Developmental dysplasia of the hip is a well-known problem, but unfortunately it is often managed inappropriately.
Late or incorrect diagnosis and treatment often lead to the need for more prolonged or more invasive treatments. For this reason, it’s essential to immediately contact experienced centers.
In Bologna, an experienced hip dysplasia center: OrthoChildren Center
Our center has world-class experience in this field and handles all aspects: from ultrasound diagnosis to treatment with braces to surgery.
Dr. Lampasi has been treating DDH for years, with extensive experience gained from his years at the Rizzoli Orthopedic Institute in Bologna (Italy).
He was Head of Pediatric Orthopedics at Meyer Hospital in Florence, where he performed (the first in that hospital) many surgical interventions in this field, and introduced management protocols for this condition to this hospital.
He is a recognized member of the International Hip Dysplasia Institute.
For years he has been working to improve the level of management of this condition in Italy, with regional working groups, training courses (for orthopedic surgeons, pediatricians and professionals in this area), national conferences, dissemination activities on the web and social media and through continuous dialogue with colleagues who are experts in hip dysplasia.
Dr. Lucchesi has been specializing in hip ultrasound and the treatment of hip dysplasia for years. Over the years, he has developed significant expertise in this field, thanks primarily to ongoing collaboration with one of Italy’s leading experts in ultrasound for congenital hip dysplasia, Dr. Salvatore Bonforte of Catania.
Hip dysplasia clinic in Bologna: what services does it provide?
The hip dysplasia clinic in Bologna at OrthoChildren Center is one of the very few centers in Italy able to manage all the various options:
- neonatal hip ultrasound screening
- hip ultrasounds for re-evaluation of doubtful conditions (second opinion)
- Treatments with braces: Doctors have experience with a wide range of braces: Ferrara, Pavlik, Coxaflex, Hip-Med, Tubingen, Milgram, Rhino, etc.
- application/adjustment of the brace directly by doctors (one of the most frequent errors is to have the brace applied by families or inexperienced personnel)
- application of spica casts, in cases where indicated
- scheduling of surgical interventions (performed by the Team doctors without the need for referral to other centers)
- execution of follow-up X-rays with direct positioning by the doctors following the patient
Hip dysplasia screening in Bologna
The most recent recommendations of the Italian Society of Pediatrics and Pediatric Orthopedics recommend performing an ultrasound of the hips:
- to all newborns
- within 4-6 weeks
Unfortunately, these recommendations have not yet been implemented in clinical practice in many facilities, resulting in many newborns arriving without an ultrasound scan or with one performed late. Our Center performs screening hip ultrasounds for all newborns, upon reservation.
Congenital hip dysplasia and dislocation: starting off on the right foot
It is essential to immediately perform:
- A correct ultrasound: must describe the morphology and classification of the hip according to Graf: hip 1a, hip 1b, hip 2a+, hip 2a-, hip 2b, hip 2c, hip type D, hip type 3a, hip type 3b, hip type 4, unstable hip, immature hip, etc.
- A correct visit: anamnesis, clinical examination with Ortolani maneuver performed correctly, etc.
What happens if the diagnosis is not made correctly?
If the initial assessment is performed incorrectly, all subsequent considerations risk being incorrect, and the wrong decisions may be made: unnecessary or excessive treatments, or, conversely, delayed treatments. These situations, unfortunately, are not uncommon.
Diagnosing dysplasia: what mistakes should we avoid?
The errors we encounter are quite common:
- Incorrect ultrasound scans: the most common cause of problems are ultrasound scans that do not comply with Graf’s principles, with incorrect classifications, incorrect measurements, etc.
- Unnecessarily performed X-rays: Centers that do not have the possibility/capacity to perform ultrasounds unfortunately frequently resort to X-rays, exposing newborns to excessive and unjustified radiation.
Hip ultrasound for hip dysplasia: Was it performed correctly?
The important thing is not to perform an ultrasound of the hips but to perform it correctly , following the criteria described by Graf. If the ultrasound does not meet these criteria, it is useless!
Our group has been working for years to explain to families and professionals how to recognize an incorrectly performed ultrasound.
For example, it is important:
- that a positioning pillow be used : Graf recommends it in all his courses. If it is not used, there is a greater risk that the ultrasound will not be performed properly.
- That the images of the examination be delivered to the family
- That an adequate report be drawn up , with the description of the morphology, angles and classification
- That the images comply with Graf’s checklists
Our Center meets these parameters.
Dr. Lampasi has also developed an original method to help parents and professionals recognize an incorrect ultrasound, which has been published in international journals.
Hip dysplasia treatment: how is it treated?
