Hip Health

QUESTION:

Dear Dr Dunlop,

I’m hoping you may be able to clarify a few things. My daughter was born 4 months ago via c section at 37wks due to turning breech. The hospital physiotherapist saw her two weeks after discharge & advised that her hips showed some laxity but said that could be because she was born early. She advised to get an ultrasound as a routine check due to being breech at birth & a distant family history of DDH (my female cousin on father’s side). I had a check-up with the health clinic nurse at 3 months & she noticed that my daughter’s hips felt tight & gave us a referral for the hospital physio. We saw them a week later & they said that her hips felt fine.

They showed me how to do some stretches for her neck as occasionally it seems tight & she tilts to one side, but nothing for her hips. I mentioned that I hadn’t had the ultrasound as yet & they said to have an X-ray on her hips as being 3 months old, she would move too much & we wouldn’t get a good view. I had the X-ray & it came back suggesting DDH in her right hip & recommended an ultrasound to clarify. We had the ultrasound today & the technician doing it said that everything looked good & the angles were within range. I am confused as to why the X-ray suggested DDH when the ultrasound didn’t.

Unfortunately I wasn’t given a copy of the report for the X-ray & forgot to ask the GP for a copy. I had the ultrasound done at a different place to the X-ray as well. The lady doing the ultrasound said the angles need to be above 50 but I have read they need to be 60 or above. I’m sure I saw one measurement was 57. The technician went & showed the radiographer the X-ray & they suggested that it looked like my daughter wasn’t laying straight in the X-ray & that could’ve given the impression of the hip being out. To me though, it clearly looks like there’s a difference between the left & right side. Happy to attach photos of X-ray.

Can you clarify what range the angles need to be, as well as to what the next step will likely be. I have a few days to wait for the report & given the weekend it may be longer. Thanks a bunch, A very confused mummy.

ANSWER:         

Dear K,

Thanks for your question and for visiting Kids Consult.

You certainly have been given inconsistent information.

The gold standard approach is that if babies are breech, they have an ultrasound at 6 weeks corrected age ie 6 weeks after the due date. Ultrasounds can be used very reliably until 6 months of age when XRay usually takes over.

The report will talk about femoral head coverage, and that needs to above 50%, so anything above that is normal. The report will also comment on the general appearance of the developing hips.

If the ultrasound report is normal, no need to do any further imaging at all, but each time you visit your GP for immunisations, you should ask them to check the hips to ensure they feel stable in the joint.

I hope that clarifies things for you.

Regards,

Dr Scott Dunlop
Consultant Paediatrician