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For children with a body harness or spica cast by hip dysplasia

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Hip luxation right hip

Hip luxation of the right hip (Femke, youngest daughter of Oeda de Jong, initiator and owner of Kiek Hip Wear) 

  • Mother also suffered hip luxation, but nobody else in the family.
  • Discovered by the doctor at the infant centre at 7 weeks (because of heredity a standard check was planned at 3 months).
  • Pavlik, 2x spica cast and hip brace.
  • Treated since she was 7 weeks old, at the age of 3 years and 7 months heard that the treatment had been successfully completed.


How old was Femke when it was discovered and by whom?

Because I was born with hip luxation myself, a standard screening had already been planned in with an orthopaedist for children like Femke at the age of 3 months. When Femke was seven weeks old, it was already obvious to the doctor at the infant centre that her hips were not okay. She suffered from so-called ‘clicky hips’. Hips are referred to as clicky hips when you can hear an obvious click when you move the child’s legs. You can try this movement by putting your child on his or her back with their knees pulled up. You grab the two bent legs, one in each hand, and move them outwards and back while keeping the child’s knees up. You repeat this movement. When moving the legs outwards and back you can feel and sometimes even hear a click. I am not a doctor but I would say that what you then feel is the acetabular cup and femoral head moving against each other.

How was Femke treated?

From the age of seven weeks, Femke wore a Pavlik bandage for a number of months. This did not have the desired outcome. When she was eight months old, she lay in traction for two weeks followed by a spica cast for three months (after a closed reposition*).

The traction was necessary because tissue had formed between the acetabular cup and the femoral head as a result of which it was difficult/impossible to place the femoral head against the acetabular cup. The closed reposition was very successful: the femoral head was back in its cup and stayed there even after the spica cast had been removed.  

After the spica cast, Femke had to wear a body harness for a couple of weeks. She then had a period without any brace or harness so that she could develop optimally: crawling and walking. The hope was that the pressure on the hips caused by walking would also improve the femoral head. 

At the following screenings it appeared, however, that her hip joint was still not okay. There was too much space between the femoral head and the acetabular cup. When Femke was two years old she had an operation: the acetabular cup was made a little rounder as a result of which the femoral head stayed in its place. This was followed by another spica cast for three months. As she was older and thus heavier, it was more difficult for us to carry her. We were amazed that so little was available for children with a spica cast or body harness and we had to reinvent the wheel, while so many parents must have encountered the same problems, which was the reason why I decided to set up Kiek Hip Wear. Initially with special clothing and practical aids, but now also with stories and practical tips from other parents. Because that is what parents seek to find when they first hear about their child’s developmental dysplasia of the hip: what is it, what are other parents’ experiences and what practical solutions are available. 

Practical tips

On the page with practical tips you can read all the tips that other parents have shared with us. Below is a short explanation of what we thought to be practical when Femke had to wear a spica cast. 

Practical tips for spica cast at 8 month

When Femke had to wear a spica cast when she was 8 months old, we were helped tremendously with an extra wide pram (urban jungle duo). During the day she could sleep in the pram in the living room and join me doing the shopping and taking my other children to school. As it is difficult to carry a child when wearing a spica cast, I was grateful that I did not have to take her up and down the stairs for her little naps during the day.

To ensure that Femke could also lie in a different position I also bought a beanbag (Doomoo Seat): ideal for letting Femke sit up and feeding her. This practical solution is also included in the range of Kiek Hip Wear: a beanbag for a spica cast or body harness.

When Femke was wearing her first spica cast, there were no clothes available which I liked. Fortunately, I have a very handy sister. She made gorgeous trousers for my daughter which she could wear on top of her spica cast. These trousers mark the start of Kiek Hip Wear. The doctors in the hospital were so enthusiastic about the trousers my sister made, that it made me think whether I could do something with this design.

Practical tips for spica cast at the age of 2

When Femke had to wear her spica cast she was already two years old and much too big for the pram. Once again I started searching, this time for a suitable buggy. I contacted pram rental organisations but to no avail. Finally, via the Dutch Association of Congenital Hip defects I was able to rent an old wide buggy. We were glad to be helped out. This buggy was not suitable for long walks, but it was something in which she could sit and was fine for short strolls.

The buggy was a godsend for the nursery in particular. We took Femke to the nursery in her buggy, she could sit in it during the day, could eat in it during lunch time, and the nursery staff could take Femke with them when the other children were playing outside. In this way, Femke was surrounded by the other children all day and whenever possible played with them. And we were very happy that Femke could continue to go to the nursery. The two-week traction period and all the hospital visits had already cost us many days of leave from work and it is impossible to stay at home and not go to work for two periods of three months.

We also rented a cot bed which could be adjusted up and down and put it in the living room. Ideal for playing, watching television and changing her nappy at a convenient height. Once again, a great advantage of this bed was that we did not need to carry her up and down the stairs during the day.

