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Congenital hip dysplasia

A congenital problem is one that is there from birth. Dysplasia in a malformation of bone.  Congenital hip dysplasia is a malformation of the hip that is there at birth. Genetic factors likely play a role in this disorder. Features include hip dislocation, asymmetry of leg positions, asymmetric fat folds, and diminished movement on the affected side. Some children will exhibit little or no features and must be diagnosed by physical examination of the hip joints.

Description of Congenital hip dysplasia

Congenital hip dysplasia is an abnormal formation of the hip joint in which the ball at the top of the thighbone is not stable in the socket. Also, the ligaments of the hip joint may be loose and stretched. The degree of instability or looseness varies. A baby born with Congenital hip dysplasia may have the ball of his or her hip loosely in the socket, the looseness may worsen as the child grows and becomes more active, or the ball may be completely dislocated at birth.

 

Left untreated, Congenital hip dysplasia leads to pain and osteoarthritis by early adulthood. It may causes the legs to be different lengths It can effect the way a person walks and their agility. Congenital hip dysplasia has a familial tendency. It usually affects the left hip and is predominant in:

  • Girls.
  • First born children.
  • Babies born in the breech position (especially with feet up by the shoulders). The American Academy of Pediatrics now recommends ultrasound screening of all female, breech babies.

Although Congenital hip dysplasia is usually noted in the newborn exam, treatment is easier and safer the earlier the diagnosis is made. Hips found normal at birth can be found abnormal later, but this is rare. Pediatricians screen for Congenital hip dysplasia at a newborn’s first exam and at every well-baby checkup thereafter. Otherwise, the condition may not be noticed until a child begins to walk – by which time treatment is more complicated and uncertain.

Symptoms of Congenital hip dysplasia

Although some dislocated hips show no signs, contact a doctor if your baby has:

  • Legs of different lengths.
  • Uneven thigh skin folds.
  • Less mobility or flexibility on one side.

In children who have begun to walk, limping, toe walking and a waddling "duck-like" gait are also signs.

In addition to visual clues, doctors use careful physical examination tests to check for subtle signs of hip instability or dislocation in babies, such as listening and feeling for "clunks." Hip X-rays also may be helpful in older infants and children.

Treatment methods depend upon the child’s age.

Causes of Congenital hip dysplasia

Clinical studies show a familial tendency toward Congenital hip dysplasia, with more females affected than males. In some cases, there appears to be a clear genetic component. Abnormalities on chromosome 13 appear to be linked with congenital dysplasia. In families with a history of hip dysplasia, children are more likely to have this condition.

Diagnosis of Congenital hip dysplasia

Because the abnormalities of this hip problem often vary, a thorough physical examination is necessary for an accurate diagnosis of congenital hip dysplasia. The hip disorder can be diagnosed by moving the hip to determine if the head of the femur is moving in and out of the hip joint.

The doctor my use one or more of these test

  • x-ray
  • ultrasound
  • CT or CAT scan.
  • magnetic resonance imaging (MRI) -

There are two method developed for evaluating infants for Congenital hip dysplasia.

The Ortolani test, begins with each of the examiners hands around the infant's knees, with the second and third fingers pointing down the child's thigh. With the legs moved apart, the examiner may be able to discern a distinct clicking sound with motion. If symptoms are present with a noted increase as the examiner move the legs the test is considered positive for hip joint instability. It is important to note this test is only valid a few weeks after birth.

The Barlow method is another test performed with the infant's hip brought together with knees in full bent position. The examiner's middle finger is placed over the outside of the hipbone while the thumb is placed on the inner side of the knee. The hip is abducted to where it can be felt if the hip is sliding out and then back in the joint. In older babies, if there is a lack of range of motion in one hip or even both hips, it is possible that the movement is blocked because the hip has dislocated and the muscles have contracted in that position. Also in older infants, hip dislocation is evident if one leg looks shorter than the other.

Treatment of Congenital hip dysplasia

Treatment usually involves bracing, splinting, harnessing, or casting to stabilize the hip joint as the child develops, with the goal of encouraging the joint to correct the dysplasia on its own. In other cases, surgical treatment may be indicated to correct the dysplasia, or for pain management if the child experiences pain in association with the condition.

 

Alternative treatment of Congenital hip dysplasia

Nonsurgical treatments include exercise programs, orthosis (a force system, often involving braces), and medications. A physical therapist may develop a program that includes strengthening, range-of-motion exercises, pain control, and functional activities. Chiropractic medicine may be helpful, especially the procedures of closed manipulations, to reduce the dislocated hip joint.

Prognosis

Unless corrected soon after birth, abnormal stresses cause malformation of the developing femur, with a characteristic limp or waddling gait. If cases of congenital hip dysplasia go untreated, the child will have difficulty walking , which could result in life-long pain. In addition, if this condition goes untreated, the abnormal hip positioning will force the acetabulum to locate to another position to accommodate the displaced femur.

