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Infant and Developmental Dysplasia of the Hip

Infant and Developmental Dysplasia of the Hip

by | Mar 20, 2019 | Hip Disorders

In its highly regarded medical journal, Pediatrics, the American Academy of Pediatricians (AAP) just published a review of current standards for evaluating and treating a condition often recognized in newborns and infants. The condition is called developmental dysplasia of the hip (DDH). Dysplasia is a term that means poorly formed. It describes this condition well because one or both sides of the hip joint do not grow correctly as the child develops.

With later recognition of the condition, the treatment becomes more complex and may even require complex surgery. In order to minimize missed cases of hip dysplasia, the AAP recommends that pediatricians periodically screen for DDH during routine office visits from infancy until the child is walking.1 With effective screening, most cases are identified and managed during infancy, leading to complete correction of hip dysplasia and the development of normal hips.

Though this condition rarely requires surgery, Scottish Rite Hospital has a team of pediatric orthopedic surgeons focused on conditions affecting the hip. Corey S. Gill, M.D., M.A., sees these and other patients in his clinic in Frisco. Here are the top four things parents of newborns need to know and do:

  1. Know that DDH occurs in approximately 1% of children. Though the occurrence is low, early identification of these cases is important.
  2. Ask for an evaluation if your baby has one of the two strongest risk factors for DDH.
    • Delivered feet first (breech position)
    • Related to someone who has been treated or monitored for DDH
  3. If your infant is diagnosed with DDH, there is a greater than 90% chance of correcting the condition without needing surgery.  
  4. Learn how to properly swaddle. Many videos online teach “how to swaddle” your baby. Watch one of our hip experts demonstrate how to properly swaddle a baby and learn more about how swaddling can increase the risk of DDH.

When infants need treatment for hip dysplasia, our first line of defense is a Pavlik harness. The harness is generally worn for 23 hours per day for approximately six weeks, but it is removable for bathing. The harness keeps the legs flexed and rotated in the right position for normal development of the hip joint.  After treatment with a Pavlik harness, we use physical exams, ultrasound and X-rays to monitor growth and confirm the hip joint is developing properly.  Most children require no further orthopedic treatment after wearing a Pavlik harness.

Learn more about our treatment and research in DDH and other conditions affecting newborns.

1Yang S, Zusman N, Lieberman E, et al. Developmental Dysplasia of the Hip. Pediatrics. 2019;143(1):e20181147
Share Your Story: Andi’s Life Changing Journey

Share Your Story: Andi’s Life Changing Journey

by | Mar 19, 2019 | Hip Disorders

Meet Andi, a patient who is treated by our spine and hip experts. Learn more about her journey below.

Blog written by Andi’s mom, Tera, of McComb, Mississippi. 

Andi’s life changing journey started the moment she was born. At birth, we were told something was severely wrong with her hips and we would need to double diaper her to keep her hips spread apart. Nobody actually went into details with us until later at our post-delivery follow-up when Andi was three days old. At that time, our pediatrician told us he had never heard or felt a clunk in hips the way Andi’s hips were reacting to the hip check. Our pediatrician told us he thought she had hip dysplasia and we would need to meet with an orthopedic doctor.

We were initially referred to Children’s Hospital of New Orleans and Andi was just 1 week old when we had our first appointment with the orthopedic doctor. She was officially diagnosed with bilateral hip dysplasia and was put into a Pavlik harness, which was to be worn 24/7 for three months. We did harness adjustments every couple of weeks and after three months, the X-rays showed that the left hip responded to treatment, but the right hip did not. Our doctor, at the time, decided to try the Rhino abduction brace. It was then that we noticed that Andi was in a lot of pain. Hip dysplasia is generally not painful, but for her it was very painful.

When you touched her right leg or made any hip movement, her entire spine curved like a ‘C’ and she screamed in pain. She had X-rays done on her spine, but this did not give us any answers. We were told her spinal curvature (32 degrees) was not severe enough to be true scoliosis.
 
My husband and I began to research our options and that is when we found Texas Scottish Rite Hospital for Children. We live eight hours away and did not even hesitate about travelling to Dallas for a second opinion. The appointment process was quick, easy and we were able to get something scheduled right away.

Our first appointment was wonderful. 

Andi had Dr. Ramo and the staff scratching their heads, but they never gave up on her. They saw how much pain she was in and were able to pick up on developmental delays that nobody else had mentioned before. X-rays showed her right hip was still out of socket, her spinal curvature was now 42 degrees and the pain she was experiencing was being caused by inflammation.