The most current recommendations recommend treatment based on ultrasound monitoring. The best results are achieved if the doctor treating the patient is skilled in performing both the ultrasound and the treatment.
If the ultrasound is performed by one doctor and then the treatment is performed by another, the results may be inferior. Unfortunately, this situation is very common.
In our center, the Team doctors perform both ultrasound and treatment.
Hip dysplasia treatment: what mistakes to avoid?
Treating DDH is not simple. Unfortunately, it is not uncommon to encounter:
- Unnecessary treatments: useless double diapers, unnecessary braces, unnecessary traction, casting for cases that can be solved more easily, etc.
- Incorrect treatments : incorrect application of spreaders, execution of forced maneuvers, etc.
- Incorrect surgical indications : excessive surgery for cases that can be managed without surgery, and vice versa.
Congenital hip dysplasia and dislocation: the relationship with families
For years, our team has been working with support groups founded by parents of children with hip dysplasia. Unfortunately, it’s not uncommon to hear stories of children experiencing the challenges described above.
Congenital hip dysplasia and dislocation: what’s the treatment?
The only possible way to limit the risk of bad results is to immediately contact centers:
- who know how to perform hip ultrasound well
- that base treatment on ultrasound , as recommended by international guidelines
- who have experience applying various types of braces. There is no single spreader that is suitable for all situations.
Our center has experience using different types of braces, adapting the treatment to the specific case.
The Team has also prepared a lot of useful material to support families
Family support video.
Hip dysplasia: what is the treatment?
- Graf type 1b hip : If a Graf type 1b hip is diagnosed, it’s important to first ensure the ultrasound diagnosis was performed correctly (see above). If the diagnosis is correct and there are no other problems, the condition is considered normal and requires no treatment. Unfortunately, it’s not uncommon to hear stories of children treated with braces for these conditions.
- Hip 2a+ and hip 2a- according to Graf : if you’re diagnosed with hip 2a+ or hip 2a-, it’s important to first ensure the ultrasound diagnosis has been performed correctly (see above) and then contact experienced centers that can distinguish between cases requiring treatment and those requiring only follow-up. These conditions are easy to resolve if managed properly.
- Hip type 2b according to Graf: if diagnosed with hip type 2b, it is important to first ensure that the ultrasound diagnosis has been performed correctly (see above) and then contact experienced centers. These conditions are easy to resolve if treated appropriately.
- Hip 2c according to Graf: If you’re diagnosed with hip 2c, it’s important to first ensure the ultrasound diagnosis was performed correctly (see above) and then consult experienced centers. These conditions are easy to resolve if treated appropriately. If treated incorrectly, there’s a significant risk of prolonged treatment or worsening of the condition.
- Hip D according to Graf: If a diagnosis of hip D is made, it is important to first ensure that the ultrasound diagnosis has been performed correctly (see above) and then consult experienced centers. These conditions can be resolved with braces if treated appropriately. If incorrectly treated, there is a significant risk of prolonged treatment or worsening of the condition.
- Graf type III hip: If diagnosed with type III hip, it’s important to first ensure the ultrasound diagnosis was performed correctly (see above) and then promptly refer to centers experienced in treating high-level cases. These conditions can be resolved without invasive treatments if treated appropriately and early. If incorrect treatment is performed, there’s a significant risk of failure and the need for more invasive treatments.
- Graf type 4 hip : If diagnosed with type 4 hip, it’s important to first ensure the ultrasound diagnosis has been performed correctly (see above) and then promptly contact centers experienced in treating high-level cases. These conditions can sometimes be resolved without invasive treatments (if treated appropriately and early), but they often fail and may require more invasive treatments. For this reason, it’s important to contact centers that know how to manage all treatment options, from braces to casts to surgery.
Hip dysplasia: how long does recovery take?
One of the biggest concerns for parents is understanding how long it will take for the condition to heal (hip 1b, hip 2a+, hip 2a-, hip 2b, hip 2c, hip type D, hip type 3a, hip type 3b, hip type 4, unstable hip, immature hip, etc.).
The first thing to understand is that it’s pointless to talk about recovery times if the diagnosis hasn’t been made correctly . Sometimes we see parents with similar diagnoses (for example, hip type 2C) confront each other, but then, upon closer inspection, in one of the two cases the ultrasound had been measured incorrectly, resulting in a milder outcome than expected and a more rapid resolution for this reason.
In general, healing times will be much quicker if:
- the diagnosis is made early and correctly
- treatment is started early
- the right brace is applied
- the brace is applied correctly
- families respect the prescribed hours of use
Again, it is important to turn to experienced centers.