Main
- Hip dysplasia — a congenital mismatch between the shape of the socket and the femoral head, leading to joint instability.
- Risk factors: breech presentation of the foetus, heredity, female sex of the child, the course of pregnancy and the mother's first childbirth.
- Signs in infants: asymmetry of the skin folds on the thighs, limited abduction of the legs, different leg lengths when lying on the back.
- Examination: examination by an orthopaedic traumatologist or paediatrician, ultrasound of the joints in infants, radiography in older children and adults.
- Treatment: observation by an orthopaedist, orthopaedic devices, therapeutic exercise and physiotherapy, and in pronounced changes — surgery.
What is hip dysplasia
Hip dysplasia is a congenital condition in which the acetabulum and the head of the femur are developed incorrectly and do not match in shape. Because of this mismatch, the joint may be unstable, which over time sometimes leads to dislocation and impaired gait.
What happens in the body
Hip dysplasia affects the junction of the pelvic and femoral bones, where the acetabulum and the head of the bone form disproportionately to each other. Normally, the head of the femur fits tightly into the acetabulum and is held there by ligaments and a cartilaginous rim. In dysplasia, the acetabulum may be too flat or shallow, and the head of the bone is displaced relative to its usual position. Because of this, the ligaments experience increased load and gradually stretch, losing the ability to hold the joint securely. The child may move the leg more freely on one side, and the folds on the thighs look unequal. Over time, the instability increases, and the head of the bone may slip out of the acetabulum, that is, a dislocation may occur. Parents should show the baby to an orthopaedic surgeon if the movements of the legs seem asymmetrical.
What causes it to develop
- Breech presentation of the fetus: the baby is positioned in the uterus with the legs or buttocks down, and the joint forms in cramped conditions.
- Hereditary predisposition: if close relatives had this feature, the risk for the child is noticeably higher.
- Female sex of the child: in girls this condition occurs more often than in boys, which is related to the characteristics of pelvic development.
- Features of the course of pregnancy: an unfavourable course of pregnancy affects the formation of the joint and increases the likelihood of the disorder.
- First childbirth for the mother: in a first pregnancy, the uterus and ligaments are less stretched, which creates additional pressure on the fetus.
Who encounters this more often
Hip dysplasia is more often detected in newborn girls, as well as in children who were in breech presentation before birth. Heredity also plays a noticeable role: if the parents or older siblings had this feature, the probability increases. The course of the mother's pregnancy, especially during first childbirth, adds its own contribution to the formation of the joint. In boys, the condition occurs less often, but is not completely excluded, so examination is carried out for all children without distinction. The doctor assesses the symmetry of the folds, the length of the legs and the range of movements in the joint during a routine appointment. Early detection helps to start observation in time and avoid serious consequences for gait. It is useful for parents to know about the risk factors in order to ask the doctor clarifying questions at the appointment.
What symptoms can occur?
Hip dysplasia is recognised by a number of external signs that depend on age. Some changes are visible already in infants, while others appear later — when walking and moving.
How it is noticed at the very beginning
In infants, hip dysplasia often causes no noticeable complaints, so it is detected during routine check-ups. Parents may notice asymmetry of the folds on the thighs, different leg lengths, or limited movement when trying to spread the legs apart. Such signs are easily put down to body build or to tiredness after bathing and swaddling. Limited abduction of the legs may be noticeable when changing a nappy, when one leg is moved to the side less well than the other. Different leg lengths show up when the child is laid on their back with the legs straightened. If nothing is done, over time the gait may change, and the joint will develop incorrectly. Therefore any doubts should be shown to a doctor at a routine appointment, without waiting for more obvious symptoms.
Signs that occur most often
- Asymmetry of the skin folds on the thighs in an infant: the folds on one side are deeper or positioned differently, which parents notice when swaddling.
- Limited abduction of the legs to the sides: the leg cannot be moved aside as freely as the other, and this is noticeable when changing a nappy.
- Different leg lengths: when laid on the back, one leg appears shorter than the other, which indicates displacement in the joint.
- Limping or a change in gait: an older child or an adult begins to limp, and the gait becomes unusual and asymmetrical.
- Pain or discomfort in the hip joint area: unpleasant sensations appear during movement and walking, sometimes at rest.
- Rapid fatigue when walking: an ordinary walk becomes harder than before and requires frequent stops to rest.
When to seek help urgently
Examinations and tests
Examination for hip dysplasia is based on a doctor's assessment and imaging methods. Some methods are suitable for infants, while others are used in older children and adults.
How the examination begins
The examination begins with an assessment by an orthopaedic traumatologist or paediatrician, and this is the first step towards understanding the condition of the joint. The doctor assesses movement in the joint, leg length and the position of the skin folds, comparing the right and left sides. They observe how the child moves, how they place their legs and what the range of motion in the hip joint is. Such an assessment helps to notice asymmetry, restricted mobility or shortening of one leg. Based on the results of the examination, the doctor decides whether imaging is needed and which method is suitable at this age. In young children, ultrasound is usually used; in older children and adults, radiography. If the examination findings and images are insufficient, additional imaging methods are prescribed to assess the condition of the joint and plan treatment. Therefore, it is worth coming to the appointment with existing reports so that the doctor can see the picture over time.
What is prescribed and what it shows
What to prepare for the appointment
- Discharge summaries: bring all previous doctors' reports so that the specialist can see how the situation developed and what was already noted during examinations.
- Images and ultrasound results: bring the images themselves and their descriptions, as they allow the current picture to be compared with the previous one.
- Observations of the child: write down how the child moves, how they place their legs and what concerned you about their gait or movements.
