Hip care

The newborn period is a golden period to diagnose and take care of any hip concerns before the condition interferes with activity, such as hip dysplasia. After birth, your pediatrician will perform a physical examination of your baby. Part of that newborn exam focuses on your baby’s hips. If a concern is detected, your pediatrician will refer you to an orthopedic specialist.

The specialists in our hip center’s infant hip program combine state-of-the-art ultrasound exams with gentle physical examinations to detect subtle differences between a normal hip and a hip that may be at risk.

In a single visit to the hip center, all components of the initial screening can be accomplished: ultrasound, consultation and diagnosis. Any questions about your baby’s hips will be answered and, if treatment is required, it can be initiated during the visit. This comprehensive visit helps limit disruptions to your baby’s schedule and alleviates parent concerns as soon as possible.

At our hospital's Adolescent Hip Preservation Institute, partnered with our sports medicine team, we can help diagnose and treat hip issues in teenagers. We are pioneers in hip arthroscopy and complex hip reconstruction in adolescents, allowing us to treat even the most complicated hip disorders.

You are your teen might be very anxious about hip injuries because they affect your student athlete’s ability to participate in a beloved sport now and in the future. We take all the time necessary to discover and explain the diagnosis and treatment plan you, your child and family. We know that the best result is achieved when your adolescent is fully informed and engaged about treatment choices.

During childhood, this is usually painless. However, as time passes, the cartilage within the hip will be damaged, resulting in degenerative osteoarthritis and disability.

Hip dislocations are relatively uncommon, affecting only one to two out of every 1,000 babies. The causes of hip dysplasia are not completely understood, but experts think that many factors are involved. The most common risk factors include:

• Breech positioning
• Being female (tend to have more lax ligaments)
• First-born children (constrained birth canal)
• Family history of lax ligaments

Symptoms of hip dysplasia

Most babies with hip dysplasia experience no pain. Infants often don’t show signs of hip dysplasia, and there may be no signs at all. Still, our doctors look for these indicators:

• The leg on the side of the dislocated hip may appear shorter.
• The leg on the side of the dislocated hip may turn outward.
• The fat folds in the skin of the thigh may be uneven.
• In a frog position of the legs, there is asymmetry.
• “Clicks” or “clunks” may be felt during the exam.

Diagnosing hip dysplasia

With gentle hip manipulations, which include pushing and pulling on your child’s thighbones, our physician can assess their range of motion and stability to determine whether their hips are loose in their sockets. Pain is not a reliable indicator of hip dysplasia in infancy because it is a pain-free condition. Because developmental hip dysplasia can be present as your child grows, the hip exam continues to be an important component of a well-child check-up.

Sometimes our orthopedists will recommend an X-ray or ultrasound to get a better view of an at-risk hip. X-rays are helpful for babies who are at least six months old or older, but ultrasounds are preferred for babies under six months. Ultrasounds can be more helpful in younger babies because their hip structures are cartilage, and cartilage does not show up on X-rays.

Treating hip dysplasia

Treatment for hip dysplasia depends on the age of your child and the severity of the condition. Mild cases may correct themselves in the first few weeks of life, but close monitoring is necessary to ensure that their hip is growing and improving normally.

The vast majority of hips with dysplasia respond to treatment very well. The goal of these treatment methods is to align the ball and socket so that they begin to influence each other to create a normal hip. Treatment options may include:

• Arthrograms
• Casting, including a spica cast
• Pavlik harness
• Rigid brace
• Surgery

For nearly all of these options, the length of treatment is an average of 12 weeks.

Like it indicates in its name, snapping hip refers to an orthopedic condition where a snapping sensation or audible pop is felt or heard when the hip is being extended or flexed.

Diagnosing snapping hip

To determine the source of your child’s symptoms, a specialist performs a physical exam to reproduce the snapping sensation.

In some instances, an X-ray will be ordered when there is a concern for bone abnormality. If your child's medical history and physical exam indicate a problem within the joint itself, an MRI may be necessary to look closely at the cartilage and labrum of the hip.

Treating snapping hip

Stretching exercises are frequently used to gain better mobility of the muscles and soft tissues, which can lessen snapping frequency and discomfort. A short course of anti-inflammatory medication, such as ibuprofen, may be helpful. In most cases, snapping hip is a benign condition with no long-term complications. Most children can continue their activities without restrictions.

FAI is essentially a mismatch between the shape of the ball and socket of the hip joint, causing the two to make contact when they should not. The abnormal contact, called impingement, causes damage and pain within the hip joint.

We diagnose and treat different types of FAI, including:

• Pincer lesions
• Cam lesion
• Combined FAI
• Labral tear

Diagnosing FAI

FAI is best diagnosed by our pediatric orthopedist who sub-specializes in the treatment of FAI. Our specialists will create a plan based on a thorough health history and an examination of the hip, knees and back. If FAI is expected, X-rays of the hip and pelvis will be reviewed. If FAI is confirmed, and MRI of the hip may be ordered to further assess the extent of the damage.

Treating FAI

Nonsurgical treatments include over-the-counter medications, along with ice, heat and massage. Physical therapy can help strengthen the joint.

If nonsurgical treatments do not succeed, we may recommend surgery. The goal of surgery is to correct the issue and repair the labrum. The initial benefit is pain relief and a return to sports. There is some evidence that surgery can also prolong the long-term function of the hip. The recommended surgery will depend on the exact type of FAI.

The three main surgical options include:

• Hip arthroscopy
• Surgical dislocation of the hip
• Periacetabular osteotomy (PAO)

When a child has SCFE, the femoral head of the thighbone slips at the physics. Sometimes this happens suddenly — after a fall or sports injury — but often it is a slow process with vague pain that is easily dismissed. We treat both types of SCFE: stable and unstable SCFE.

Causes of SCFE

No one knows for sure what causes SCFE. However, it is known that it mostly occurs in kids between 11 and 16 years old who are going through a growth spurt. It is more common in boys, though girls can be affected too.

SCFE is also more likely to occur in kids who have the following risk factors, all of which can have an effect on bone health:

• Obesity (carrying extra weight puts increased pressure on the growth plate)
• Endocrine disorders, such as diabetes, thyroid disease or growth hormone problems
• Kidney disease
• Cancer treatments, like radiation and chemotherapy
• Certain medications, such as steroids
• A family history of SCFE

Sometimes referred to as "irritable hip," transient toxic synovitis is a condition in which the inner lining of the hip joint is inflamed.

Symptoms of transient toxic synovitis

While the exact cause is, unknown, transient toxic synovitis causes pain in the hip, thigh, groin or knee on the affected side. There may be a limp (or abnormal crawling in infants) with or without pain.

Treating transient toxic synovitis

Transient toxic synovitis gets better on its own, but because the hip joint can be irritated with infection or trauma, it is important to have a specialist see your child.

For a child without fever who is still willing to bear weight, an X-ray and trial of anti-inflammatory medications may be enough.

For children who appear more ill and who are unwilling to walk, blood work is often included. Sometimes (but rarely), an MRI may be necessary to thoroughly assess the structures of the hip.