Hip Disorders Archives

Diagnosing, Referring and Treating Newborns with DDH

by rona@revdojo.com | Aug 18, 2022 | Hip Disorders

Watch the lecture on YouTube or read this summary to catch the highlights.

This is a summary of a presentation for medical professionals that focuses on developmental dysplasia of the hip, or DDH. Presented by William Z. Morris, M.D., the seminar dives into everything medical professionals need to know about evaluating and treating DDH in newborns, helping physicians recognize the condition and respond earlier.

DDH is a common condition that occurs in about one in 100 infants. The condition is characterized by a shallow acetabulum and/or under-covered femoral head in the hip. It can occur due to a malformation of anatomic structures that have developed normally during the embryonic period and ranges in severity from physiologic immaturity to subluxation to frank dislocation. The presentation covers the epidemiology of DDH and its risk factors.

Dr. Morris provides updated guidelines for selective ultrasound screening for high-risk infants and includes data from his recent publications and presentations at national conferences. The presentation covered a full DDH screening and physical exam, showing providers exactly how to look for signs of DDH in newborns. He explains that physical findings fall on a spectrum and vary with the severity of the pathology and the age of the child. The presentation includes a detailed video of a newborn physical exam, showing participants hip-specific tests that can be performed to identify even subtle signs of dysplasia.

Email medicalprofessionals@tsrh.org to request access to the full exam video.

Imaging is a valuable tool in helping to diagnose DDH, but Dr. Morris shares why it is best to wait until the patient is 6 to 8 weeks of age in cases of screening ultrasounds for stable hips, using facts and figures to illustrate this reasoning. He recommends ultrasounds at 6 to 8 weeks of age, which reduces false positive rate, and X-rays after 6 months of age once the hip has undergone sufficient ossification.

The presentation continues with Dr. Morris describing treatment protocols for DDH. For many, primary treatment for DDH begins with a Pavlik harness for six to eight weeks. He shares what to watch for with this treatment and its success rate using granular data in order to arm primary care physicians with data that can be used to reassure families once the diagnosis is made. He then talks about further treatments, including hip abduction brace, closed or open reductions and spica cast, and in which cases each may be used.

Finally, Dr. Morris shares vital information about DDH prevention, such as healthy hip swaddling, the use of proper sleep sacks and the correct use of baby carriers and how each of these can contribute to DDH in newborns.
Dr. Morris encourages physicians to refer patients early and often in cases of suspected DDH, know the risk factors and help parents with prevention techniques. He stresses that in most cases, nonoperative treatment is very successful, especially when the condition is caught early. Pediatric physicians and their patients can greatly benefit from Dr. Morris’ expertise with DDH, learning everything physicians need to know to provide their smallest patients with the best care.

Preventing Hip Problems for Your Baby

by rona@revdojo.com | Jun 8, 2022 | Hip Disorders

Newborns need a lot of care, and that means plenty of visits to the pediatrician during the early months. One thing your pediatrician will carefully screen for is developmental dysplasia of the hip (DDH), a common condition that young babies are especially susceptible to. Learn more about DDH, its risk factors, tips on how to prevent the condition and guidelines on how to spot hip-safe baby accessories from our experts.

Could my baby have DDH?
DDH occurs when there is inadequate coverage of the ball by the socket or there is a dislocation of the hip (the ball is completely outside the socket). The cause of the shallow socket is complex, but it’s a gradual process that occurs during infancy and does not happen at a specific moment.

Many different factors contribute to DDH, including genetics, as children with a family history of the hip condition are more likely to have DDH than children who do not have a family history.
Babies who were breech during the third trimester and girls are also more likely to be diagnosed with DDH.
Studies have shown that if a baby is swaddled incorrectly, it could cause DDH.

At the Center for Excellence in Hip at Scottish Rite for Children, we typically treat DDH using a Pavlik harness, which keeps the hips gently flexed and separated in the right position for encourage 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. Even when starting with a dislocated hip, most infants require no further orthopedic treatment after wearing a Pavlik harness.

What other factors could cause my baby to have DDH?
While developmental dysplasia of the hip (DDH) cannot always be prevented, there are some things to look out for as you care for your baby to avoid causing abnormal stress and pressures to the hip that could lead to future problems.

Swaddle Safely
Many parents choose to swaddle their newborn infants. Swaddling involves wrapping a blanket around the upper body of the baby to create a snug fit so that the baby feels secure, but if done improperly, swaddling may lead to DDH. When swaddling your baby, be sure of the following to prevent hip dysplasia and other hip issues:

A parent/guardian should wrap the blanket around the upper part of the body while keeping the legs free to move and kick. The baby should be able to flex their hips freely.
If the legs are wrapped tightly with the hips in an extended position, it could affect hip development and increase the risk of dysplasia.
In young babies, developing hips are very moldable and growing rapidly. Keeping the legs free while in a swaddle allows the baby’s hips to develop normally.
To avoid swaddling incorrectly, consider using a certified hip-safe swaddle that does not restrict the baby’s legs.

