As you may know Erin has been diagnosed with a hip problem, her hip was found to be dislocated when she was a toddler at 22 months. This appears to be a very late hip dysplasia diagnosis and means more invasive treatment and possibly a less successful outcome. Finding out your child has a serious condition is frightening, Erin may not be ill but she now needs to endure years of treatment which could have been avoided. Yes, hip dysplasia surgery could have been avoided if identified and treated at birth.
Developmental Dysplasia (dislocation) of the hip
Hip Dysplasia treatment
Statistics suggest that 1 or 2 children in every 1000 have a hip dislocation that requires treatment. However, if clinical signs are shown early and if children are diagnosed quickly the first line of treatment for hip dysplasia in a baby is usually a pavlik harness worn day and night for a number of weeks. If this window of opportunity is missed the treatment often involves surgery followed by months in a hip spica cast. This is what we now find ourselves facing.
Symptoms of DDH
I am a mum of three and class myself as experienced! Yet I had no idea of the symptoms of hip dislocation and now wish I had. The symptoms include:
- one leg appears shorter than the other
- an extra deep crease is present on the inside of the thigh
- one of the hip joints moves differently from the other and the knee may appear to face outwards
- when a baby’s nappy is changed one leg does not seem to move outwards as fully as the other one
- the child crawls with one leg dragging.
Hip Dysplasia in a toddler
After walking age, it may be noticed that:
- a child stands and walks with one foot on tiptoes with the heel up off the floor. (The child walks this way in an attempt to accommodate the difference in leg length)
- the child walks with a limp (or waddling gait if both hips are affected).
Erin presented with an extra deep crease at her nine-month check, she was not crawling and was reluctant to weight bear. The health visitor commented on this and said Erin would be monitored. I feel very angry and guilty that I did not push for more at this stage. An x-ray at least – but hey I am not medically qualified or looking for problems.
Signs of DDH in a 1-year-old
I received two phone calls during the next few months from the health visitor and I said that no progress had been made on her walking. I was told to wait until 18 mths as the normal range to start walking is up to 18 months. At 18mths Erin was again seen by another health visitor who commented on the creases but nothing more was suggested.
At the same time, I took Erin to the doctors as she was still not walking. Her hips were checked again but nothing suggested. Finally at 21mths Erin started walking, yet it wasn’t the ending I hoped for. I immediately noticed it was with a limp and made another appointment with the GP. This time she was referred to a physio after the GP could feel some crunching on her hip and commented on the deep crease on her thigh.
Two weeks later I found myself in a playroom with a physio. The physio checked her hips and said nothing was wrong. It wasn’t until we were leaving the room that she even acknowledged the limping by calling us back into the room. Her whole tone changed and she measured Erin and claimed that her left leg was 2cm longer than the other. This scared me and I became very concerned, especially when she started suggesting a growth disorder.
I wasn’t satisfied though and made another appointment with the GP I had previously seen. He didn’t record a 2cm difference but referred me to a paediatric consultant.
Hip Dysplasia x-ray
Three long weeks later I had the appt and he immediately suspected a hip problem and sent us for an x-ray. The following day it was confirmed that Erin needed hip surgery. Now a little over a week later I am starting to understand the process that lies ahead. I have been told to expect a years treatment. It is going to have a massive impact on the family, I will need to take parental leave from work, all which could have been avoided if it had been picked up at birth.
The success rate varies and this next section is quoted from orthopeadic topics:
For the child discovered to have hip dysplasia within the first 6 weeks of life, treatment in a Pavlik harness is successful in more than 90% of cases. With successful treatment, the hips develop normally, and no long-term problems need be expected.
For the child discovered to have hip dysplasia later in infancy, treatment is more prolonged or complicated, but good results with a normal hip can be expected.
After the age of 1 year, treatment can definitely complicated, and results more guarded. Multiple operations are not unusual, and a normal hip may not result.
The untreated hip causes a limp, which is not painful in childhood. However, arthritis develops early in adult life, and pain sets in. When pain is severe, joint replacement becomes necessary.
Therefore I want to highlight to parents to push for x-rays or if your baby presents with any of the previously mentioned Hip Dysplasia symptoms.
In the past week, I found so many stories of hip dysplasia being missed. If you suspect a problem with hips or mobility be informed and push for an X-ray or an ultrasound of the hips.
If you have found yourself reading this blog post because of a DDH diagnosis do check out my other posts for support and advice. The products I found essential for looking after Erin in a hip spica cast was the Totseat The Washable Squashable Highchair and the Doomoo Seat – Baby Bean Bag which Erin even slept in a few nights when she could not get comfy, obviously she was supervised by me.