Early, specialized care for pediatric hip dysplasia can mean the difference between a child who grows up active and pain‑free—and one who faces surgery, limited mobility, or even early hip replacement. Yet many patients are still diagnosed much later than they should be.

Rachel Goldstein, MD, MPH, Director of the Hip Preservation Program in the Jackie and Gene Autry Orthopedic Center at Children’s Hospital Los Angeles, treats hundreds of infants, teens, and young adults with hip dysplasia—also known as developmental dysplasia of the hip (DDH). As a high‑volume center, CHLA also contributes to every major multicenter hip research consortium, helping to advance care from infancy through young adulthood.

Dr. Goldstein shares seven ways that care for pediatric hip dysplasia is evolving for both babies and teens.

Across the country, high‑volume centers have been anecdotally reporting a significant rise in infants reaching walking age before their hip dysplasia is diagnosed.

“This is a trend that started during the pandemic but never corrected. And we don’t know why,” Dr. Goldstein says. “It’s concerning because bracing with a Pavlik harness is not an option after 6 months of age. So kids diagnosed late need surgery that otherwise could have been avoided.”

New guidelines from the American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons now call for two imaging studies for breech infants: a screening ultrasound at 6-8 weeks of age, and a pelvic X‑ray at 6-8 months.

The X-ray is recommended even when that initial ultrasound is normal.

“The screening recommendations for breech babies are more intense now,” she notes. “Many pediatricians are not yet aware of this change, but it’s critical to identifying hip dysplasia much earlier in these higher-risk babies.”

CHLA is one of the few centers in the country—and the only one in Los Angeles—that performs point‑of‑care ultrasound for babies with hip dysplasia. Under this model, babies are seen by Dr. Goldstein and the ultrasound technician in the same visit.

“This allows us to make bracing adjustments and refine treatment plans immediately, while families avoid the burden of multiple appointments,” Dr. Goldstein says.

Traditionally, surgery for hip dysplasia focused mostly on reshaping the hip socket. But newer strategies increasingly involve femoral osteotomies and derotational procedures.

“We have become more proactive about changing the rotation of the femur to help put the femur deeper in the socket,” she explains. “The goal is to improve hip stability and help the socket to better develop.”

For closed reduction surgeries, it has long been standard at many centers to bring patients back to the operating room after six weeks for a cast change. A new CHLA study published in the Journal of Pediatric Orthopaedics- Opens in a new window¹ suggests that this routine practice may not be necessary.

“Kids did well with a full three months in the same spica cast,” Dr. Goldstein says. “We saw very low rates of cast‑related issues. Eliminating these cast changes would reduce anesthesia exposure and lower burdens for families as well.”

"We think that most teens with adolescent hip dysplasia were born with normal hips but did not develop the secondary ossification needed to deepen the socket," she notes. "Without timely intervention—typically with a periacetabular osteotomy (PAO)—they face pain, early arthritis, or even premature hip replacement."

Importantly, it’s now recognized that even teens with borderline dysplasia may benefit from treatment.

“Even in borderline cases, a PAO can significantly improve symptoms and help protect the joint from early degeneration,” says Dr. Goldstein, who performs 30 to 40 of these procedures annually. “The goal is to correct the underlying structural problem before it leads to arthritis or premature hip replacement.”

DDH surgery and PAO are highly technical procedures, making referral to an experienced, high-volume center essential to reduce complications and ensure better outcomes.

CHLA’s program combines this extensive experience with the full spectrum of care—from noninvasive options to advanced surgical approaches.

“Hip preservation is incredibly complex, and experience truly matters,” Dr. Goldstein says. “At a high-volume center like CHLA, patients are more likely to get the right diagnosis and treatment. We want to give each child the best chance at a healthy hip for decades to come.”

Reference:

1) https://doi.org/10.1097/BPO.0000000000003175

(Newswise/HG)