Bone & Joint
The hip is a ball-and-socket joint, meaning that the femoral head (the top of the femur) is shaped like a ball and sits within the cup-like socket in the pelvis. In some cases, parents may notice abnormalities when an infant or young child’s legs are moved, such as a clicking sound or the feeling of looseness or displacement of the hip.
James Engels, MD, a pediatric orthopaedic surgeon with Rochester Regional Health, advises parents on what to do if their child has a hip click and provides need-to-know information on hip dysplasia.
A “hip click” refers to an audible clicking or popping sound that occurs when a baby’s hips are being examined or moved around. Most clicks are not problematic.
There are tendons or ligaments associated with an infant’s hip joint that can make a snapping or popping sound for a variety of reasons. A hip click could be a sign of abnormalities in hip development, but further examination and possible testing are required to reach a diagnosis. More importantly, instability or displacement of the hip is a significant concern for hip dysplasia.
“A child that has a hip click or hip instability should be monitored for hip dysplasia or other developmental abnormalities. This is something that is usually caught early on by physicians during well-child visits.”
After a child is born at the hospital, pediatric specialists perform a newborn examination. During this thorough physical exam, a specialist will check the baby's hips and legs for abnormalities to assess for hip dysplasia. They do this by gently pushing and pulling the baby’s thigh bones to see how they move in the hip socket.
“If we notice an abnormality in a newborn’s hips, we may order an ultrasound to get a more in-depth look. Once we perform further examinations and testing, we can determine the best way to treat the problem,” said Dr. Engels.
Some factors may lead to a greater likelihood that a child will have hip dysplasia, such as:
If any of the above are present, the patient should receive further testing to check for hip dysplasia.
Parents may notice clicking or popping sounds when their child walks or moves their hips or legs. In this case, they should schedule an appointment with their child’s pediatrician for an examination. After the exam, the pediatrician can determine whether further evaluation from a pediatric orthopaedic surgeon is necessary.
Children should have routine well-child visits from the moment they are born up through age 21. For children under 2, these exams occur 2-3 months. At these early visits, a physician will check their hips and legs for signs of hip dysplasia or other abnormalities.
If there is no detection of hip dysplasia or other abnormalities and your child is experiencing a hip click after three or more years of age, schedule an exam with their pediatrician to check for any undetected orthopaedic abnormalities.
“Abnormalities or signs of problems in the hip joints can often be identified at the child’s routine well-exams, especially during the first few years of life. However, if a parent notices clicking, popping, abnormal walking pattern, they should schedule an additional exam with their pediatrician.”
Hip dysplasia is a condition in which the hip socket does not fully cover the ball of the upper thighbone, allowing the hip joint to become partially or completely dislocated.
Hip dysplasia can damage the cartilage lining in the hip joint, and in some cases, can lead to loss of the soft cartilage that lines the socket portion of the hip joint, resulting in a painful arthritic hip. That’s why early detection and treatment of hip dysplasia is so important.
Signs and symptoms of hip dysplasia vary based on age and severity. A hip click may be a sign of hip dysplasia, but it does not guarantee the condition.
Symptoms of hip dysplasia may include:
“Many of the signs of hip dysplasia go unnoticed in everyday life, which is why it’s so important for infants to have routine well-child exams that include hip screen examination right from the moment they’re born. This way, we are more likely to detect any abnormalities early on and begin treatment as needed,” said Dr. Engels.
The most common treatment for hip dysplasia in infants is a Pavlik harness. The Pavlik harness is a soft splint that helps keep the infant’s hips and knees bent and the thighs apart. An infant treated with a Pavlik harness stays in the harness at all times of day and night.
In most cases, the infant will wear the harness for 3-4 months and will be monitored as they grow.
“The Pavlik harness is very comfortable for baby. It’s soft and easy to clean. Most importantly, it is extremely effective in treating and curing hip dysplasia,” said Dr. Engels.
If an infant’s hips do not stabilize with the Pavlik harness, or if hip dysplasia is diagnosed later than 6-8 months of age, an orthopaedic physician may prescribe a semi-rigid orthosis.
Instead of a harness, this is more like a brace that keeps the infant’s legs and hips in a more stable and secure position.
In severe cases, an infant may need surgery to correct the development of their hips. There are two types of surgical options: closed reduction surgery and open reduction surgery.
Closed reduction surgery occurs under general anesthesia and the infant's hip is placed back into the socket. To help with this process, a tendon in the groin is usually lengthened through a small incision. The infant is then put into a body cast, bracing the pelvis area to hold their hips in position.
In open reduction surgery, under general anesthesia, an incision is made to put the hip back into place. This option is for severe cases in which bones may also need to be cut to help keep the hip in place.
“After any surgical option, we follow-up with the patient routinely until they’re at least 5-7 years of age. We continue to check on their development to ensure everything is healthy."
