The first time Adalyn Mandich’s parents heard her hips “click,” they were at her newborn wellness visit at Akron Children’s Hospital Pediatrics in Barberton. Dr. Kimberly Shookman, pediatrician, was examining 4-day-old Adalyn from head to toe.
When Dr. Shookman did an Ortolani test and Barlow maneuver, 2 standard procedures used to test for developmental dysplasia of the hip (DDH), there was an audible noise.
“I could hear it and her parents heard it, too,” she said. “If a baby has DDH, sometimes we hear a pop or click. In Adalyn’s case, we heard a ‘clunk.’ Her hips were so unstable, it wasn’t subtle or hard to pick up.”
Hip dysplasia is the most common newborn abnormality
Two out of every 1000 babies are affected by DDH, a term used to describe hip instability, dislocation or shallowness of the hip socket. Approximately 1 in 100 infants will need treatment for DDH, according to the International Hip Dysplasia Institute. But diagnosing hip dysplasia can be difficult since it doesn’t cause pain in babies.
“Babies are born all compact and ‘folded up,’ Dr. Shookman said. “They have loose ligaments holding everything in place. That laxity sometimes allows the hips to wiggle in the socket until the ligaments tighten over time.”
If hip dysplasia isn’t detected and corrected at an early age, hip health can deteriorate as the person grows into adolescence or adulthood. Depending on DDH’s severity, a person’s quality of life can suffer because of pain, osteoarthritis and mobility problems.
In Adalyn’s case, abnormal movement caused both of her hips to dislocate and relocate in the hip sockets. Dr. Shookman didn’t wait for additional tests to confirm her suspicions. She immediately referred Adalyn to Akron Children’s orthopedic department, getting Adalyn an appointment to see Dr. Patrick Riley, Sr., pediatric orthopedic surgeon, six days later.
Treating hip dysplasia takes time
When Adalyn and her parents, Anna Hilty and Jason Mandich, met Dr. Riley, he was friendly, easy-going and answered all their questions, Anna said.
“Dr. Riley explained to us who is most likely to have hip dysplasia: first-born girls who are born in a breech or bottom-down position,” she said. “Adalyn met many of the criteria.”
After getting an ultrasound to confirm Adalyn’s DDH, Dr. Riley fitted Adalyn with a Pavlik harness. She was required to wear the harness 24/7 for 8 to 12 weeks, only removing it for diaper changes and baths.
“The harness held Adalyn’s hips in a ‘T’ shape, with her knees bent and out to each side,” Anna said. “At first, she didn’t like it. For us, it was emotionally painful because we couldn’t hold and cuddle her like we wanted. We knew this was the best treatment for her, though, especially after reading posts on several hip dysplasia Facebook groups. People described the surgeries their children had and the casts they wore for months afterwards.”
Quick action brings good results
During Adalyn’s treatment, Dr. Riley saw her every few weeks at his Akron or Medina office to check her hip position. At her young age, Adalyn’s hip sockets were shallow and made of soft, flexible cartilage. By holding the hips in the sockets, the hips usually go back to normal and become stable.
“If we find it early and treat the baby for a few months, usually 90% of the time, you win,” Dr. Riley said.
For Adalyn, her treatment was definitely a win. After her hips stabilized, she wasn’t required to wear the harness all day. Gradually, she was weaned out of it. At her November 2020 appointment, Dr. Riley gave Adalyn the all-clear, even though he is continuing to monitor the development and growth of her hip joints until she turns 1 in August.
“We see hip dysplasia quite often,” Dr. Riley said. “It so much easier to treat if the pediatrician finds it early like Dr. Shookman did. I also recommend that parents look at the International Hip Dysplasia Institute website. They have good prevention and ‘hip-healthy’ recommendations, such as how to swaddle a baby and the sort of baby carriers to use.”