CONGENITAL DISLOCATION OF HIP-

Also known as DEVELOPMENTAL DYSPLASIA OF HIP

• This is a defect in the development of the hip joint.

• The hip joint is made of a long bone in the thigh which rotates in a socket of the hip. This joint is stabilised by a capsule(cover that surrounds the joint).

• When the bone doesn’t fit into the socket adequately, there are more chances of the bone to get dislocated from the socket.

• This becomes more prominent after the child starts walking.

 

TYPES

• The long bone of thigh(Femur) may make little contact in the socket (subluxation) or completely have no contact with the socket (Dislocation)

 

RISK FACTORS

• This problem depends on various hormonal, mechanical and genetic factors

• Runs in families (up to 10 to 30%)

• Breech presentation at birth- during the last month of pregnancy, the child increases in size. Instead of lying with head down (in the uterus) if the baby lies horizontally, the space for growth is limited and may have this problem.

• Similarly, if there is less amniotic fluid around baby or a large baby, there are higher chances of this.

 

SYMPTOMS

• In new-born, this dislocation does not cause any symptoms because the baby has not yet started standing yet.

• Every baby is screened for this problem by pressing on the hip joint to try to dislocate it and then replace( at birth). Don’t attempt it yourself.

• The basis of doing this test early is that if it can be identified early then the repair is easier.

• In older babies difference in foot length may be found with a decreased movement of the affected leg.

• When the child is old enough to start walking you would find a limp or abnormal walking stance.

• The child may walk tiptoe to compensate the length difference.

 

DIAGNOSIS

• The child is specifically looked for this at birth( within 3 days). Make sure you have it documented also.

• Scans- ultrasonography. This generally done at 6 to 8 weeks to see the stability of joint

• X Rays- This may be considered at 4 to 6 months.

 

TREATMENT

• The aim is to help keep the bone end within the socket. The earlier the treatment, the more favourable the outcome.

• Pavlik Harness-One method at birth is by placing a harness( straps) to keep the joint stable. it could be used for 1-2 months based on the effectiveness.

• Most cases improve in first 2 months. You may need a review ultrasound test at 1 month.

• If no improvement, then the surgical method is used. It is done under general anaesthesia. A cast(plaster) may be put around the joint for 3 months.(closed or open reduction)

• If no improvement, at 5-6 years of life the bone may be trimmed to maintain equal leg length.

 

PROBLEMS-

Dislocation can compromise the blood supply to the bone and cause problems in further life.