Congenital Hip Dislocation
Some children are born with a hip problem called congenital hip dislocation (dysplasia). The condition is usually diagnosed as soon as a baby is born. Most of the time, it affects the left hip in first-born children, girls, and babies born in the breech position.
In hip dislocation, the ball at the top of the thighbone (femoral head) does not sit securely in the socket (acetabulum) of the hip joint. Surrounding ligaments may also be loose and stretched. The ball may be loose in the socket or completely outside of it.
The cause of this problem is still unknown.
In congenital dislocation, the earliest sign may be a “clicking” sound when the newborn’s legs are pushed apart. If the condition goes undetected at the newborn stage, eventually the affected leg will look shorter than the other one, skin folds in the thighs will appear uneven, and the child will have less flexibility on the affected side. When he starts to walk, he’ll probably limp, walk on his toes, or “waddle” like a duck.
A careful physical examination of a newborn usually detects hip dislocation. In older infants and children, hip x-rays can confirm the diagnosis.
Treatment of dislocation depends on the child’s age. In a newborn or very young infant, for example, a soft positioning device called a Pavlik harness will keep the hip bone in the socket and stimulate normal hip development. If that method doesn’t work, the hip bone can often be pushed back into place in children aged 6 months to 2 years. The procedure, called closed reduction, is done under anesthesia. If closed reduction fails to remedy the problem, open surgery to reposition the hip may be necessary. Once the child is over 2 years of age, closed reduction is no longer an option.
Following either the closed or open procedure, the child will wear a cast and/or braces for several months. This will help keep the hip bone in the socket while it heals.
Very young children may experience a delay before walking because of the cast. Although a difference in leg lengths may remain, early treatment of congenital hip dislocation can promote normal hip joint function and ultimately permit an active lifestyle.