Developmental Dysplasia of the Hip Treatment in Sharjah

What is developmental dysplasia of the hip treatment?

Developmental dysplasia of the hip treatment is care that places the ball at the top of the thigh bone securely in the hip socket and keeps it there while the joint grows. In DDH the socket is too shallow, or the joint is loose enough for the ball to slip partly or fully out. A baby's hip socket shapes itself around the ball: when the ball sits deep and steady, the socket grows deeper around it. Treatment uses this natural growth, which is why an early start usually means simpler treatment.

At Dar Al Kamal Hospital, Sharjah, DDH is treated by the orthopedic team together with the Pediatrics department, from the first hip check after birth through to surgery in older children when it is needed.

Who needs it

DDH treatment is for babies and children whose hip is shallow, unstable or dislocated. Many cases are found at the hip examination that forms part of newborn screening, when the doctor gently moves each hip to feel for a clunk as the ball slips in or out. A hip ultrasound is then arranged, because in the first months of life the hip is mostly cartilage that shows clearly on ultrasound and poorly on X-ray.

Babies with certain risk factors are offered a hip ultrasound even when the examination seems normal: a breech position late in pregnancy, a parent or sibling with hip dysplasia, or a foot deformity at birth. First-born girls are affected more often. In an older baby or toddler, signs include uneven skin creases on the thighs, one leg looking shorter, a hip that opens less far during nappy changes, or a limp once walking starts.

The treatment chosen depends mainly on your child's age and how unstable the hip is. A mildly shallow hip in a young baby is often rechecked on ultrasound, as many settle as the baby grows. A loose or dislocated hip in a young baby is usually treated with a harness. When the harness fails to hold the hip, or DDH is found later, the choices are closed reduction and casting, or open surgery. The surgeon explains the options for your child before you decide.

What happens

For a young baby, a soft fabric harness holds your baby's knees up and apart, so that the ball points into the socket. Your baby wears the harness day and night, and hip ultrasound checks at regular clinic visits confirm the ball is sitting well. The team adjusts the straps as your baby grows and shows you how to bathe, dress and feed your baby with it in place.

In closed reduction, under general anaesthesia, the surgeon gently guides the ball back into the socket without an incision. A dye X-ray of the joint, called an arthrogram, confirms the position, and a hip spica cast is applied from the chest down the legs to hold it. The cast is changed under anaesthesia while the hip stabilises, and a brace may follow.

In open surgery, used mainly for older children or when the hip can be placed well only through an incision, the surgeon opens the joint, clears tissue blocking the socket and places the ball in position. In older children, an osteotomy is often added: the pelvis is reshaped to deepen the socket, or the top of the thigh bone is turned to point the ball into it. A spica cast usually follows.

Preparing for it

For harness treatment, bring vests and baby-grows a size larger that fit over the straps. For casting or surgery, the team gives you fasting instructions for your child and explains the anaesthetic; tell the team about any recent cough, cold or fever.

Plan ahead for a spica cast. Your usual car seat may be too narrow for a baby in a cast, so check the fit before the operation day. Loose clothing, larger nappies and a firm, supportive cushion for sitting help at home. If the treatment date falls in Ramadan or near travel plans, raise it early so the timing suits your family.

Afterwards

Babies usually adapt to a harness or cast within a few days. Keep the straps fitted as shown, and for a spica cast, tuck a small nappy inside the cast edge under a larger one, and change it often to keep the cast clean and dry. In the Sharjah heat, keep your child in a cool room with light clothing, as sweat under plaster irritates the skin. Turn your child regularly between back and tummy while awake.

After the cast comes off, stiff hips and knees loosen with movement and play. Dar Al Kamal Hospital's pediatric physiotherapy team can guide your child's return to crawling and walking, and hip X-rays at regular reviews through childhood check that the socket keeps developing.

Contact the hospital the same day if the cast cracks, softens, becomes soaked or smells, or if the skin at the cast or harness edges is red or broken. **Go to the emergency department straight away if your child's toes turn pale, blue or cold, if the legs swell, if your child has a fever, or if a baby in a harness stops kicking one leg.**

Cost and insurance

Most UAE health insurance plans cover hip ultrasound, consultation and medically needed DDH treatment for babies and children, and surgery or casting under anaesthesia usually requires pre-approval. The harness and later braces are sometimes assessed separately or covered up to a limit. Dar Al Kamal Hospital, Sharjah can help you confirm your child's cover on 06 599 7777.