What is a congenital hip dislocation?

Congenital hip dislocation (CHD) occurs when a baby is born with an unstable hip. It is caused by abnormal hip joint formation during the early stages of fetal development. Another name for this condition is “developmental dysplasia of the hip (DDH)”. The instability gets worse as the child grows.

The hip joint (which is like a ball-and-socket) may sometimes dislocate. This means that the ball will slide out of the socket. One in 1,000 children is born with a dislocated hip.

What causes congenital hip dislocation?

The cause of CHD is unknown in many cases. Contributing factors include low levels of amniotic fluid in the womb, breech presentation, which occurs when a baby is born in breech first, and a family history of the condition. Dystocia due to the narrowing of the uterus, especially in the firstborn, may cause injury.

Who is at risk of congenital hip dislocation?

More common in girls than in boys. However, any child can develop this condition. This is why the doctor routinely checks the baby for signs of hip dislocation and continues to check the baby’s hip until the end of the first year of life.

What are the symptoms of congenital hip dislocation?

There may be no symptoms, which is why the pediatrician routinely checks the condition. If a child has symptoms, they may include:

• Leg rotation outward and it appears disparate in length from the other leg

• Limited hip range of motion

• Folds on their legs and buttocks that are uneven when their legs extend

• Delayed gross motor development, which affects how your child sits and walks

How is a congenital hip dislocation diagnosed?

The baby is examined at birth and throughout the first year of life. The most common examination method is a physical examination. The doctor gently maneuvers the hip and legs while listening for popping or popping sounds that may indicate a dislocation. This examination consists of two tests:

• During the Ortolani test, the doctor will apply an upward force while moving the baby’s hip away from the body (abduction).

• During the Barlow test, the doctor will apply a downward force while bringing the baby’s hips across the body.

These tests are only accurate before the baby is 3 months old. In infants and older children, findings suggestive of congenital hip dislocation include lameness, limited adduction, and a difference in the length of the legs if only one hip is affected.

Imaging tests can confirm the diagnosis. Ultrasounds for babies younger than 6 months old can be helpful. X-rays are used to examine

older children.

How is congenital hip dislocation treated?

If a baby is less than 6 months old and diagnosed with congenital hip dislocation, he or she will likely be placed in a Pavlik harness. This harness presses the hip joints into the hollows. The harness abducts the hip in a frog-like position. The baby may wear the harness for 6 to 12 weeks, depending on his age and the severity of the condition. The child may need to wear the harness all day or part-time.

Other useful harnesses are existing for hip abduction.

The baby may need surgery if treatment using a harness does not work, or if the baby is older than a year. The surgery is under general anesthesia and includes maneuvering the hip to insert the ball into the socket, called a closed reduction, and it may be accompanied by excision of the adductor muscles of the hip immobilization and a plaster cast for at least 12 weeks.

If a child is 18 months or older or doesn’t respond to treatment, he or she may need an open surgical reduction, a pelvic osteotomy, and possibly a femur osteotomy too for the hip joint reconstruction. This means that the surgeon will reshape the head of the femur as a ball in the acetabular cavity.

How can congenital hip dislocation be prevented?

This cannot be prevented without medical treatment. It is important to bring the child to regular check-ups so that the doctor can identify, follow up and treat the condition as soon as possible.

What are the long-term expectations?

Complex or surgical treatment is less likely to be necessary when the diagnosis is made early and when the child receives treatment with harnesses or plaster. It is estimated that between 80 and 95 percent of cases that are diagnosed early and treated well have satisfactory outcomes.

Surgical treatments vary in their success rates. Some cases require only one procedure, others require multiple surgeries and years of observation. The congenital hip dislocation that is not successfully treated in early childhood can lead to early arthritis and severe pain later in life that may require total hip replacement surgery.

Regular follow-ups and regular visits to the orthopedic doctor are necessary to ensure that the condition does not recur and that the hip grows and develops well.