Hip Dysplasia: total solutions across age
Introduction
Pediatric hip pathology varies depending on patient age. Newborns are often screened for developmental dysplasia of the hip, whereas toddlers and older children can present later with pain, leg length discrepancy, or limp. Young children may have hip pain related to transient synovitis, septic arthritis, or Legg-Calvé-Perthes disease. Older children are more likely to suffer from slipped capital femoral epiphysis or apophyseal avulsion fractures. Knowledge about how the growing skeleton differs from adults as well as the classic imaging findings in many of these diagnoses is paramount when taking care of pediatric patients with suspected hip pathology.
Why do you choose our hospital?
The goal of our pediatric orthopedic team is to provide the most technologically advanced treatments to those who suffer from congenital, developmental, and post-traumatic orthopedic conditions. We have experienced nation-class surgeons who perform high volume of surgeries every year. Physicians and specialist in Taiwan frequently refer their patients to our institute particularly when the diagnosis is unclear, the procedure is complicated, or even the most common conditions warrant the best of care. We have built a coordination team formed by pediatric orthopedic surgeons, pediatrician, neonatologist, pediatric nurse, psychologist and physical medicine and rehabilitation specialists. Our patient care coordination team will provide personalized and thorough approach to achieve the right diagnosis and the right access to care. We focus not only on the disease but also on the patient. Patients and their families can trust they will receive the world-class comprehensive medical care in our institute.
What conditions do we treat?
Developmental dysplasia of the hip
・Summary
Developmental dysplasia of the hip (DDH) is an abnormal development of the
osseous and soft tissue of the hip joint, leading to insufficient coverage of the femoral head. DDH has varying clinical manifestations and typically presents as mild dysplasia, subluxation, or frank dislocation. The reported incidence of DDH is 3–5 per 1,000 newborns. Significant dysplasia can lead to hip instability, hip pain, and early hip osteoarthritis if left untreated.
・Treatment options
Treatment for DDH varies between children and depends on its severity. If the dysplasia detected early, most of infants with DDH can be successfully treated with a special brace. This brace holds the hip joint in the correct position so that the joint develops properly. The treatment duration may last for several months until the hip is stable.
If brace does not work, procedures called closed reduction or open reduction may be needed to move the hip joint into the correct position. The hip joint is made more stable by operating on the surrounding ligaments. This can be done through a small cut near the groin. After closed reduction surgery (and sometimes after open reduction surgery) your child will need a hip spica – a plaster cast that covers your child's body from the knees to the waist. Hip spicas may need to be worn for several months. Children may then need to wear different splints or braces to make sure the hip joint remains stable and in the right position.
When DDH is diagnosed late, surgery to the thigh or pelvic bones may be needed to make sure the hip joint stays in place. This surgery is called an osteotomy. Bony cut is made at pelvic bone or femur to improve the contact area of hip joint so the stress at hip joint is decreased. This procedure can alter the natural history of DDH and help prevent early degeneration of hip joint.
Finally, some patients may present to clinic with end-stage osteoarthritis because of neglected dysplasia. Total hip replacement is an ideal treatment for these patients. We have experienced surgeons performing high volume of total hip arthroplasty on dysplastic hip, which was considered as a challenging procedure in the past. In our institute, it is now a safe and effective treatment option for DDH patients with advanced hip arthritis.
Legg-Calvé-Perthes disease
・Summary
Legg-Calve-Perthes disease (also known as Perthes disease) is a rare condition in which the ball-shaped head of the thighbone (femoral head) temporarily loses its blood supply. As a result, the head of the thighbone collapses, and the area becomes inflamed and irritated. As the condition runs its course, the body will absorb the dead bone cells and replace them with new bone cells. The blood supply will eventually return and the femoral head will heal. But the shape of the femoral head will have changed and no longer move smoothly in the hip socket. If left untreated, Perthes disease can cause arthritis later on.