Prevention

Prevention includes proper prenatal care to determine the position of the baby in the womb. This may be helpful in preparing for possible breech births associated with hip problems. Avoiding excessive and prolonged infant hip adduction may help prevent strain on the hip joints. Early diagnosis remains an important part of prevention of congenital hip dysplasia.

Definition of Congenital hip dysplasia

A malformation of the hip joint that is present at birth. Genetic factors likely play a role in this disorder. Features include hip dislocation, asymmetry of leg positions, asymmetric fat folds, and diminished movement on the affected side. Some children will exhibit little or no features and must be diagnosed by physical examination of the hip joints.

Description of Congenital hip dysplasia

Congenital hip dysplasia is a disorder in children that is either present at birth or shortly thereafter. During gestation, the infant's hip should be developing with the head of the thigh bone (femur) sitting perfectly centered in its shallow socket (acetabulum). The acetabulum should cover the head of the femur as if it were a ball sitting inside of a cup. In the event of congenital hip dysplasia, the development of the acetabulum in an infant allows the femoral head to ride upward out of the joint socket, especially when weight bearing begins.

Causes & symptoms of Congenital hip dysplasia

Clinical studies show a familial tendency toward Congenital hip dysplasia, with more females affected than males. This disorder is found in many cultures around the world. However, statistics show that the Native American population has a high incidence of hip dislocation. This has been documented to be due to the common practice of swaddling and using cradleboards for restraining the infants. This places the infant's hips into extreme adduction (brought together). The incidence of congenital hip dysplasia is also higher in infants born by caesarian and breech position births. Evidence also shows a greater chance of this hip abnormality in the first born compared to the second or third child. Hormonal changes within the mother during pregnancy, resulting in increased ligament laxity, is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the womb. Other symptoms of complete dislocation include a shortening of the leg and limited ability to abduct the leg.

Diagnosis of Congenital hip dysplasia

Because the abnormalities of this hip problem often vary, a thorough physical examination is necessary for an accurate diagnosis of congenital hip dysplasia. The hip disorder can be diagnosed by moving the hip to determine if the head of the femur is moving in and out of the hip joint. One specific method, called the Ortolani test, begins with each of the examiners hands around the infant's knees, with the second and third fingers pointing down the child's thigh. With the legs abducted (moved apart), the examiner may be able to discern a distinct clicking sound with motion. If symptoms are present with a noted increase in abduction, the test is considered positive for hip joint instability. It is important to note this test is only valid a few weeks after birth.

The Barlow method is another test performed with the infant's hip brought together with knees in full bent position. The examiner's middle finger is placed over the outside of the hipbone while the thumb is placed on the inner side of the knee. The hip is abducted to where it can be felt if the hip is sliding out and then back in the joint. In older babies, if there is a lack of range of motion in one hip or even both hips, it is possible that the movement is blocked because the hip has dislocated and the muscles have contracted in that position. Also in older infants, hip dislocation is evident if one leg looks shorter than the other.

X-ray films can be helpful in detecting abnormal findings of the hip joint. X rays may also be helpful in finding the proper positioning of the hip joint for treatments of casting. Ultrasound has been noted as a safe and effective tool for the diagnosis of congenital hip dysplasia. Ultrasound has advantages over x rays, as several positions are noted during the ultrasound procedure. This is in contrast to only one position observed during the x ray.

Treatment of Congenital hip dysplasia

The objective of treatment is to replace the head of the femur into the acetabulum and, by applying constant pressure, to enlarge and deepen the socket. In the past, stabilization was achieved by placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position. More recently the Pavlik harness and von Rosen splint are commonly used in infants up to the age of six months. A stiff shell cast may be used, which achieves the same purpose, spreading the legs apart and forcing the head of the femur into the acetabulum. In some cases, in older children between six to 18 months, surgery may be necessary to reposition the joint. Also at this age, the use of closed manipulation may be applied successfully, by moving the leg around manually to replace joint. Operations are not only performed to reduce the dislocation of the hip, but also to repair a defect in the acetabulum. A cast is applied after the operation to hold the head of the femur in the correct position. The use of a home traction program is now more common. However, after the age of eight years, surgical procedures are primarily done for pain reduction measures only. Total hip surgeries may be inevitable later in adulthood.

Alternative treatment of Congenital hip dysplasia

Nonsurgical treatments include exercise programs, orthosis , and medications. A physical therapist may develop a program that includes strengthening, range-of-motion exercises, pain control, and functional activities. Chiropractic medicine may be helpful, especially the procedures of closed manipulations, to reduce the dislocated hip joint.

Prevention of Congenital hip dysplasia

Prevention includes proper prenatal care to determine the position of the baby in the womb. This may be helpful in preparing for possible breech births associated with hip problems. Avoiding excessive and prolonged infant hip adduction may help prevent strain on the hip joints. Early diagnosis remains an important part of prevention of congenital hip dysplasia.

Modified 3-12-13
Information compiled from the National Institutes of Health

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