Watch our Proper Swaddling video:

Babywear Properly
Babywearing has been practiced for generations, but a baby’s improper hip position when babywearing could cause problems, while proper placement can contribute to natural hip development.

The “M-position” is a natural clinging position for infants. In this position, the baby’s thighs spread around the parent’s torso with the hips flexed and the knees slightly higher than the buttocks with the thighs supported.
Babywearing with your baby facing inwards toward your chest may be better for hip development, especially in babies under six months of age.
By babywearing your infant in the correct position, you can promote healthy hip development.
Purchase a hip-healthy baby carrier that has been recognized as hip-safe for babywearing.

Shop Smart
When shopping for baby products such as baby carriers for babywearing or swaddles for sleeping, look for products that have been recognized as hip-safe by the International Hip Dysplasia Institute. Products that have been recognized by the organization promote proper hip placement. View the list of hip-healthy products: https://hipdysplasia.org/hip-healthy-products/.

Look for recognized hip-safe products.
Discuss best practices and recommended products with your pediatrician.
Always use products as instructed and ask your pediatrician for guidance if needed.
Do not use products that have been altered or damaged, as they may not work properly and could promote poor hip placement.
Limit time in baby seats that hold the legs in a fixed position.

“We know that the position of baby’s hips are held in infancy can have a dramatic impact on early hip development. We want to ensure they are not positioned in forced hip extension.”

– William Z. Morris, M.D.

At Scottish Rite for Children, our Center for Excellence in Hip has hips covered. We treat a wide array of hip conditions and disorders in patients of all ages. Hip health is important throughout your child’s life, and we’re here to help every step of the way. Learn more about our Center for Excellence in Hip and all of the conditions we treat.

Learn more about our Center for Excellence in Hip and all of the conditions we treat.

Treating Perthes Disease

by rona@revdojo.com | May 18, 2022 | Hip Disorders

Perthes disease, also known as Legg-Calvé-Perthes disease, is a childhood disorder of the hip. The disease affects the ball portion of the hip joint, known as the femoral head. Perthes is uncommon — approximately five to 10 children per 100,000 will be diagnosed each year — and it more commonly affects boys — 1 in 760 boys. Here are some interesting facts about this pediatric hip condition.

What Happens to the Hips in Perthes Disease
In a normal hip joint, the round femoral head of your femur fits perfectly into the round socket of the pelvis. Perthes disease interrupts the blood flow to the femoral head, causing all or part of it to die due to the lack of blood. The bone death is medically referred to as osteonecrosis.

Once the bone dies, the femoral head is more prone to breakage and heals poorly in older children. As a result, the pressure and weight on the bone from normal rigorous activities can cause the round portion to become flat over few months to a year after the diagnosis. For one to two years after bone death occurs, new bone gradually begins to fill in the areas where the body has removed the dead bone.

The Cause of Perthes Is Still Unknown
While we know what happens to the hip to alter the round shape of the femoral head, we still don’t know what causes the precipitating interruption of blood flow. We also know that Perthes is not heritable, since less than five percent of the patients have a family history of the disease. However, some other heritable hip conditions or blood disorder can mimic Perthes, such as inherited bone dysplasia like multiple epiphyseal dysplasia and sickle cell disease. History of taking corticosteroid for treatment of asthma, inflammatory conditions or cancer can also produce bone necrosis that mimics Perthes.

Diagnosing Perthes Disease
Because so many other diseases can mimic the symptoms of Perthes, it is known as a disease of exclusion. Doctors will rule out other conditions by taking a careful medical history and performing a physical exam. The physician will typically ask about the following diseases to rule them out:

Family history of hip disorders or early joint replacement
Steroid use, such as for asthma
Prior hip surgeries
History of sickle cell disease
History of hip infection
History of endocrine or clotting disorders

To confirm a potential Perthes diagnosis, doctors will perform X-rays of the hips. If an X-ray is taken too soon after symptoms have begun, it may appear normal. In that case, physicians can order a very sensitive diagnostic test called perfusion MRI if they still suspect Perthes.

Treatments and Complications
The body will naturally remove and replace the dead bone of the femoral head with new bone, so, to some extent, Perthes is self-healing. However, the healing process may be slow and even after healing has taken place, the femoral head may not return to its original round shape. When that fails to happen, patients may experience long-term complications, such as pain, stiffness and arthritis later in life.