For Femke, the big hit was the wooden trike, which we used as a sort of wheel chair and took with us wherever we went. The first time we put Femke on the wooden trike, she was very cautious and it took a little while for her to discover how she could move herself around on it. She became better, faster and wilder (!) at it as you can see in the video clip practical tips.

Children’s physiotherapist

During this period we contacted a children’s physiotherapist at our own initiative as we wanted to be ensure that Femke developed her movements in the right manner. Because she had already had a period in which she developed a little less optimally because of her hip problems, we wanted to prevent her from having another period in which she would be moving around on her bottom or otherwise which could have led to more delays in the development of her movements. The support we received from the physiotherapist was very useful and reassuring, in particular because she confirmed that Femke was moving correctly and was making progress. The physiotherapist visited us weekly at home and practiced movements with Femke. In a playful manner, she was encouraged to move in the correct manner and she gave us tips so that we could encourage this process. Think of from sitting to crawling and from getting up to sitting down. 

I would definitely recommend everybody to ask the help of a children’s physiotherapist, but always in consultation with the orthopaedist in attendance. There is no national protocol and I have experienced that some doctors suggest it themselves and others don’t, but actually find it a great idea when parents propose this to them.  

Does it run in the family or was it due to a breech delivery?

I was born with a hip luxation to my left hip myself. Below you can read my story to illustrate what the effects could be when hip luxation is not treated early enough.

After I was born forty years ago, my mother pointed out to her GP that she thought that something was not right with my legs. Each time, it was brushed aside by the GP with a comment like ‘you are over-concerned’. A pity, because when I was not able to stand and walk, I was diagnosed with a hip luxation of my left hip just after celebrating my first birthday.  

A hip brace was not an option anymore, so an operation and spica cast were necessary. After two days in the spica cast, it appeared that my hip joint was already dislocated and the spica cast had to be removed. When the doctor in attendance did not have the intention to continue treatment, my parents decided to see another orthopaedist in a different hospital.

This was followed by some sort of traction with sandbags for a period of eight weeks. The traction was, unlike nowadays, not with the legs up in the air, but with the legs down on the bed. I had to stay in hospital for a total of three months. That was a very different time: parents were only allowed to visit one hour per day and brothers and sisters were not allowed to visit at all. After another spica cast, I was ultimately able to walk at the age of one year and ten months. Unfortunately, with a limp.

At the age of 10 I had another hip operation. The upper leg was sawn in two and reconnected in a different angle from the femoral head and acetabular cup. When I was 14 years old, doctors delayed the growth of my right leg by placing clamps in the disc of my right knee. The purpose of this treatment was to decrease the difference in length of my legs. The difference in length is now within the normal margins. The clamps are still in place and cause irritation from time to time.

Unfortunately my walking with a limp has not improved despite the operations. The limp is not caused by the difference in length of my legs but by the abnormal formation of my hip and weak or no longer existent muscles. With the support of the best physiotherapists I have tried to train my hip to improve my limp, but the result has been minimal. The conclusion is that my muscles are no longer functioning optimally because they were cut through during the operations and were not reconnected properly or have become too tight or too loose due to the rotation of my hip. As a result of this, I have very little muscle strength in my left hip joint and the muscles that are still there are extremely tight due to the pressure on them.

After the last operation I visited orthopaedists every few years for screening. The left hip is deteriorating slowly, but unfortunately too much pressure on the right hip has meant it is as bad as my left hip.

I am now forty years old and my hips are now getting more painful, in particular in cold (autumn) weather or when there are large differences in temperature. The limp has also put a strain on my back, as a result of which I now visit a physiotherapist once a week to make and keep it supple.

During my last check up in 2012 the advice was to wait for an operation until the pain has become unbearable, despite the use of painkillers. Replacing the left hip is very complex because it is deformed. The complete hip joint must be replaced but the question is: at what angle must the hip joint be placed so that my body is at the same angle as before; and what will happen if my body ‘straightens up’ after the operation. Nobody can foresee what kind of other problems an operation might bring.

The big question for me now is: which orthopaedist is best able to operate me? Who has most experience with this kind of hip replacement for relatively young people? Checking with orthopaedists has only provided me with contradictory answers. If you read this and know somebody who is willing to share his or her experiences with me or who knows an experienced hip specialist, please contact me via info@kiekhipwear.com

How long did the treatment take?

Femke’s treatment started when she was seven weeks old and during the check-up at three years and seven months we received the news that everything looked good and that no problems are expected later in life. Femke did not need to wear a body harness or spica cast for this entire period. There were months that she was not treated when we had to wait and see how her hip would develop.

The next hospital screening to monitor the development of her hip will be in six months and thereafter every other year.

What is the outcome?

The outcome is a girl with a good and properly functioning hip joint. The children’s orthopaedist expects her to be able to function normally and not to suffer problems with her hip later in life.

And last but not least: she only has a small horizontal scar underneath her bikini line. This in contrast with my own scars which run vertically across my hip, approximately 35 centimetres long and a few centimetres wide. Fortunately, the expertise and knowledge in this area has significantly improved over the years!!!