Other imaging methods that may be used for babies or children are x-rays and arthrograms. Sometimes this is treated and sometimes it is observed with a repeated ultrasound study at age three months. Some instability in a six-week old infant is not very uncommon. The instability is much more common in newborn infants and the ligaments get tighter with age. When the number is less than 45% then there is instability. In general more than 50% of the ball should remain in the socket. Of course, this depends on how hard the examiner pushes. The images can generally show how far out of the socket the hip will move. Many babies have slightly loose hips so this can be very difficult to interpret. During the ultrasound examination, the hip is also examined for stability in the same manner as the Barlow test, but the ultrasound is used to see if the hip is unstable instead of relying on the feel of the doctor. Dysplasia is severe when the alpha angle is less than 43 degrees. Mild dysplasia is present when the alpha angle is between 43-60 degrees. This angle is considered normal if it is more than 60 degrees. The one that is used the most to help guide treatment is the alpha angle. There are angles that are measured during the examination. This is necessary to make the diagnosis or to be sure the hip is normal. It goes into the socket when the hip is held in a flexed position in the Pavlik Harness.Īn ultrasound study in young infants is performed when hip dysplasia is suspected. The left hip of this infant is dislocated.
Patient’s left hip joint is better aligned when in the Pavlik Harness.Most children do not need surgery, but for those who do, an arthrogram (x-ray dye injected into the hip joint) at the beginning of the surgery can help the surgeon decide exactly what needs to be corrected. This is necessary to make the diagnosis or to be sure the hip is normal.ĭuring treatment x-rays can reveal the progress of the hip as it improves. X-Ray Screeningįor babies 4 months of age or older and children, x-rays are performed when hip dysplasia is suspected. The cause of these late developing cases is unknown. In some cases, hip dislocations have developed in older babies even when the infant exam was normal and the ultrasound was normal at six weeks of age. If only one hip is affected, it is easier to spot the affected hip because it can be compared to the other hip. When a baby with dislocated hips walks, he or she has a waddling gait that is a little more exaggerated than a normal toddler gait. When both hips are dislocated, the exam is symmetrical. The hips could be a little loose, but otherwise fine, and then get progressively worse as the baby gets older, especially if they slip farther out of the socket when the baby is relaxed, such as while sleeping. Hip dysplasia can be difficult to diagnose, especially if it is bilateral (both hips are affected) because the hips are symmetrical. An x-ray at four months of age or older is sometimes recommended. Babies with other risk factors may also benefit from an ultrasound, especially when the pediatrician has any concerns about the examination of the hips. The American Academy of Pediatrics recommends an ultrasound study at six weeks of age for almost all baby girls who were in the breech, or bottom-first position. There are signs and symptoms of a possible hip problem, such as a limp in a child of walking age.The doctor is concerned about the results of the physical exam.
There is a family history of hip dysplasia.Babies are at increased risk for hip dysplasia in the following situations:The baby is a twin or multiple, or was in a breech position at birth.Standard practice in the developed world is to do hip exams for newborns and babies for hip dysplasia at well-baby checkups. Doctors use a combination of physical exams and imaging such as ultrasound or x-rays to diagnose hip dysplasia.
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