Congenital Dislocation of Hip
Congenital dislocation of hip is a condition present since birth in which the head of the femur is detached from the acetabulum or can be moved in and out of the acetabulum easily. Over time the ability to move the head back into the acetabulum is lost and the head remains permanently dislocated (outside the acetabulum).
About one in every thousand babies is born with this condition.
This condition is more common in
- left hip followed by both hips. Least of all the right hip is involved.
- first born child (eldest)
- breech babies (delivery in which the buttocks come out first; normally head comes first)
- Caucasians than Negro's
- with positive family history (increases the likelihood by 5 to 10%)
Other congenital defects associated with it include club foot and torticollis (wry neck).
Diagnosis is difficult and relies on a careful clinical examination along with a high degree of suspicion.
- Ortolani Test is used to detect the dislocated hip
- Barlow Test is used to detect potential for dislocation
In both these tests the hips are manipulated and the examiner attempts to feel the hips dislocating and reducing.
If the dislocation is missed initially and the child continues to grow, then various other changes can be seen in the extremity.
- the affected limb appears short (called Galeazzi sign)
- increased skin folds are present
- attempted movement of the hip towards the outside (abduction) is reduced as compared to the normal hip
In dislocations involving both hips these signs can be missed. If the child begins to walk then a "waddling" (as if rocking from side to side) type of gait is seen.
of the pelvis (hip bone) can detect congenital dislocation of the hip. The younger the patient the more difficult is the assessment of dislocation on x rays. Various reference lines are used to detect possible dislocation.
Ultrasound can also be used to diagnose a dislocated hip. It is better than x rays in the first month of life. Its effectiveness depends on the expertise and experience of the ultrasonologist.
Treatment of congenital dislocation of hip depends on the age and the reducibility of the hip.
Between birth to 6 months- A Pavlik harness is used to maintain the reduction. Treatment in a Pavlik harness requires compliance from the parents to be effective. Frequent visits to the treating surgeon on a weekly or twice weekly basis are essential.
6 to 24 months- Traction, reduction of the dislocation by closed (manipulation without operation) or open (surgical) means, followed by the application of a plaster cast to hold the reduced hip. Follow up with x rays to check continuity of reduction.
2 to 4 years- Operative treatment is required. Open reduction along with various femur and pelvic bone operations.
Beyond 4 years- There are no strict guidelines for treatment at this age, therefore the treating surgeon will use the modality with which he is comfortable and knowledgeable.
- If the dislocation is unilateral (only one hip dislocated) and the age is between 4 to 5 years then I would attempt an open reduction.
- Between 5 years to 14 years my strategy is to wait in bilateral (both hips dislocated) cases. In unilateral cases I give a shoe raise.
- At 14 to 17 years in unilateral patients, I do a pelvic support osteotomy with Ilizarov fixator.
- In adult patients with bilateral disease, total hip replacement is done when the patient has pain and difficulty in walking.
Frequently Asked Questions
When can I suspect that my baby has congenital dislocation of hip?
If you notice the following signs then you can suspect dislocation
- one hip moves less than the other hip
- one limb appears shorter than the other
- you have difficulty in changing diaper
- one thigh has more skin creases than the other
What causes the dislocation to occur?
Many factors are thought to cause the dislocation, these include
- maternal hormones secreted during pregnancy cause the the joint to become loose
- mechanical forces during breech delivery
- genetic influence
- shallow acetabulum (cup of the hip joint)
What factors influence the outcome of treatment?
The main factor that decides the result of treatment is the how early the diagnosis is made. If the diagnosis is made within 1 to 2 months and the treatment is started with a Pavlik harness then up to 95% patients have a good outcome.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 2nd March 2009.
Other causes of hip pain...
Congenital Dislocation of Hip
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