Until the healing phase is complete, nonsurgical treatments might include crutches, wheelchairs, casting and/or bracing, and reduced physical activity. Surgical treatments might include pelvic or femoral osteotomy a process that re-orient the pelvis or femur. In older children, another treatment option is to make bone channels to speed up healing and to inject bone marrow stem cells.

While Perthes is in some ways self-healing, femoral heads sometimes don’t heal properly but there are other treatment options are available. With the interventions we have today and new treatment knowledge about the condition, those with Perthes can usually return to daily activities and sports activities without problems.

Learn more about the various hip conditions our experts treat.

Exercises for Hip Pain

by rona@revdojo.com | May 11, 2022 | Hip Disorders

Hip pain can be caused by a variety of underlying factors. Weak hip muscles can cause poor body mechanics when walking or performing other activities, which can eventually lead to pain. Muscles that are too tight may also cause pain and/or popping sounds in the hip during movement. Stretching and exercises can help improve the strength and flexibility of the hip muscles, decreasing pain and improving overall hip health.

Working with your child on proper stretching and exercises can help prevent hip pain. We recommend the following exercises and stretches to strengthen hip muscles:

Quadruple Fire Hydrant

Get down on all fours.
Keeping your knee bent, lift your hip out to the side.

Single-Leg Bridge

Lie on your back with knees bent.
Lift your hips off of the ground and then lift and straighten one leg.
Lower leg and repeat on the other side.

Side-Lying Hip Abduction

Lie on your side with the bottom leg straight or bent.
Tighten the muscles on the top of your leg, in the front part of your thigh.
Lift the top leg while keeping the muscle tight and your knee straight.

Half-Kneeling Hip Flexor Stretch

Kneel on one leg.
Slowly push your pelvis down while slightly arching the back until a stretch is felt on the front of your hip.

Supine Hamstring Stretch

Lie on your back with one leg on the ground and one leg extended straight.
Hook a strap on the extended leg to reach a maximum stretch.
Straighten the extended knee further by tightening your front thigh muscles (quadriceps.)
Slowly press the other leg down as close to the floor as possible.

Standing ITB Stretch

Stand with one leg crossed behind the other leg.
Bending at the waist, reach toward your back foot.

While daily exercises and stretches may prevent or alleviate hip pain, in some cases physical therapy might be needed. At Scottish Rite for Children, our Physical Therapy experts can work with your child to create a custom home-exercise program to address their specific needs. The home exercise program can be adjusted based on your child’s pain, progress and goals.

Learn more about our Physical Therapy services.

World-Renowned Hip Care

by rona@revdojo.com | May 3, 2022 | Hip Disorders

Scottish Rite for Children’s Center for Excellence in Hip has a long tradition of providing the highest-quality medical care to thousands of children, from newborns to adolescents and young adults. Led by director and pediatric orthopedic surgeon Harry Kim, M.D., M.S., the team provides a coordinated and comprehensive approach to care that brings together hip specialists from orthopedics, radiology, physical therapy, psychology and more. This multidisciplinary team approach allows us to offer a broad spectrum of operative and nonoperative care options to preserve, improve and repair the native hip joint. At the Forefront of Innovation Our experts are committed to advancing clinically important research to provide the best care to our patients. Several of the center’s research projects have led to revolutionary, life-changing results. Patients who had evaluation and treatment at our center have the opportunity to participate in large patient registries to allow for evaluation of treatment outcomes for a variety of conditions. These studies lead to new insight and significant improvement as our team modifies treatment algorithms based on these results. In addition, doctors and researchers are involved in multicenter hip research groups with peers at top-tier institutions around the country. They regularly collaborate to discuss the latest innovations and treatment techniques regarding patients diagnosed with pediatric hip conditions and injuries. Movement Science Laboratory The accredited movement science laboratory is an integral part of the treatment of our patients. The multidisciplinary team of engineers and kinesiologists use leading-edge technology to evaluate and identify joint motion, net joint forces, muscle activity, strength, foot plantar pressures and oxygen consumption. These analyses guide the development of individualized treatment plans for our patients and support research. The clinical research team partners with movement science to study the changes experienced with surgical intervention to ensure each patient continues to maintain improved hip functions. Multidisciplinary Complex Hip Clinic This clinic brings all of our hip experts together in one clinic to review and evaluate each patient in person together. The history, physical examination and images are evaluated, and various options are discussed for treatment. The multidisciplinary approach also includes experts in the fields of physical therapy, psychology, pain management and nursing. A comprehensive diagnostic (if necessary) and treatment plan is then developed specifically for each patient. If surgical treatment is necessary, the full range of procedures are available with the experts in the field to include hip preservation surgery (both open and arthroscopic options) as well as the potential for utilizing total hip arthroplasty (replacement) when appropriate. This clinic occurs every month and only those patients requiring this multidisciplinary approach are included. Patients may request to be seen in this clinic. Hip Team All of our pediatric orthopedic surgeons are board certified in orthopedic surgery and also completed a fellowship in pediatric orthopedics. Several of our medical staff have a particular interest in treating and studying pediatric and adolescent hip conditions. Harry Kim, M.D., M.S.

