Hip Dysplasia in International Adoptees

When I was born I apparently had hip dysplasia and my family pediatrician instructed my parents to use extra diapers to correct the asymmetrical hip ball joints. It looks like it corrected itself. Although, as I get older they tend to get out of line easily. It is nothing a good chiropractor can’t fix. …until we got AJ’s medical report.

Hip Dysplasia is a term that is fairly antiquated, especially in the United States. It is more commonly known as Congenital Hip Dislocation. However, in Russia it is common because normal developing children are often diagnosed with disease, when in reality it is just a part of normal development.

The true Western definition of Congenital Hip Dysplasia describes: an abnormal development of the hip joint with instability and possible dislocation of the thigh bone from the hip socket. This condition is also referred to as developmental hip dysplasia. This medical condition generally is present at birth or shortly afterwards.

During normal gestation of the fetus, the head of the thigh bone (femur) should be sitting centered in a shallow socket called the actetabulum. This actetabulum should cover the head of the femur bone as if it were a ball sitting in a cup. When congenital hip dysplasia occurs, the development of the actetabulum in the infant allows the head of the femur (thigh bone) to ride upward and out of the socket. This condition becomes more noticeable especially during weight bearing stages of a child’s development.
Causes of Congenital Hip Dysplasia
There is a familial tendency towards hip dysplasia, with females being affected more so than males. This type of disorder is found across many different cultures and around the world. The incidence has been higher in cultures where there is a practice of swaddling and using the cradleboards for restraining infants.

The incidence is also higher in infants born via cesarean section and in those born in a breech presentation.
Diagnosis

The hip disorder is generally suspected during a physical examination by moving the hips to determine if they the head of the femur moves in and out of the hip socket. During the examination a distinct clicking sound is produced with the motion. This test is performed in the newborn period. In the older babies, there may be a lack of range of motion in one or both hips; while in the older infant hip dislocation is evident if one leg looks shorter than the other.

In the past x-rays were performed to detect abnormal finding of the hip joint. Ultrasound is now performed because it is a safe and diagnostic of hip dysplasia. Ultrasound has advantages over x-rays because it can investigate several positions during the procedure, while x-rays observe only one view. It is very hard to make a diagnosis of hip dysplasia without radiological images to support that diagnosis.
Treatment

The treatment of hip dysplasia has an objective to replace the head of the femur back into the socket (acetabulum), by applying constant pressure. By doing this, it enlarges and deepens the hip socket.

In the past stabilization was achieved by placing rolled cotton diapers or a pillow between the thighs, thus forcing the knees to remain apart in a frog leg position. With the advances in technology, different harnesses and slings were created to obtain the same effect. These slings are used in infants up to six months of age.

A hard cast can be used to obtain the same effect of spreading the legs apart and forcing the head of the femur into the socket. In older children, surgery may be required to reposition the joint.

Unless this condition is corrected soon after birth, abnormal stresses can cause malformation of the developing femur bone, causing a limp or waddling gait. If cases of congenital hip dysplasia go untreated, this unfortunate child will have difficulty walking, and subsequent pain as the child gets older.

by George Rogu, M.D.

When we had AJ’s first check-up there was no present indication (and not past indication for that matter) of hip dysplasia.