Congenital Dislocation of Hip
Congenital Dislocation of Hip Congenital dislocation of the hip (CDH), also known as developmental dysplasia of the hip (DDH), is a condition present at birth where the hip joint is improperly formed. It involves a spectrum of abnormalities, ranging from a shallow acetabulum (hip socket) to complete dislocation of the femoral head from the pelvis. This condition can lead to long-term problems such as gait abnormalities, hip pain, and osteoarthritis if not diagnosed and treated early. Understanding the causes, early detection, and management strategies is crucial for preventing complications.
The exact cause of congenital dislocation of the hip remains unknown, but it is believed to result from a combination of genetic, environmental, and mechanical factors. Certain risk factors increase the likelihood of developing DDH. These include a family history of the condition, breech presentation during delivery, female gender (due to the influence of maternal hormones on ligament laxity), and conditions such as oligohydramnios or first-born status. Additionally, tight swaddling practices that restrict hip movement in infants can contribute to the development of DDH.
Early detection is vital for effective treatment. Newborns are routinely screened using physical examination techniques such as the Ortolani and Barlow tests, which assess hip stability. The Ortolani test checks if the dislocated femoral head can be reduced into the socket, while the Barlow test evaluates whether a dislocated hip can be pushed out of the socket. These examinations, typically performed within the first few days after birth, help identify infants at risk. If clinical suspicion remains, imaging studies such as ultrasound or X-rays are used to confirm the diagnosis. Ultrasound is particularly useful in infants under six months because the bones are not yet fully ossified.
Management of congenital dislocation of the hip depends on the age at diagnosis and the severity of the dislocation. In newborns and infants up to six months, non-surgical methods are usually effective. The most common treatment is the use of a Pavlik harness, which
maintains the hips in a flexed and abducted position, allowing the femoral head to settle into the socket as the joint develops. The harness is typically worn for several weeks, and regular follow-up ensures proper positioning.
If diagnosed later, or if non-surgical methods fail, surgical intervention may be necessary. Procedures such as closed or open reduction, sometimes combined with osteotomy (surgical cutting and realignment of bones), are performed to reposition the femoral head and improve joint stability. Postoperative care involves immobilization and physiotherapy to restore function and strength.
Prognosis for infants treated early is generally excellent, with most children achieving normal hip function. However, delayed diagnosis can lead to persistent instability, limp, leg length discrepancy, and degenerative joint disease in adulthood. Therefore, routine screening and prompt treatment are essential for optimal outcomes.
In conclusion, congenital dislocation of the hip is a manageable condition when diagnosed early. Awareness of risk factors, thorough neonatal screening, and appropriate intervention are key to preventing long-term complications and ensuring healthy hip development.