Special interest in treating patients with Perthes disease, adolescent and young adult avascular necrosis, and developmental dysplasia of the hip (a member of International Hip Dysplasia Institute).
Leader and chair of the International Perthes Study Group – multicenter research study focused on advancing the care of children diagnosed with Perthes disease.
Extensive basic and clinical research on Perthes disease and avascular necrosis.

Daniel J. Sucato, M.D., M.S.

Special interest in treating adolescent patients with various hip conditions including hip dysplasia, adolescents and young adults with Perthes disease, slipped capital femoral epiphysis and femoroacetabular impingement.
A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study. A multi-center project that analyzes hip function and pain, quality of life and other factors on patients who undergo hip preservation surgeries.

Henry B. Ellis, M.D.

Special interest in treating femoral acetabular impingement, labral tears and other sport-related injuries and conditions in the hip.
Involved in multi-center research projects with a special interest in hip arthroscopy.
A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.

David A. Podeszwa, M.D.

Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.

William Z. Morris, M.D.

Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
Extensive clinical research in the pediatric and adolescent developing hip with expertise in the pathogenesis of slipped capital femoral epiphysis and femoroacetabular impingement.

Corey S. Gill, M.D.

Special interest in treating infants with hip dysplasia and patients with cerebral palsy with various hip disorders/dysplasia.
Other common hip conditions seen include slipped capital femoral epiphysis, Perthes disease, transient synovitis of the hip, osteoid osteoma and proximal femur cysts.

Learn more about the Center for Excellence in Hip.

Share Your Story: A Happy Ending

by rona@revdojo.com | Mar 31, 2022 | Hip Disorders

Meet Max, a patient seen by our experts in the Center for Excellence in Hip. Learn more about his journey below.

Blog written by Max’s mom, Melinda.

Giving birth is one of the most exciting things a mother can experience. When our son, Max, was born, he weighed 10 pounds. We couldn’t wait to bring him home from the hospital, so we could begin getting to know him. When the pediatrician visited him in the hospital for his newborn exam, he identified that Max had symptoms of hip dysplasia. Developmental dysplasia of the hip occurs when a baby’s hip socket is too shallow to cover the head of the thighbone properly, and left uncorrected, he might experience pain when he tried to learn to walk.

Fortunately, our pediatrician recognized the issue and recommended we take Max to Scottish Rite for Children for treatment. The pediatrician’s office made our initial appointment, and Max had his first consultation when he was just a week old. As first-time parents, there was a lot we didn’t know about taking a baby to a doctor’s appointment. For example, we didn’t even pack a diaper bag because we thought we’d be home long before he needed a diaper change.

My husband and I were very nervous — we knew nothing about hip dysplasia, and we were worried about the long-term consequences. Could it be fixed? Would he eventually be able to walk? The team at Scottish Rite and our pediatric orthopedic surgeon Dr. John Birch were fantastic. They calmed our fears and answered all of our questions. During the comprehensive evaluation, they provided a private room for us to use when Max needed to nurse. They also provided us with diapers when he needed to be changed. He was a big baby — apparently his newborn diapers and T-shirt were already too small, so they gave him a new T-shirt too.

Max was fitted with a Pavlik harness that he wore 24 hours a day, except during bath time. We visited Scottish Rite weekly for several months. The doctors assessed his progress and adjusted his harness as he grew. The doctors and staff could not have been nicer or more supportive. After a couple of months, they determined that his hips had grown and developed properly, and he would no longer need to wear his harness. We returned to Scottish Rite regularly to gauge his progress. He started walking at 14 months, without any problems. We eventually moved to San Antonio but returned to Scottish Rite annually to make sure his hip and leg development was on track. We couldn’t have been happier with the support and guidance we received.

Everyone loves a happy ending, so we’re happy to share ours. Max grew and grew – he played varsity basketball and baseball during high school. He recently enrolled at Williams College in Massachusetts, where he is continuing his baseball career. He’s a 6’8 left-handed pitcher, and he can’t wait to play for the Ephs. We are incredibly grateful to the team at Scottish Rite for the compassion and amazing care we received.

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