Developmental dysplasia of the hip (DDH)
DDH used to be known as Congenital Dysplasia of the Hip, but we now know that many children develop this problem in their early months and years rather than only being born with the condition.
Hips affected by DDH are easily able to dislocate, or slip in and out of the socket or cup. This causes the “clicky hips” often picked up by Child and Maternal Health Nurses or Family Doctors on screening new babies. Other signs that are looked for are uneven thigh creases and different leg lengths. These factors warrant further examination with an Ultrasound to see if the hips are enlocated and assess the shape and size of the femoral head (ball) and the acetabulum (cup) of the hip joint. Older babies will need an X-ray to fully examine the hip joint.
DDH affects girls six times more frequently than boys and predisposing factors include family history and breech position in pregnancy. One third of children with DDH will have both hips affected.
Many babies respond very well to being braced and will then have normal hips. Some kids will need an operation to help align the hip joint and some will go on to need more surgery. If not found and treated early, children with DDH may have delayed walking and may limp. Without appropriate management, DDH can develop into early onset osteoarthritis.
Mr Loh’s philosophy about treating DDH is that an early concentric reduction gives the hip the best chance of developing normally. Normal development of the hip requires the ball (femur) to press against the socket (acetabulum) to create a congruent joint. The sooner we can achieve this, the better.
During your consultation, Mr Loh will discuss all the options for your child and explain his decision-making process in detail with you and your family.
The hip is commonly involved in patients with neuromuscular disorders. As a result of muscle imbalance, the hip joint is “pulled out” into a subluxated or dislocated position. This can result in joint inflammation and ultimately, premature joint degeneration and intractable pain.
Whilst the method of treatment will depend on the cause of the pain and the state of the hip joint, Mr Loh will weigh up the options with you and your family. His aim is always to provide the most reliable and least traumatic solution for your child.
Legg-Calve-Perthes Disease of the Hip
Often called Perthes Disease. Perthes is caused by a disruption to the blood supply to the head of the femur (the ball of the thigh bone). This lack of blood supply causes the bone to degrade and eventually die. As it does it changes shape.
It affects males more than females and typically children between 4 and 8 years of age. It presents as an ache and the child will limp. The hip will often be stiff on abduction (out to the side) and internal rotation. On X-ray we see changes in the joint space and the femoral head. As the disorder progresses, there are more advanced changes in the femoral head as it progressively collapses. It can often affect both hips.
Kids with Perthes do best when referred quickly to a surgeon. The aim of treatment is to stop the the head of the femur from flattening. The mainstay of treatment is to keep of the hip and be non-weight bearing. Sometimes surgery is required to contain the head within the socket and to preserve range of motion at the hip.
Without appropriate management, Perthes Disease can lead to early osteoarthritis.
Slipped Capital Femoral Epiphysis
The femur is made up of a ball, or head attached by a thin “neck” of bone to the main shaft. In children there is a growth plate between the head and the neck. In a SCFE the head or ball of the femur slips down off the neck. This can then lead to a disruption of the blood supply and avascular necrosis or “bone death” can occur. As for so many conditions, the earlier a SCFE is found and the earlier management occurs, the better the results.
SCFEs present as hip and knee pain in adolescents aged 10-15 who are often obese. The child will have a limp and an irritable hip on movement. They often complain of knee pain. In 20% cases both hips are involved.
Management involves immediate cessation of weight bearing. The head of the femur then needs to be realigned and pinned in place through surgery.