Saturday, June 16, 2012

Hip Dysplasia

As most of you know, Emerson was born with hip dysplasia in her left hip.

Hip dysplasia is the medical name used to describe a problem with formation of the hip joint in children. The location of the problem can be either the ball of the hip joint, the socket of the hip joint , or both.
What causes hip dysplasia?The exact cause of hip dysplasia is not easy to pin down, as there are thought to be several factors that contribute to developing this condition. Hip dysplasia occurs in about 0.4% of all births, and is most common in first born girls. Some known risk factors for a child to have hip dysplasia include:
  • A family history of hip dysplasia
  • Breech position in the womb
  • Hormonal loosening of the female ligaments
  • Etc.
In mild cases, the ligaments and other soft tissues around the hip joint are not tight, and they allow the thighbone (femur) to move around more than normal in the hip socket.

This is what our case is, mild.

How is hip dysplasia diagnosed?Diagnosis of hip dysplasia in the infant is based on the physical examination findings. Your doctor will feel for a "hip click" when performing special maneuvers of the hip joint. These maneuvers, called the Barlow and Ortolani tests, will cause a hip that is out of position to "click" as it moves in and out of the proper position.

If a hip click is felt, your doctor will usually obtain a hip ultrasound to assess the hip joint. An x-ray does not show the bones in a young baby until at least 6 months of age, and therefore a hip ultrasound is preferred. The hip ultrasound will show the doctor the position and shape of the hip joint. Instead of the normal ball-in-socket joint, the ultrasound may show the ball outside of the socket, and a poorly formed (shallow) socket. The hip ultrasound can also be used to determine how well the treatment is working.

This is how Emerson was diagnosed. Our pediatrician, Dr. Fuqua, came in and examined her each morning in the hospital. From the get-go she found the hip click. She called Dr. Timms in to reexamine her, he found the same thing. We left the hospital on a Thursday. That Friday we were sent to Shriner's Hospital for Children in Greenville, SC.
There, we saw a Pediatrician Orthopedic Surgeon. He (officially) diagnosed her with hip dysplasia. That day, she was fitted for and put in a Pavlik harness.

This is her, right after she was put in it.



What is the treatment of hip dysplasia?The treatment of hip dysplasia depends on the age of the child. The goal of treatment is to properly position the hip joint ("reduce" the hip). Once an adequate reduction is obtained, the doctor will hold the hip in that reduced position and allow the body to adapt to the new position. The younger the child, the better capacity to adapt the hip, and the better chance of full recovery. Over time, the body becomes less accommodating to repositioning of the hip joint. While treatment of hip dysplasia varies for each individual baby, this is what we are doing:
  • Birth to 6 months
    Generally in newborns, a hip dysplasia will reduce with the use of a special brace called a Pavlik harness. This brace holds the baby's hips in a position that keeps the joint reduced. Over time, the body adapts to the correct position, and the hip joint begins normal formation. About 90% of newborns with hip dysplasia treated in a Pavlik harness will recover fully. 
Each week to two weeks, we'll go to Greenville Memorial Hospital, get an ultrasound of her hips then walk over to Shriner's Hospital to see the specialists. I cannot say enough good about everyone that we have seen there. We are working with a doctor that is new to Shriner's. He is very hands-on. He does everything, the nurses do not. You usually don't see that. Lately, he's been walking over to Greenville Hospital to meet us in the ultrasound room to see for himself. Then he'll re-adjust her harness there. WE LOVE HIM!! Dr. Mendelow is his name and I recommend him to anyone!

In the past few weeks, he thought that the harness wasn't doing its job 100%. We talked about surgery. Thankfully he wanted to wait another week with her in the harness, then come back to reassess things.
After many prayers, we went back to find that it looks better! He gave her ANOTHER week. This time when we went back, he talked more in depth about doing surgery....unless she had made a huge change. Praise the Lord! Her hip looked wonderful! It was in the perfect position in the socket. So...no surgery at this time!!! We'll keep her in the harness another 6 weeks, for a total of 12 weeks.
I believe in prayer and it worked!!

We bathe around it, change her diaper around it, the harness does not come off for any reason, unless it is doctor ordered. She was put in the harness when she was 4 days old and thankfully I don't think she knows the difference. It doesn't bother her, it seems pretty comfortable.

We are so thankful to have these doctors, our family support and the good Lord on our side. Emerson is improving everyday and we are so proud of every big and little accomplishment she makes.



This was week 4 of wearing her harness. We were able to take it off at the hospital. She killed her sweet legs and we kissed her precious feet!
(Notice the big smile at the end...she's smiling at her big brother!)
video






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