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Question of the Month

March 2017


Question:

My baby was born with right and left displaced hips, but the left one is worse. He wore a harness for more than two months. After three months and an X-ray the doctor said the right hip is quite normal, but the left one still needs time. I don't want to lose time to find out the left hip is still not normal. Please advise me on what to do.

- Meriem - United Arab Emirates (Parent)


Answer:

Thank you for your question. It sounds like your son is being treated for DDH (developmental dysplasia of the hip). Pavlik harness (or brace) is the common treatment for this problem in infants. Hip joints are like ball and socket joints. In order for a hip to form properly, the ball (femoral head or thigh bone) must be located in the socket (acetabulum or pelvic bone). If a hip joint is dislocated, the ball is not in the socket, and the two bones cannot help shape each other properly. If a hip is located, the ball and socket have good contact and continue to help mold each other over time. Think of ice cream in an ice cream scoop. The ice cream needs to be in the scoop to form a nice round shape. If the ice cream is out of the scoop, it will not form a ball and hold this shape. Similarly, if the femoral head does not sit in its socket properly, it may flatten over time. The first goal of harness treatment is to get the dislocated joint to come back together (reduce the joint). This usually happens within a few weeks. The second goal is to help maintain the position over time so the ball and socket can start to remodel each other and become more stable. This can take a few months. If the hip is showing any signs of improvement in the harness, the doctor usually recommends continuing that treatment until the hip is truly normal (based on measurements made on ultrasound or x-ray). Rarely, a hip fails to improve and other treatments (different brace, cast, or even surgery) may be recommended. You mentioned that the left hip was worse at first, so it is not surprising that it will take longer for the left hip to improve. It sounds reasonable to continue the harness for a few more weeks. As long as the hip is getting any better, you are not losing time. When you go to the next appointment, you can ask your doctor to show you the ultrasound or x-ray pictures. Ask your doctor to show you the femoral head (ball) and acetabulum (socket) on the image. Hopefully, you will be able to see how the joint is forming.

- Kristan Pierz, MD


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