I receive dozens of press releases each day on a variety of topics. I just came across one that discusses the importance of screening for hip dysplasia (also called clicky hips) in infants. I have mild hip dysplasia and can throw both of my hips out on a whim – some people call them double jointed hips. I thought it was a cool college trick to throw my hips in and out because it is kind of gross and cool all at the same time. Well lo and behold, in my late 20s I started experiencing hip pain and a few years ago, I ended up being diagnosed with osteoarthritis in my hips. Now the purposeful hip dislocations aren’t so cool.
When Alexander was born in 2001, he had clicky hips. His pediatrician checked him at a few sequential appointments and they weren’t getting better so she referred us to the local hospital for an ultrasound of his hips. I was petrified because I was on the Internet researching clicky hips in kids. I saw that the recommended treatment for many kids was the Pavlik harness. While we waited for the appointment, the pediatrician had us double diaper Alex – one diaper on forwards and one on backwards to kind of force the top of his leg to stay in the hip joint.
Finally we got around to the ultrasound and the doctor said that although his hip joints were shallow, we didn’t need to do anything else. As far as I know, his hips are fine now and although he’s seen me throw mine out, he hasn’t tried to throw his out.
When Ava was born, I don’t recall if the doctor checked for clicky hips. I’m guessing that he did but didn’t notice anything so didn’t mention it. After a few specialists visits for joint pain this year, a rheumatologist based at the local children’s hospital diagnosed Ava with Joint Hypermobility Syndrome. She scores 7/9 on the Beighton Scale but surprisingly, her hips don’t appear to be affected. Both of her elbows hyperextend to 15%, she can place both of her thumbs flat onto her forearm, each of her pinky fingers can bend back more than 90 degrees, and she can place both hands flat on the floor while standing with locked knees. Her knees both hyperextend but only between 5 and 10% which is considered normal at this age.
She is pretty darned flexible though. Thankfully, she is also strong. The physical therapist that we met with last week said that her strength will help her. As time passes, the therapy will help her build up the muscles around the joints so that she doesn’t hyperextend as easily. So although we have a family history of clicky hips, she didn’t inherit that but did inherit some of our joint hypermobility symptoms.
Anyhow, I digressed a bit, back to the press release. Here it is, in case you’re interested.
Developmental hip dysplasia is the most common congenital defect in newborns. The condition occurs when a hip joint is shallow, unstable or when the joint is dislocated. Infants with the condition are often at risk of developing arthritis of the hip as a young adult. A new study published in the July 2009 issue of The Journal of Bone and Joint Surgery (JBJS) finds that screening all infants for hip dysplasia can significantly decrease their chance of developing early arthritis.
“This study systematically evaluated what we know about hip dysplasia to determine the best screening strategy for newborns,” said study author Susan Mahan, M.D., Pediatric Orthopaedic Surgeon with Children’s Hospital in Boston and instructor in orthopaedic surgery at Harvard Medical School. “Our study confirms that pediatricians need to continue their current screening strategies for hip dysplasia. However, our findings refute a recent report from The United States Preventive Services Task Force that was unable to recommend screening strategies.”
Symptoms associated with hip dysplasia in infants can include: legs that appear asymmetrical during diaper change or a limp or waddle as a toddler walks.
Dr. Mahan and her colleagues analyzed data from more than 70 research studies and clinical trials dating back to 1939. They compared long-term outcomes in the following screening strategies:
– Ultrasound screening for hip dysplasia for all newborns
– A physical exam by a pediatrician for all newborns with ultrasound
screening used selectively only for infants with risk factors
– No screening for any newborn“We found that the best chance for avoiding early arthritis of the hip as a young adult occurs when you screen all babies with a physical clinical exam and utilize ultrasound for those who have risk factors,” said Dr. Mahan. Those risk factors include a family history of hip dysplasia, an infant delivered breech at birth, or positive physical exam.
Hip dysplasia can be difficult to detect, because it is a pain-free condition until adolescence or young adulthood when a patient can experience abnormal wear of the hip joint or hip arthritis.
If the condition is caught early, the most common treatment option for infants is a harness — consisting of a soft brace, straps and Velcro –that helps to hold the legs in an optimal position for hip development. If the condition is not identified until a child is older, a cast or surgery may be required to reposition the hip in the socket.
“We are trying to catch the cases that do not get better on their own,” explains Dr. Mahan. “The younger the child, the easier the condition is to treat. And, with early treatment, it is more likely that long-term complications may be avoided.”
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I’d forgotten about all that hip manipulation in those baby checks. Thanks for the wander down memory lane. And yes, she is pretty darned flexible.
Cheers
My daughter had a clicking hip at birth, the recommendation was double nappies for six weeks. At her six week exam, she got the all clear were totally free of the condition when they were born. A simple test at birth and the double nappies were better than a harness for her. She was walking perfectly at 11 months and now has legs like a giraffe!