Hip dysplasia is a developmental condition that affects the hip joint in children, characterized by an abnormal formation of the hip socket (acetabulum) and/or the upper part of the thigh bone (femoral head). This condition can range from mild instability to complete dislocation of the hip joint.
Causation
The exact cause of hip dysplasia in children is multifactorial, involving both genetic and environmental factors. Genetic predisposition plays a significant role, with studies showing a higher incidence in families with a history of hip dysplasia[1]. Environmental factors during fetal development also contribute to the condition. These include:
- Intrauterine positioning: Breech presentation, particularly in the last trimester, increases the risk of hip dysplasia due to restricted fetal movement and pressure on the hips[2].
- Firstborn status: Firstborn children have a higher risk, possibly due to a tighter maternal uterus[1].
- Female gender: Girls are 4-5 times more likely to develop hip dysplasia than boys[3].
- Oligohydramnios: Reduced amniotic fluid can restrict fetal movement, increasing the risk of hip dysplasia[2].
Postnatally, tight swaddling that keeps the hips in an extended and adducted position has been associated with an increased risk of hip dysplasia[4].
Sequelae
Untreated or inadequately treated hip dysplasia can lead to significant long-term complications:
Short-term consequences:
- Limb length discrepancy: This can result in an abnormal gait and compensatory scoliosis[3].
- Delayed motor development: Children may experience delays in sitting, crawling, and walking milestones[1].
Long-term consequences:
- Early-onset osteoarthritis: The abnormal hip mechanics lead to increased wear and tear on the joint, resulting in premature osteoarthritis[5].
- Chronic pain: As the condition progresses, patients often experience chronic hip and groin pain, limiting their mobility and quality of life[5].
- Labral tears: The shallow acetabulum can lead to increased stress on the labrum, causing tears and further joint instability[3].
- Femoral acetabular impingement: The abnormal hip anatomy can result in impingement, further damaging the joint[5].
- Gait abnormalities: Persistent hip dysplasia can lead to a limp or Trendelenburg gait[1].
- Psychological impact: Chronic pain and functional limitations can affect mental health and social interactions[5].
Early diagnosis and treatment are crucial in preventing these sequelae. Screening programs, including clinical examination and ultrasound imaging, have significantly improved early detection rates[2]. Treatment options vary based on the child’s age and severity of the condition, ranging from non-invasive methods like the Pavlik harness for infants to surgical interventions for older children[3].
In conclusion, hip dysplasia in children is a complex condition with multifactorial etiology. While genetic predisposition plays a significant role, environmental factors during fetal development and early infancy also contribute to its occurrence. The potential long-term consequences of untreated hip dysplasia underscore the importance of early detection and appropriate management. Ongoing research continues to enhance our understanding of this condition, improving diagnostic and treatment strategies to optimize outcomes for affected children.
Citations:
[1] https://my.clevelandclinic.org/health/diseases/17903-hip-dysplasia
[2] https://www.mayoclinic.org/diseases-conditions/hip-dysplasia/symptoms-causes/syc-20350209
[3] https://www.healthdirect.gov.au/hip-dysplasia
[4] https://www.ncbi.nlm.nih.gov/books/NBK563157/
[5] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/developmental-dysplasia-of-the-hip-ddh
[6] https://orthoinfo.aaos.org/en/diseases–conditions/adolescent-hip-dysplasia/
[7] https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10585185/
CASE REPORT ON HIP DYSPLASIA
This case report from Frontiers in Pediatrics provides an interesting perspective on the potential role of manual therapy in late-diagnosed developmental dysplasia of the hip (DDH)[1]. The study describes two cases of children with late-diagnosed DDH who underwent a 6-month trial of manual therapy, resulting in improvements in femoroacetabular joint morphology, gross motor activity, and lower extremity muscle tone[1].
The authors hypothesize that manual therapy may promote changes in hip joint morphology through the restoration of normative mechanotransductive activity[1]. This is based on the principle that appropriate mechanical forces, when applied to joint surfaces, can direct growth and development through cellular responses to mechanical stimuli.
While these case reports present intriguing results, it’s important to note that they represent limited evidence. The authors acknowledge that additional cases and future trials are needed to further investigate this hypothesis[1]. The potential of manual therapy as an adjunct or alternative to static bracing in late-diagnosed DDH cases not responding to traditional methods is an area that warrants further research.
This study highlights the need for continued exploration of conservative management options for late-diagnosed DDH, especially in cases where traditional bracing methods may be less effective or poorly tolerated. However, larger-scale studies with rigorous methodologies are necessary to establish the efficacy and safety of manual therapy in managing DDH before it can be recommended as a standard treatment option.
Citations:
[1] https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.1045812/full