Dysplasia Institute, around one in 20 full-term babies have a degree of hip instability and between two to three in every 1,000 infants will require medical treatment.
Despite the prevalence of the condition, information is scare and support scant. When Natalie Trice’s son was diagnosed six years ago all she could find were horror stories and awful images when all she wanted were the facts.
The facts about developmental hip dysplasia
just in case you are wondering, it is a little something like this:
- DDH occurs when the ball and socket hip joint fails to develop correctly and whilst it isn’t life threatening, it certainly is life changing and that has been the case for my family.
- The ball is called the “femoral head” and is at the top of the femur or thighbone. The socket is called the “acetabulum” and this is a part of the pelvis. Ligaments, muscles and a joint capsule hold them together and promote growth and strength.
- In a normal, healthy hip, the head of the femur is smooth and round and the acetabulum is a smooth cup-like shape and the two sit together like an egg in an egg-cup.
- DDH occurs when the two don’t fit snugly together.
- There are various degrees of DDH severity and it is fair to say that no two cases are ever the same and this can be one of the hardest things about this condition.
- The main elements for parents, and health professionals, to be aware of are:
- If the ball is not held in place securely this can indicate a shallower than average socket; this is called acetabular dysplasia
- A shallow socket can create an unstable joint which means the ball may slide in and out of the socket, this is called a dislocatable or subluxatable hip
- If the ball simply has no contact with the socket and stays outside the joint, it is called a dislocated hip
In many cases there is no clear, identified cause or risk and even the most qualified medical professionals cannot predict DDH and do not known why a baby develops the condition.
Can DDH be detected in the womb
DDH cannot be detected in the womb but we do know that statistically DDH is more common in:
- A baby born in the breech position
- A baby who was breech in the last three months of pregnancy
- A family history of DDH
- First pregnancies
- Baby girls
- A deficiency of amniotic fluid in the womb
- Babies with tortorticollis, a tightness of the muscles on one side of the neck
- Babies with a mild foot abnormality
If any of these risk factors apply to you, it is worth discussing them with your midwife and having the details recorded.
Within 72 hours of giving birth, your baby’s hips should be checked as part of the newborn examination and will be checked again when they are between six and eight weeks of age.
During the examination there will be some gentle manipulation of your baby’s hip joints and whilst this shouldn’t cause any discomfort, they might protest at cold hands and being handled.
If it as this pint that an unltrasound scan might be requested and this will be because:
- the hip feels unstable
- there’s a family history of childhood hip problems (as above)
- your baby was breach, you had twins or a multiple birth or your baby was born before the 37th week of pregnancy
Sometimes a baby’s hip stabilises on its own before the scan is due, but if this isn’t the case and DDH is diagnosed, do not panic.
For some children, those found earlier enough, a soft harness (Pavlik harness) can correct the situation. This harness secures both hips in a stable position and allows them to develop normally.
For others, like Natalie’s son, surgery is necessary and not only will this allow the hips to develop but also prevent a life of pain, hip replacements and limps.
Natalie told us
“I was left floundering to navigate the murky waters of DDH six years ago and I hope that the writing on my blog, and the launch of my book Cast Life, will make things a little bit easier.
As well as looking at the medical details of DDH and treatments, this book also looks at the emotional issues. It contains comments from experts as well as parents and real life case studies show that however hard life with DDH might seem, you can do it and there is light at the end of the tunnel.”
Natalie’s son was a late diagnosis, this isn’t uncommon, so it is also worth noting some of the signs to look out if you are worried about your child:
- one leg is longer than the other
- uneven skin folds in the buttocks or thighs – this is a class sign that many parents do look for
restricted movement in one leg when you change their nappy
- one leg drags behind the other when your child is crawling
- a limp, walking on toes or developing an abnormal ‘waddling’ walk
If you do have concerns, speak to your health visitor or GP who can then referred you to an orthopaedic specialist in hospital for an ultrasound scan or X-ray, depending on your child’s age.
It was information like this that Natalie felt simply wasn’t out there, so not content with writing a book, Natalie also set up DDH UK, the only charity in the UK dedicated to supporting those on their hip journey as well as raising awareness and putting this life changing condition on the map for once and for all.
As well as a growing, supportive Facebook forum, there is a buddy system, regional groups, coffee mornings and fundraising events and the charity’s Patron is Gemma Almond, a Paralympic swimmer with bilateral DDH.
If you are concerned about your child, speak to your health visitor or GP and for more information go to www.ddh-uk.org