INTRODUCTION:
Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It’s caused by abnormal formation of the hip joint during their early stages of fetal development. Another name for this condition is “developmental dysplasia of the hip.” This instability worsens child grows.The ball-and-socket joint in the child’s hip may sometimes dislocate. This means that the ball will slip out of the socket with movement. The joint may sometimes completely dislocate.
CAUSES:
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 the baby is born hips first, and a family history of the condition. Confinement in the uterus may also cause CHD or contribute to it. This is why baby is more likely to have this condition if pregnant for the first time. Pregnent uterus hasn’t been previously stretched.
RISK POPULATION:
CHD is more common in girls than in boys. But any infant can have the condition. This is why child’s doctor will routinely check newborn for signs of hip dislocation. They’ll also continue to examine child’s hips at well-baby checkups during their first year of life.
SIGNS & SYMPTOMS:
- legs that turn outward or appear to differ in length
- delayed grow motor development, which affects child sits, crawls, and walks.
DIAGNOSIS:
Screening for CHD occurs at birth and throughout the first year of child’s life. The most common screening method is a physical exam. The child’s doctor will gently maneuver child’s hip and legs while listening for clicking or clunking sounds that may indicate a dislocation. This exam consists of two tests:
- During the Ortolani test, your child’s doctor will apply upward force while they move child’s hip away from the body. Movement away from the body is called abduction.
- During the Barlow test,child’s doctor will apply downward force while they move child’s hip across the body. Movement toward the body is called adduction.
These tests are only accurate before child is 3 months old. In older babies and children, findings that indicate CHD include limping, limited abduction, and a difference in leg lengths if they have a single affected hip.
Imaging tests can confirm a CHD diagnosis. Doctors examine ultrasounds for babies younger than 6 months old. They use X-rays to examine older babies and children.
TREATMENT:
If the baby is younger than 6 months of age and diagnosed with CHD, it’s likely they’ll be fitted for a Pavlik harness. This harness presses their hip joints into the sockets. The harness abducts the hip by securing their legs in a froglike position. Baby may wear the harness for 6 to 12 weeks, depending on their age and the severity of the condition. Baby may need to wear the harness full time or part time.
child may need surgery if treatment with a Pavlik harness is unsuccessful, or the baby is too big for the harness. Surgery occurs with general anesthesia and may include maneuvering their hip into the socket, which is called a closed reduction. Or the surgeon will lengthen baby’s tendons and remove other obstacles before positioning the hip. This is called an open reduction. After baby’s hip is placed into position, their hips and legs will be in casts for at least 12 weeks.
If child is 18 months or older or hasn’t responded well to treatment, they may need femoral or pelvic osteotomies to reconstruct their hip. This means a surgeon will divide or reshape the head of their femur (the ball of the hip joint), or the acetabulum of their pelvis (the hip socket).
PREVENTION:
You can’t prevent CHD. It’s important to bring child to regular checkups so their doctor can identify and treat the condition as soon as possible. It may want to verify their doctor examined newborn for signs of hip dislocation before leave the hospital following delivery.
PROGNOSIS:
Complicated or invasive treatment is less likely to be necessary when your doctor identifies CHD early and your baby received treatment with a Pavlik harness. It’s estimated that between 80-95% of cases identified early receive successful treatment, depending on the severity of the condition.
Surgical treatments vary in their success rates. Some cases only need one procedure, and others require many surgeries and years of monitoring. CHD that’s not successfully treated in early childhood can result in early arthritis and severe pain later in life that might require total hip replacement surgery.
If child’s CHD is successfully treated, they’ll likely continue to regularly visit an orthopedic specialist to make sure the condition doesn’t return and that their hip is growing normally.
THANK YOU,
SRIKUMARN PHYSIOTHERAPY CLINIC & FITNESS CENTER
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