Dr. Ramo suggested we allow Andi to continue to grow and develop and the plan was to repeat her scans in a couple of months. Time passed and we made another trip to Dallas. Her scans showed that her spinal curvature had since progressed to 54 degrees and Dr.Ramo decided to focus on her spine before we continued with further hip treatment. She was then placed in a Mehta cast – this process was rather simple, and the hospital staff made it easy.
 

From the moment we walked in the doors of the hospital to when we were discharged, our family felt comfortable, safe, loved and we knew our daughter was receiving the best care possible.

 
Fast forward a year later and Andi’s last Mehta cast was removed. Her spinal curvature had improved to 28 degrees and we were over joyed. She continues with nighttime bracing for a few months and then decided it was time to fix her hip.

Andi underwent a pelvic Osteomoy of the right hip and was placed in a unique spica/Mehta combination cast. She was in the combo cast for 13 weeks and at the end of this treatment, her hip looked wonderful! She did lose a little correction in her spine, but Dr. Ramo knew this would improve once she was able to wear a brace. She wore a rhino abduction brace for a month and then we continued with nighttime bracing.
 
Andi has been such a trooper throughout this entire process. For her, this is her normal nighttime routine – take a bath and then put on her brace. We had a follow-up appointment in December 2018 and her spinal curvature is now just 16 degrees. We will continue with her nighttime brace until our follow-up this summer and hopefully then, she will become an observation patient.

Everyone at Scottish Rite Hospital – from the registration staff, to the volunteers, nurse Marviel, Dr. Ramo and the cafeteria staff – they are all amazing. So kind, helpful, caring and welcoming! All of the hospital volunteers are always so giving and constantly put smiles on people’s faces.

This hospital made our struggles bearable.

Additional information on Developmental Dysplasia of the Hip

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Share Your Story: Too Hip for Dysplasia

Share Your Story: Too Hip for Dysplasia

by | Mar 11, 2019 | Hip Disorders

Meet Sadie, a patient who is treated by our experts in our Center for Excellence in Hip. Learn more about her journey below.

Blog written by Sadie’s mom, Sarah Beth, of Longview. 

Sadie on her bed, smiling.

Sadie was diagnosed with Developmental Hip Dysplasia (DDH) at the age of 2 months old, when our pediatrician noticed a clicking in her right hip. We lived in Houston at the time and initially saw a pediatric orthopedic surgeon there. She wore a pavlik harness until she was 6 months old, with little to no improvement, and then switched to a Rhino brace. Both the Pavlik and the Rhino were worn for 23 hours a day, only giving her one hour of “freedom” each day. While she was hitting her development milestones, she was making little improvement on the angle of her hip. As we approached her second birthday, surgery became more and more of an option.
During this time, we moved to the Dallas area and made the switch to Texas Scottish Rite Hospital for Children.

We immediately felt a sense of calmness when we met with Dr. Herring and his staff for the first time.

His knowledge on her condition and his willingness to wait to let her body continue to grow was exactly what we were hoping for. For the first time in Sadie’s hip journey, I felt peace with her condition.

As time passed, we continued with her checkups and eventually decided that a pelvic osteotomy would be necessary for Sadie to gain adequate coverage of her hip socket.  The hospital staff did a great job answering all of our questions and helped us through this journey. Sadie likes to explain the surgery by telling people that her hip was shaped like an “L” and they had to shape it more like a “C.”
Deciding to have a major surgery did not come without some hesitation, but the doctors and nurses were incredibly patient with my lists of questions.

Dr. Herring with Saddie

The child life specialists were able to provide a sense of calm for Sadie in situations where my husband and I did not know how to keep her calm. 

They walked her through the surgery beforehand, helped keep her entertained throughout her inpatient stay, distracted her when different lines were removed and eventually told her that it was okay to giggle when the cast came off because it may tickle. That team was an absolute life-saver!

Sadie
Sadie spent six weeks in a Spica cast and during that time, learned to army crawl, maneuver herself and function with absolutely no problems. Her attitude and determination during this time was amazing.

Since having her cast removed, she has had two X-rays and they each show good coverage of her right hip socket. She quickly returned to normal activity and seeing her now, you would never know that there had ever been anything wrong with her hip or that she was in a cast for six weeks.

I completely trust the doctors, nurses, child life specialists and staff of the hospital. Their knowledge and welcoming atmosphere have made many potentially stressful situations a lot easier for our family.

From Sadie’s point of view – “My favorite part of staying in the hospital was getting to go the playroom and meeting the Texas Rangers. I love getting popcorn after each checkup and playing on the playground.”

Additional information on Developmental Dysplasia of the Hip

 

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