- Questions for the doctor: formulate in advance what you want to clarify so that you do not forget anything important during the conversation at the appointment.
- Brief timeline: note when the first changes appeared and by what age they became noticeable; this will help the doctor assess the dynamics.
Which doctor should I see?
This section explains which doctor to consult if hip dysplasia is suspected, what happens at the first appointment and what areas of care the treatment consists of.
Which specialist manages this condition
Hip dysplasia is managed by a trauma and orthopaedic surgeon, while in infants this feature is first noticed by a paediatrician and a neonatologist. The paediatrician examines the child at routine appointments and, if in doubt, refers them to an orthopaedic surgeon; the neonatologist observes newborns while still in the maternity hospital. At the first appointment, the trauma and orthopaedic surgeon examines the joints, assesses movement in them and compares both legs with each other. The doctor clarifies how the pregnancy and childbirth went, how the child is growing and when they started walking. If there is no specialist orthopaedic surgeon nearby, start with the paediatrician at your place of observation: they will examine the child and advise where to go next. For adults with discomfort in the pelvic area, the first step is also a trauma and orthopaedic surgeon. Write down in advance the questions you want to ask the doctor so that you do not forget anything at the appointment.
What the treatment consists of
- Observation by a trauma and orthopaedic surgeon: regular examinations show how the joint develops over time and help to change the approach in time.
- Orthopaedic devices for infants: special devices hold the legs in the required position so that the joint forms correctly.
- Therapeutic exercise and physiotherapy: exercises and procedures strengthen the muscles around the joint and maintain its mobility at an older age.
- Selection of therapy by the doctor if necessary: the decision on additional help is made by the specialist taking into account the age and degree of the disorder.
- Surgery for pronounced changes: intervention is discussed when conservative measures have not given the required result and there are indications.
What depends on the patient themselves
The regularity of observation by a specialist largely determines how the situation with the hip joints will develop. If appointments are missed, the doctor does not see changes in time and cannot adjust the care. Parents should come to examinations at the appointed times and honestly tell how the child tolerates the devices and exercises. Home therapeutic exercise sessions give an effect only with constant repetition, and not from time to time. It is useful to record observations between visits: how the child moves, how they sleep, what causes concern. If new complaints appear, do not postpone the visit to the doctor, even if there is still time until the routine appointment. Calm and consistent implementation of the specialist's recommendations helps not to miss important changes.
What helps prevent an exacerbation?
Preventing the worsening of hip dysplasia is helped not by a single remedy, but by everyday care and an attentive attitude to the child's development. Below — what depends on the parents themselves and how regular monitoring reduces the risk of deterioration.
What is changed in habits
Organising everyday care for a child with hip dysplasia directly affects the course of the condition and its prognosis. Free swaddling without tightly binding the legs leaves the joints the opportunity to move through a physiological range. Carrying in a sling or in the arms with the hips abducted maintains the correct position of the femoral head in the socket. Placing the baby on the tummy during waking periods strengthens the muscles of the back and gluteal region, which is important for joint stability. Exercises and massage recommended by a specialist are performed at home daily and gently, without sudden movements or forcing through pain. Timely onset of crawling and walking without forcing events reduces the load on immature structures. If the child lies in one position for a long time or parents postpone the recommended exercises, the muscles weaken, and the position of the joint changes for the worse. Therefore, the daily routine should be arranged so that movement and rest alternate evenly.
What should be kept under control
- Preventive check-ups: they are carried out by the paediatrician and orthopaedic surgeon according to an established schedule, in order to notice changes in time.
- Ultrasound screening: it is prescribed for infants from risk groups, since it shows the condition of the joints at an early stage.
- Suspicious signs: asymmetry of the skin folds, limited hip abduction or different leg lengths require early consultation with a doctor.
- Physical development: following the specialist's recommendations on exercises, massage and movement regimen supports the correct formation of the joints.
- Observation diary: brief notes about the child's movements and reaction to exercises help the doctor assess the dynamics more accurately.
How often to see the doctor
Regular visits to the paediatrician and orthopaedic surgeon are needed even when the child feels well and nothing worries the parents. There is no specific prevention of dysplasia, since it forms in utero, so it is monitoring that allows changes to be caught at an early stage. The doctor assesses the symmetry of movements, the range of hip abduction and whether the skills match the age, and if necessary refers for an ultrasound examination. Between check-ups, parents themselves watch how the child rolls over, sits up and takes the first steps, and notice lagging behind or stiffness. If scheduled appointments are missed, changes may remain unnoticed, and treatment begins later, when it is more difficult to correct the position. Early detection and timely start of therapy improve the prognosis, so the schedule of check-ups is best not shifted without reason. It is useful to write down questions for the doctor in advance and to take the observation diary with you, so that the appointment is meaningful.
What is worth remembering
Hip dysplasia is a condition in which the acetabulum and the femoral head do not develop fully and do not match in shape. The discussion of it should be concluded with a few points that will help the reader make the right decision.
Key conclusions
Hip dysplasia does not always manifest as pain, so it is often discovered incidentally during an examination for another reason. Asymmetry of the folds in an infant, limited hip abduction, different leg lengths and limping when walking help to notice the problem. In adults, hip dysplasia makes itself known through rapid fatigue on exertion and discomfort in the hip or groin area. The earlier the condition is detected, the more ways there are to influence its course without radical measures. One should not postpone a visit to the doctor if hip dysplasia is suspected: lost time narrows the choice of options. The support in making a decision is not the internet, but an examination by a specialist and the investigations they prescribe. The main mistake is to attribute the first signs to fatigue or age and not have the joints checked for years.