Perthes disease is idiopathic, which means that there is no known cause for this condition. What is clear is that when blood supply to the femoral head is disrupted, the bone starts to break down. About one out of every 12,000 children develop Perthes disease. Boys are five times more likely to be affected than girls, but when girls are affected, the condition tends to be more severe. Perthes disease most often affects children who are between 4 and 10 years old, very physically active, and small for their age. The condition tends to be more common in children who have been exposed to second-hand smoke.
・Treatment options
Treatment plan will depend on age, range of motion in hip, and extent of the condition. We will recommend a treatment based on the degree of your child's hip pain, stiffness, and how much of the head of the thighbone has collapsed.
Some kids with Perthes disease can be treated with non-surgical management, including activity restrictions, anti-inflammatory medication, bed rest and traction, casting or bracing to allow the thighbone to remold itself into a round shape and physical therapy to keep the hip muscles strong and promote hip movement.
If non-surgical treatments prove inadequate, your child may need surgery to hold the head of the thighbone in the hip socket. A pediatric orthopedic hip specialist can perform a procedure known as a femoral osteotomy, which reorients the way the femoral head fits inside the hip socket. In this procedure, the femur is cut and rotated for better alignment of the femoral head in the hip socket. The bone is then secured with a metal plate and screws.
Slipped capital femoral epiphysis
・Summary
Slipped capital femoral epiphysis (SCFE) is one of the most common developmental conditions of the hip joint; it usually affects teens and pre-teens. In SCFE, a weakness of the growth plate (physis, the area at the end of the bone responsible for bone growth) in the upper end of the thigh bone (femur) causes the head, or "ball," of the thigh bone (femoral head, epiphysis) to slip off the neck of the thigh bone, much as a scoop of ice cream can slip off the top of a cone.
In pre-adolescent and adolescent growth and development, a child is growing quickly as adult hormones begin to circulate in his or her system. The growth plate (the area at the end of bone responsible for growth, which is not as strong as bone) gets weaker because it’s broadening. These phenomena, combined with certain anatomical factors, such as the shapes of the femur and the socket, can lead to slippage.
A SCFE is actually a fracture of the growth plate. The fracture is usually a fairly stable one, and the slippage occurs very slowly. Occasionally, the gradual slippage can become very unstable and the ball can completely slip, leading to severe deformity and even blood supply problems to the “ball.” For this reason, every hip with SCFE should be treated immediately to prevent unstable SCFE.
・Treatment options
SCFE is usually an emergency and must be diagnosed and treated early. In 20 to 40 percent of affected children, SCFE will be present in both hips at the time the child is diagnosed. If only one hip is affected, the other hip will eventually slip 30 to 60 percent of the time. Treatment is surgical. The goal of treatment is to prevent the femoral head from further slippage, to avoid complications and eliminate hip impingement, which can cause arthritis later in life.
The standard of care for SCFE is limited open surgery, which uses steel screws and pins (internal fixation) to hold the femoral head onto the femur to stabilize it and prevent from slipping further. Some children need more complex surgery to realign the femur or reshape the bone.
If a child who has a mild case of SCFE remains relatively pain-free, parents may be tempted to leave their child’s diagnosed condition untreated. However, left untreated, SCFE almost always worsens with time — and the ball may completely slip off. Even if the child grows to adolescence without developing serious pain or a noticeable limp, it’s inevitable that the untreated hip will wear out and become arthritic in adulthood.
Treatment timeframe
・Consultation (Online available)
・Pre-treatment planning
・Explain treatment option, pros and cons, benefits and risks of treatment
・Estimate cost
・Informed consent
・Hospitalization
・Surgery
・Physical Therapy and rehabilitation program
・Follow-up visit
Potential complication
Treatment for pediatric hip pathology is usually challenging and requires longer treatment duration and follow-up compared to general orthopedic surgery. For these reasons, we are very conservative regarding many aspects of surgical option. The first priority of our care is patient safety and preventing complications. Potential complications are listed below, most of which are reversible and will not cause permanent sequela.
・Wound infection requiring antibiotic treatment or debridement
・Intraoperative bleeding requiring transfusion
・Nerve injury during correction
・Nonunion after osteotomy
Estimated cost
For estimated medical costs, please contact International Medical Services Center.