HIP TO PREVENTION | by Debra Melani

Dr. Laurel Benson, a pediatric orthopedic surgeon at Rocky Mountain Pediatric Orthopedics (right), spends time with her precious patient, Stella Alden.

Posted on Wed, Apr 3, 2013

Detecting Congenital Defects, Such as Hip Dysplasia, Early Boosts Outcomes for Babies

Hip dysplasia wasn’t something Nicole Alden even thought about when her first child was born. In fact, if it hadn’t been for an alert pediatrician, and her willingness to follow through with specialists on that doctor’s suspicion, her daughter could have been doomed to a life of painful disability.

Instead, baby Stella, born breech but otherwise appearing normal, was referred to the experts at Rocky Mountain Pediatric Orthopedics, part of the Rocky Mountain Hospital for Children’s Center for Maternal Fetal Health. Now she wears a supportive brace that should spur normal development of what was diagnosed via ultrasound as an overly shallow left hip.

“Hip dysplasia is a silent, destructive process,” says Dr. Laurel Benson, Stella’s orthopedic specialist. “In infancy and childhood, it is absolutely painless, but damage to the joint is ongoing. The child walks and crawls on a normal schedule of milestones. Once pain begins to plague the child in adolescence, the surfaces of the hip joint are already beyond repair.”

“I probably wouldn’t have caught it if it hadn’t been for the doctors because, visually, you can’t tell anything is wrong.”

Benson is one of a team of perinatal specialists, pediatric surgeons, neonatologists and OB/GYNs that work together with the Rocky Mountain Center for Maternal Fetal Health to detect, diagnose and treat a number of congenital health disorders that can put mom or baby at risk. Hip dysplasia, which has a higher incidence among breech babies (those in the head-up position in the womb), can require major surgery when not detected in infancy, and, in severe cases, result in total hip replacement as early as age 20. “The surgical procedures that are used to try to salvage the damaged hip in the interim are major procedures with long recoveries, and not something that any parent would want for a child,”

Dr. Benson says. When detected early, babies are placed in a harness-like brace at about age 4 to 6 weeks, which they wear for an average of six weeks. In 95-percent of those cases, the problem is corrected without need for further treatments. “I probably wouldn’t have caught it if it hadn’t been for the doctors because, visually, you can’t tell anything is wrong,” Alden says, adding that the brace is fairly easy for Stella to live with. “It’s kind of hard on her only in that it limits the mobility of her legs.

It doesn’t cause her pain, but she’s a little colicky, so in the evenings when she tries to kick her legs, that really upsets her and increases her fussiness.” The hip joint includes the ball, or femoral head, and socket, called the acetabulum. In normal hips, the socket is deep and cupshaped, and the femoral head has a broad contact area with the acetabulum. The broader contact leads to less weight-bearing pressure. In hip dysplasia, the socket is shallow and slanted upwards with the femoral head perched on a small zone. All the force of weight bearing is then concentrated on a very small area, increasing pressure and causing destruction. “In the past, we worried the most about babies who were born breech or who were in utero for extended time periods in the breech position,” Dr. Benson says. “But recent research conducted at the Naval Hospital in San Diego revealed that even a short period of breech positioning puts some infants at risk for dysplasia.”

Other risk factors include being female (probably because they are more sensitive to hormones in utero), being a firstborn (likely due to decreased mobility because of mom’s tighter muscles), and having a family history. Babies with more than one of those risk factors should visit the Hippity Clickity Clinic in Dr. Benson’s office between age 4 and 6 weeks. In one visit, babies will be diagnosed and receive a treatment plan. Alden, who takes Stella in weekly for checkups, says having the clinic and children and adult (Presbyterian/St. Luke’s) hospitals all in one spot is convenient, and she recommends parents with any concerns follow up with specialists. And the earlier, the better. “In Stella’s case, it’s much more treatable in infancy,” Alden says. In fact, Dr. Benson says, “It’s so much better, we call it winning the hip lotto.

Nicole Alden with her baby daughter, Stella.

Nicole Alden with her baby daughter, Stella.



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