Congenital dislocation hip/ DDH Treatment

 

If your newborn child is diagnosed with congenital dislocation hip or developmental dysplasia of the hip – DDH within the first two months after birth or during the very first year, then immediate treatment is required.

Delay in the treatment of congenital dislocation hip will lead to the child suffering from instability in the hip joint, improper functioning of the hip, and premature degenerative joint disease.

According to Dr, Ratnav Ratan, an orthopedic doctor Gurgaon, it is important to consult a specialist and get the treatment as soon as possible if your child is diagnosed with congenital dislocation of the hip.

Symptoms of Congenital Dislocation of the Hip

Generally, the child will not show any signs of a dislocated hip.  However, a parent can lookout for the following visible signs –

  • Limping
  • Walking on toes
  • Waddling style of walking
  • Legs of different lengths,
  • Less mobility or flexibility on one side,
  • Uneven Skin fold at the thigh

Also, the parents can approach a pediatrician or a pediatric orthopedic surgeon for an accurate diagnosis who will diagnose it accurately.

Causes of Congenital Dislocation of the Hip

Congenital Dislocation of the Hip runs in the families, especially in the left hip. Also, this condition is detected more in firstborn children, girls, and babies born in the breech position or with low levels of amniotic fluid, i.e., oligohydramnios.

Anatomy of Congenital Dislocation of the Hip

In a normal hip, the ball at the upper end of the thighbone fits perfectly into the socket of the large pelvis bone. But in a child with congenital dislocation hip, the ball does not fit properly in the socket and can dislocate from the socket easily. The ligaments that hold the joint in place are stretched to some extent. The degree of looseness or hip instability varies from one child to another.

The three types of stages of Congenital Dislocation of the Hip –

Anatomy of Congenital Dislocation of the Hip
Total Dislocation

The ball of the femur is entirely out of the socket. It is the severest condition of congenital dislocation of the hip.

Dislocatable

The ball of the femur lies within the socket loosely. It is possible to move it outside during a physical examination.

Partial dislocation

The ball of the femur is slightly loose in the socket. The orthopedic surgeon can move the bone within the socket without dislocating it.

Doctor Examination and Evaluation

The pediatric orthopedic surgeon will physically examine the child. The doctor will look out for visible signs as he or she places the hip in varying positions to determine the dislocation and instability of the hip. The doctor will try to hear or feel the ‘dull noise’ of bones striking together.  If required, x-rays and sonography of the hip also help in an accurate diagnosis of the DDH condition.

Treatment of Congenital Dislocation of the Hip

A harness or a brace is used to treat a congenital dislocation of the hip is detected at birth. The treatment gets difficult with non-specific outcomes, in case of late detection and treatment.

To begin with, the child’s age determines the treatment approach while nonsurgical treatment is preferred in the initial stages –

Newborns are placed in a Pavlik harness, a soft positioning device for at least 1 or 2 months. The Pavlik harness is designed to keep the hip and the thighbone in their respective position. The harness promotes normal hip socket formation while tightening the ligaments. Both the child and the parent are comfortable in using and managing it. The child can move the legs freely and allow diaper care quite comfortably.

The treating doctors and medical assistants teach and guide the parents on using the Pavlik harness and looking after the child, especially changing clothes, diapers, feeding, bathing, and dressing.

Congenital Dislocation

In the case of a child up to 6 months, the dislocated condition is repositioned using a harness with positive results. The time frame for using the harness varies from child to child. It could range from wearing the harness full-time for six weeks and yet another six weeks for shorter periods.

The doctor can suggest an abduction brace for improving the position of the legs in the child.The orthopedic surgeon can suggest an application of a body cast or spica cast to firmly place the thighbone in the correct position in the child. This procedure requires anesthesia, and the doctor and medical team will provide suitable guidance on how to look after the child.

For child up to 6 months to 2 years

Apart from closed reduction and spica cast, skin traction is used to reposition the thighbone. The skin traction readies the soft tissues around the hip to enable change in the position of the bones.

Surgical Treatment

In the event of failure of nonsurgical treatment, a surgical procedure is suggested to rectify the dislocation of the hip when the child is between 6 months to 2 years of age.The surgeon will perform an open surgery to modify the thighbone and ensure it fits perfectly into the socket. A spica cast is used to maintain the hip in the desired position.

For children above two years of age, the orthopedic surgeon will perform open surgery to realign the hip, followed by a spica cast to maintain the hip in the socket.

Recovery after the surgery

The child needs to have a body cast and/or brace to keep the hip bone in its proper position in the joint for best healing.The child may have to keep the cast for 2 to 3 months. If required, the cast is changed regularly.It is necessary to have follow-up treatment, including checkups and x-rays, till the child attains full growth.

Recovery

Early detection of DDH and early treatment are necessary for the child to grow and walk normally. Delayed DDH treatment means the child can develop osteoarthritis, decreased movement, and legs with varying lengths. At times, despite treatment, the child is likely to develop osteoarthritis and hip deformity.

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