Patient's question:
Female, 20 months. I noticed that my daughter's right leg seems shorter when she walks, and she walks with a limp. Additionally, she always uses her left leg as the primary support leg when standing. There are no obvious creases in her buttocks, and her right leg is very flexible.I took her to the hospital for a checkup, but they said everything was fine. Then I went to another hospital and had an X-ray taken, which also said nothing was wrong. However, I am still quite concerned and wonder if the X-ray results can serve as evidence to rule out congenital hip dislocation in children?
Doctor's answer:
Congenital hip dislocation, also known as developmental hip dysplasia, is a condition that significantly impacts children's health and is one of the leading causes of childhood limb disability. Its characteristic is that, at birth, part or all of the femoral head may dislocate from the acetabulum, and the condition often affects the acetabulum, femoral head, joint capsule, and surrounding ligaments and muscles. After the age of 2, children with bilateral hip dislocation exhibit very noticeable side-to-side pelvic movement while walking, with the buttocks protruding backward and an increased forward curvature of the lumbar spine, known as a waddling gait.Early diagnosis and early treatment should be emphasized for developmental hip dysplasia. The best outcomes are achieved during infancy, with effectiveness decreasing as age increases. Warning: It is generally believed that if treatment is delayed until after 2–3 years of age, even if very successful, hip pain will likely develop after the age of 35. Therefore, most scholars emphasize the importance of screening newborns to enable early diagnosis and treatment, which is a crucial measure for achieving a full recovery. Clinical examination is the first step in diagnosis, but it only indicates that there is a problem with the hip. The final diagnosis requires X-ray examination.
Relevant X-ray examinations
1. Standard pelvic anteroposterior radiographs: In the first 6 months after birth, the majority of children have not yet developed the ossification center of the femoral head. Diagnosis requires a combination of bilateral hip anteroposterior radiographs and bilateral frog-leg radiographs. After 6 months of age, when the ossification center appears, bilateral hip anteroposterior radiographs alone can confirm the diagnosis.
2. CT and MRI examinations are also important for older children with developmental hip dysplasia:
- CT can evaluate the bony condition of the femoral head and acetabulum and measure parameters such as the anterior tilt angle of the femoral head and the neck-shaft angle of the femoral neck.
- MRI allows for observation of the cartilage within the hip joint, including the femoral head cartilage, acetabular cartilage, round ligament, and labrum.