Congenital hip dislocation (CHD) is the instability of hip joint in children from birth. The hip functions abnormally. With aging, the condition of hip worsens. In some severe condition, the complete dislocation of hip can also occur. Congenital hip dislocation is sometimes also known as developmental dysplasia of the hip. Girls mostly develop this disease condition.
Any individual can be affected with congenital hip dislocation. The actual cause is still not much clear. The people mainly in risks include:
- Family history
- First-born children
- Babies born in breech position
- Nerve and muscle disorders
No major symptoms exists for congenital hip dislocation. Some of the assumed symptoms are:
- Different length of legs
- Unequal skin folds in legs as well as body
- Delay in gross motor development
- Toe-walking, waddling, or limping
To diagnose the actual cause of symptoms, the doctor physically examines the hips and legs. Two physical tests are mainly used:
- Ortalani Test
It checks the upward force on the hip while it is moved away from the body.
- Barlow Test
This test determines the downward force involved when the hip is moved closer to the body.
? Imaging tests such as MRI scan, x-rays, etc are also used to confirm CHD. Ultrasound examination is mainly chosen for children under 6 months of age. After diagnosis, the actual treatment is decided. It includes both non-surgical treatment and surgical treatment procedures.
- Non-surgical Treatment:
The type of non-surgical treatment is based upon the age of the child:
For newborn children, diagnosed with congenital hip dislocation, extreme care is given. Pavlik harness, a soft positioning device, is used to place the child. This enables the thighbone to be placed in the socket. This type of braces are specially designed for newborn babies. This holds the hip in correct position. It also allows free and easy movement of legs with proper diaper care. As a result, the hip joint ligaments are tightened. This promotes the formation of normal hip socket.
- 1 month to 6 months
This is one of the successful method even with hips which are initially dislocated. The baby is kept under proper local or general anesthesia. In this method, a harness device is used to reposition the thighbone of baby in the socket. The duration for wearing harness varies with every child. If harness device fails to hold hip, then a closed reduction procedure is used. During procedure, the thighbone of baby is moved to proper position. A body cast( spica cast) is then used to hold bones in proper position. Specific instructions are to be followed while caring a baby in spica cast.
- 6 months to 2 years
Closed reduction and spica casting method are also used for older group children. Prior to thighbone repositioning, a skin traction is used. Skin traction provides soft tissues around the hip while bone repositioning. This treatment can be done both at home or hospital.
- Surgical Treatment:
If the non-surgical treatments fail, then surgery is chosen. The different surgical procedures include:
- 6 months to 2 years
In some children, closed reduction method do not improve symptoms. In such cases, open surgery is opted. During surgery, tiny incisions are created on the hip of the child. These incisions help in proper viewing of the bones and soft tissues. If required, the thighbone is shortened. This allows proper fitting of bone in the socket. To confirm the bone position, x-rays are used in between surgery. Later, spica cast is used to hold the hip in exact position.
- Older than 2 years
In severe cases, the condition worsens as child grows. To correct this, open surgery is done. Open surgery involves re-alignment of the hip. To maintain the hip in socket, a spica cast is required.
After surgery, the child is usually discharged after 2 days from the hospital. Braces or casts are used until the healing process is over. The healing process usually comprises of 2 to 3 months. The old cast is replaced with new one during this period. X-rays are done in between to monitor the recovery. Simple exercises are helpful to enhance recovery. It often takes 6 months for complete recovery.
The possible risks with congenital hip dislocation surgery are:
- Difficulty in walking
- Skin irritation due to braces or casts
- Growth disturbances
- Persistent shallow hip socket