Congenital Hip Dislocation Treatment
What is Congenital Hip Dislocation in Children: Congenital hip dislocation is also known as developmental dysplasia of the hip (DDH) or hip dysplasia. It means that the hip joint in a new born child is not develop fully, it may be just subluxation / dysplastic acetabulam or complete dislocation of joint. The hip is a kind of ball and socket joint. Hip joint is formed by upper rounded end of thigh bone & socket of the pelvic bone.
Causes of Congenital Hip Dislocation: It is congenital anomaly present since birth only. Most of time causes are unknown but breech presentation, less amniotic fluid in uterus and family history is the common causes. More common in female child.
Symptoms of Congenital Hip Dislocation: Symptom of congenital hip dislocation depends upon the age of the child at presentation. In new born, only unstable hip can be seen in reducible hip but in teratogenic hip it may not be reducible. Hip joint will be completely dislocated so affected thigh cannot be abducted and shortening of limb. If both sides is affected then distance between both lower limb be decrease. Common symptom of CDH in walking age is painless limping, shortening, decrease in abduction of limbs, abnormal gluteal fold, decrease range of motion at affected hip joint. Diagnosis can be confirmed by clinical examination, x-ray of hip & pelvis and ultrasound.
Risk Factors of Congenital Hip Dislocation: Breech presentation, female sex, positive family history, first born, oligohydramnios, intrauterine position and positive family history are important risk factors.
Treatment Options For Congenital Hip Dislocation: Congenital hip dislocation Treatment is started once diagnosis is being made. In infancy only Pavlik harness is required. It helps the child in holding hip join insitu. It is being wear by the child continues 24 hours in day for few months. But correct indication and reduciblilty will be decided by pediatric orthopedic surgeon. In some children, hip is not reducible in pavlik harness so these children may need close reduction & hip spica plaster. In children with teratogenic CDH, Early surgery to reduce the hip joint needed. Surgery is being contemplated once infant is fit for anesthesia but usually not before the age of six months. After 6 months of age, most of child need close reduction & hip spica plaster application. Child with CDH after the age of 1 year need open surgery to reduce the hip joint. Surgery will be followed by hip spica plaster application and brace for few months. Once child started walking, proximal femur goes up so they need shortening of femur bone and reconstruction of socket. Type of Congenital hip dislocation treatment is depends upon many factor and being decided by pediatric orthopedic surgeon after detail evaluation, considering the age, reducibility, grade of dysplasia etc.
How Congenital Hip Dislocation can be Prevented? Congenital hip dislocation cannot be prevented but its complication can be prevented in long term if managed timely with good planning.
What are the Long Term Outcomes: Early detection, early onset of treatment give the best outcome. Whole hip joint growth is depends upon in-situ position of femoral head in acetabulam socket. So earliest placement of femoral head in well formed acetabular socket give excellent outcome. Delay in the surgery affect growth and development of acetabulam socket, femoral head and quality of smooth gliding surface of joint. One side hip dislocation can be operated upto any age with good outcome but in bilateral dislocation, results may not be good if delayed beyond 8 year age.
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Dr. Jitendra Kumar Jain
Trishla Orthopedic Clinic & Rehab center, 182C / 350A, Tagore Town, Prayagraj (Allahabad) U.P-211002, India