The hip is a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.

Although DDH is most often present at birth, it may also develop during a child’s first year of life.

In all cases of DDH, the socket (acetabulum) is shallow, meaning that the ball of the thighbone (femur) cannot firmly fit into the socket. The degree of hip looseness, or instability, varies among children with DDH.

When we refer to Limb Length Discrepancy (LLD) we are specifically referring to differences between the lengths of the upper and/or lower legs.

A limb length difference may simply be a mild variation between the two sides of the body. This is not unusual in the general population.

Greater differences may need treatment because a significant difference can affect a patient’s well-being and quality of life.

Causes can include:

• Previous Injury to a Bone in the Leg
• Bone Infection
• Bone Diseases (Dysplasias)
• Multiple hereditary exostoses
• Ollier disease
• Inflammation (arthritis) and neurologic conditions

• Scoliosis is a sideways curvature of the spine that makes the spine look more like an “S” or “C” than a straight “I”.
• Scoliosis can cause the bones of the spine to turn (rotate) so that one shoulder, scapula (shoulder blade), or hip appears higher than the other.
• The term “idiopathic” means that the cause of this disorder is not known (in most cases).

Natural History

If left untreated, curves exceeding 50° can lead to problems in the long term. Progressive deterioration of the scoliotic curve can occur, which in some patients can lead to diminished lung capacity and the development of restrictive lung disease. Cosmetic concerns are significant to many patients. The incidence of back pain among patients with scoliosis is similar to that of the general population.

Surgical Treatment

If the curve is more than 45° and the child is still growing, the doctor may recommend surgery. If the patient has reached skeletal maturity, surgery may still be recommended for scoliotic curves that…

There is debate as to whether early discovery and treatment of a curve improves the long-term outcome, but we know that if curves are discovered late, when they are already severe, the results of treatment can be compromised. Therefore it is important that early referral to a scoliosis specialist is achieved. It is well established that early intervention where and when required improves outcome, function and rapid recovery. Delayed intervention in more severe deformity is associated with higher risk and less satisfactory results and slower return to function.

American Academy of Orthopaedic Surgeons: www.aaos.org

The Pediatric Orthopaedic Society of North America (POSNA): www.posna.org

British Scoliosis Society: www.britscoliosissoc.org.uk

Enable Ireland: www.enableireland.ie

CMRF: www.cmrf.org

Scoliosis Association UK: www.sauk.org.uk

British Orthopaedic Assocation: www.boa.ac.uk

Children in Hospital Ireland: yoobyoo.ie

Our Ladies Children’s Hosptial Crumlin: www.olhsc.ie