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Hip Dysplasia

Posted 03 October 2018

What Causes Hip Dysplasia-

The cause of hip dysplasia is not known but we do know human babies are not born ready to walk, their hips are poorly formed and mother forms hormones around the time of birth that allow the ligaments to become loose. The hips tighten up after few weeks and mild dysplasia goes away without treatment.

What is Adult Hip Dysplasia –

The hips are usually stable but the socket did not develop properly and this leads to arthritis secondary to shallow hip socket. Hip dysplasia is not life threatening but can lead to disability.

Screening

In Australia, screening for DDH is performed as part of the routine examination of the newborn. Serial clinical examination is continued after discharge from hospital and is performed by a number of health professionals including GPs, maternal and child health nurses and paediatricians.

The role of routine ultrasound examination of the neonatal hip remains controversial due to issues of over sensitivity, potential for over treatment and cost.

First ultrasound examination is ideally done at six weeks of age. In preterm babies with risk factors and normal clinical examination, the first ultrasound study should be done at corrected age of six weeks.

In the presence of a normal examination, ultrasound imaging can be considered for

  • Infant with breech presentation
  • Family history (First Degree relative with DDH)
  • Oligohydramnios
  • Birth Weight more than 4000 g.
  • Foot Deformities
  • Multiple gestation is not a risk factor for DDH. Hence, if one of the twins had breech presentation, only the twin with breech presentation should be referred.

Despite clinical examination and screening practices for DDH there is a 1:5000 rate of late-onset dislocation of hips.

Role of Imaging-

Ultrasound (Investigation of Choice- Six weeks to Six Months of age) :

After the age of six weeks, ultrasound can help detect hip dysplasia.

Before the age of six months the infant’s hip is largely cartilaginous, therefore ultrasound is the investigation of choice. As there is no exposure to radiation, repeated evaluation is safe.

X-ray :

After six months of age an X-ray can detect hip dysplasia as the bony development is advanced enough to allow a complete assessment of the hip.

What to expect in Radiologist Report-

Ultrasound-

  • Acetabular Morphology (Mature/ Immature according to infant age -Graf Classification)
  • Femoral Head Coverage
  • Laxity (Dynamic Assessment)
  • Recommendation for Orthopedic referral in abnormal cases.

X-ray-

  • Proximal Femoral Epiphysis Development (Ossification) and location
  • Acetabular Angle
  • Normal Acetabular angle range for patient’s age

Early Treatment

Early treatment is really the key. Treatment in infants starts with a brace or harness which keeps legs separated with femoral head in the socket while hip tightens up.

Referral to a paediatric orthopaedic surgeon is indicated when

  • there are significant risk factors present
  • the clinical examination is abnormal
  • the medical imaging examination is abnormal

How can Western Radiology and Advanced Diagnostic imaging and Intervention help

We aim to provide families with suspected or established hip dysplasia high quality supervised hip ultrasound and X-ray service.

  • Daily Appointment Available
  • Highly trained and experienced Sonographer/ Radiographer.
  • High Quality images- easy access to images for GP’s and Specialist (Intele-Viewer)
  • Prompt Radiology Reports- 4-24 Hours. Critical cases- verbal report.
  • No out of pocket expenses

Note:

The above information is of a general nature and is based on a review of published evidence and expert opinion. Western Radiology and Advanced Diagnostic Imaging and Intervention does not accept responsibility for the quality or accuracy of information contained within the material used to prepare above information.

Health practitioners are expected to review specific details of each patient and professionally assess the applicability of the relevant information to that clinical situation.

This information does not address all the elements of clinical practice and assumes that the individual clinicians are responsible for discussing care with consumers in an environment that is culturally appropriate and include providing care within scope of practice, meeting all legislative requirements and maintaining standards of professional conduct.