All newborn babies have their
hips checked within a few days of birth and, at 6 weeks, if
a dislocation goes unnoticed, the child will grow up with
a short leg on one side, a painful limp, and arthritis later
in life. So, while is not a life threatening problem, (and
as a baby, he is unlikely to experience any pain), it can
have long term complications, especially if not treated early.
Hips are a ball and socket joint
The hip joint is a ball and socket joint - that is, the end
of the leg bone forms a ball shape, which rolls around in
a cup-shaped socket in the pelvic bones. The benefit of this
sort of joint is that, the leg can move at the hip, through
a large circle.
But the cup shape of the socket may be very shallow in new
babies and, this allows the ball of the leg bone to slip in
and out of the cup.
More than 1 in a 100 newborn babies have "unstable"
hips, (i.e. hips which can be dislocated by the doctor during
testing), but only 1 in 10 of these is a true dislocation
that requires more intensive treatment.
Girls are affected 6 times more often than boys are, and,
rather strangely, left hips are 4 times more likely to be
affected than the right side. In a third of cases, both hips
are affected, like your friend's baby.
Dislocated hips missed at birth cause symptoms later
Sometimes, a dislocation is missed when babies are tested,
and x-rays aren't a lot of help because, at this age, so much
of the hip joint is made of cartilage, not bone.
If tests in the newborn baby don't pick the problem up, it
may cause symptoms when the baby starts to walk. These may
include:
delayed walking
an abnormal waddling gait (the affected leg is shorter)
asymmetrical thigh creases (there is an extra crease on the
affected side)
an inability to fully abduct the affected hip (i.e. to move
the leg out, away from the body)
Double nappies is the first treatment
The treatment depends on the extent of the dislocation and
the shape of the hip socket.
Initial treatment consists, very simply, of putting the baby
in double nappies, which keep the leg in the right position
to stop it dislocating, so allowing normal growth of the cartilage
of the socket.
After three weeks, the baby is reassessed and, if there is
still a problem, referral to a specialist orthopaedic surgeon
will be needed. They will most likely recommend a splint or
plaster cast to hold the legs slightly open. This is kept
on for 3 months, to allow the socket of the joint to grow
into the right shape.
After this, if the problem has not sorted itself out by about
6 months, then more complex traction and splinting may be
needed, or sometimes, even an operation.
If your friend's baby needs splints, it does make carrying
him around a bit more complicated, so offer to help as far
as you can. But other than the practical nuisance, it may
cause few other problems, and may improve rapidly with treatment.
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