Too hip for dysplasia

developmental dysplasia of hip Thirty-something moms Tosha LoSurdo and Jessica Rohrick have been friends since college. In 2015, both learned they were pregnant for the first time. They thought they might share similar sagas as new moms — diapers, sleepless nights and teething. They didn’t expect to bond over infant hip dysplasia.

When Tosha’s daughter Carmela was born on Feb. 4 at Brigham and Women’s Hospital, the pediatrician noticed her hips were a little “clicky.” She was told the connection between the femoral head (top of her thigh bone) and hip socket wasn’t stable, and Carmela might have developmental dysplasia of the hip; Carmela was referred to Dr. Eduardo Novais, a pediatric orthopedic surgeon and hip specialist in the Boston Children’s Hospital Orthopedic Center and Child and Young Adult Hip Preservation Program, who examined her before she was discharged home.

“He provided the perfect level of information, being straightforward and providing realistic and detailed scenarios, taking Carmela’s condition and our concerns seriously but not scaring us,” says Tosha. Novais also prepared Tosha and her husband Tindaro for the next steps in Carmela’s care, stressing the importance of bonding with their new baby and healthy hips for life.

Babies with infant hip dysplasia often need a Pavlik harness or Rhino brace to immobilize their hips as the hip socket and ligaments become more stable.

The LoSurdos brought Carmela to Boston Children’s one week after birth, and Novais told the couple Carmela would need a Pavlik harness. “The first time we saw the harness on her little body, it was difficult — very emotional — but we felt informed enough to take care of her in it. Dr. Novias’ team made themselves available to us whenever we had questions,” says her mom. Carmela had to wear the harness 24/7, and she couldn’t wear any clothes under it.

infant hip dysplasia
Dr. Eduardo Novais exams Carmela.

Novais encouraged Tosha and Tindaro to find a support group. They found one on Facebook and connected with other parents who provided tips, like where to find clothes for babies being treated for hip dysplasia and how to nurse and provide comfort to a baby while in the harness.

As Tosha came up to speed on the basics of infant hip dysplasia, her friend Jessica was preparing for her baby’s birth. After Phallon, a breech baby, was born on March 24 at South Shore Hospital, her pediatrician heard the same click in her hips.

He recommended monitoring Phallon’s hips for six weeks, explaining that breech babies are at higher risk for hip dysplasia and typically have an ultrasound at that age. Phallon also met two other hip dysplasia risk factors — she’s first-born and a girl.

Phallon’s ultrasound showed hip dysplasia. Dr. Travis Matheney, another Boston Children’s orthopedic surgeon and hip specialist, prescribed a Pavlik harness just like Carmela’s.

Having a connection with Tosha and Carmela really helped, says Jessica. “I had an idea of what to expect.”

Carmela’s care

After three weeks in the Pavlik harness, ultrasound exams showed that one of Carmela’s hips had not improved, so Novais prescribed a Rhino brace. Carmela wore the brace 24/7, except for diaper changes, before moving to nights and naps only. During that time, Novais monitored her closely, scheduling ultrasound exams and appointments first weekly, then bi-weekly, then monthly.

“It was easier with the brace than the harness. We had to take off the harness to change her, while we could put clothes on her under the brace,” says Tosha. When Carmela graduated to night and naptime-only use at four months of age, it was a milestone.

developmental dysplais of the hip
Tosha celebrates good news with Carmela.

Carmela’s six-month follow-up appointment with Novais was her next milestone. At that August appointment, Novais reviewed the results of Carmela’s ultrasound and radiographs.

Good news. Her hip dysplasia had been corrected. She no longer needed the brace. The LoSurdo family will return to see Novais in February when Carmela turns 1 for a follow-up x-ray and checkup to ensure her hips have remained stable.

“For babies younger than 4 to 6 months old, we typically use ultrasound as the diagnostic tool to assess the development of the hip joint. After this age, the hip starts to ossify (bone starts to form in the femur head), and x-rays become more reliable,” explains Novais.

Phallon’s care

Though Carmela and Phallon had the same diagnosis, Phallon’s hip dysplasia resolved more rapidly. Phallon used the Pavlik harness 24/7 for four weeks and then only at night for another four weeks. “Our experience was very quick and painless compared to others,” says Jessica.

Dr. Travis Matheney exams Phallon
Dr. Travis Matheney exams Phallon

At her follow-up appointment in October, Matheney showed Jess her daughter’s x-ray. “Everything looks good,” he told Jess and predicted Phallon will crawl, walk and run on her own timetable, unaffected by hip dysplasia.

There is a small chance for recurrence of hip dysplasia. Novais and Matheney will monitor Carmela and Phallon by x-ray at 1 year, 2 years, 5 years, 10 years and at around 15 years old.

“If hip dysplasia doesn’t return by age 2, fewer than 5 percent of kids have recurrence. If it doesn’t recur by age 6-8, it’s very rare, so a lot of doctors end follow-up there. I’ve seen enough patents with adult hip dysplasia who weren’t followed through their teens to recommend follow-up through the early teen years,” says Matheney.

Learn more about how Boston Children’s hip specialists care for babies with developmental dysplasia of the hip.