Hip dysplasia (Congenital Hip Dislocation)

What is Hip dysplasia or Congenital hip dislocation?

Congenital hip dislocation is also known as dysplasia of the hip. Hip dysplasia is the medical name used to describe a problem with formation of the hip joint in children. The location of the problem can be either the ball of the hip joint (femoral head), the socket of the hip joint (the acetabulum), or both. Historically, many doctors have called the problem congenital dysplasia of the hip, or CDH. More recently, the accepted terminology is developmental dysplasia of the hip, or DDH.

Developmental Dysplasia of the Hip

 

What causes hip dysplasia?

The exact cause of hip dysplasia is not easy to pin down, as there are several factors that contribute to developing this condition. Hip dysplasia occurs in about 0.4% of all births, and is most common in first born girls. Some known risk factors for a child to have hip dysplasia include:

  • Children with a family history of hip dysplasia
  • Babies born in breech position
  • Babies born with other “packaging problems”
  • Oligohydraminos (lack of intrauterine fluid)

How is hip dysplasia diagnosed?

Diagnosis of hip dysplasia in the infant is based on the physical examination findings. Your doctor will feel for a “hip click” when performing special maneuvers of the hip joint. These maneuvers, called the Barlow and Ortolani tests, will cause a hip that is out of position to “click” as it moves in and out of the proper position.

If a hip click is felt, your doctor will usually obtain a hip ultrasound to assess the hip joint. An x-ray does not show the bones in a young baby until at least 6 months of age, and therefore a hip ultrasound is preferred. The hip ultrasound will show the doctor the position and shape of the hip joint. Instead of the normal ball-in-socket joint, the ultrasound may show the ball outside of the socket, and a poorly formed (shallow) socket. The hip ultrasound can also be used to determine how well the treatment is working.

What is the treatment for hip dysplasia?

The basic principles for treatment are:

  • Reduce the dislocation or subluxation.
  • Hold the reduction until hip stabilizes.
  • Careful follow-up until skeletal maturity.

In a child less than 6 months of age the reduction can easily be achieved by flexing and abducting the hips (frog position). The reduction is usually maintained using a brace such as a Pavlik harness for a period of 2-3 months.

In a child in the age group of 6-18 months this condition is associated with major soft tissue contractures. To achieve reduction a period of traction for 1 week is usually necessary. This is then followed by an attempt of closed reduction under general anaesthesia. The reduction would require confirmation using an arthrogram (injection of dye into the hip joint under X-ray control). In the cases that there is resistance to reduction, additional surgical procedures such as tenotomy (muscle release) or limited open reduction of the hip may be necessary. Following this procedure the reduction is maintained using a frog plaster for a period of at least 4 months.

In a walking age child (>18 months) major surgery is often required to reduce and stabilize the hip. This could be in the form of an open reduction of the hip +/- pelvic or femoral osteotomy. Postoperatively a period of casting in a hip spica is necessary for 10 weeks.

What is the Prognosis of hip dysplasia?

Prognosis for this condition is directly related to the age of the child at the time of presentation and the severity of the hip dysplasia. In children less than 6 months of age 98% success rate is generally expected. This is reduced to 95% if the child is within the age group of 6-24 months and 85-90% if the child is over the age of 2 years at the time of treatment. Careful follow-up until skeletal maturity (age 16 years) is needed to confirm satisfactory progress and to identify complications such as recurrent dysplasia or avascular necrosis (loss of blood supply to femoral head) at an early stage.

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