Congenital hip dislocation in babies is a condition in which the hip joint is abnormal. It is also known as developmental hip dysplasia.
Some babies are born with this malformation. It is characterized by the fact that the femoral head does not fit properly into the joint, which can lead to lameness and later pain.
It can also happen that, in the most severe cases, this condition is disabling for the person suffering from it.
Congenital hip dislocation affects 1 in 1,000 babies and mild instability is seen in this joint in 1 in 3 children. Also, girls are more likely to develop it.
Causes of congenital hip dislocation
Congenital hip dislocation is considered a “multifactorial inheritance” condition, which means that the birth defect can be caused by many factors, usually genetic and environmental.
One of the environmental influences that can contribute to hip dysplasia is the baby’s response to the mother’s hormones during pregnancy. A narrow uterus that does not allow fetal movement or a pelvic birth can also cause hip dysplasia.
Generally, the left hip is more likely to be affected than the right hip because of the position of the fetus within the uterus.
First-born babies are at increased risk of dislocating this joint. This is because the primiparous mother’s uterus is smaller and the baby’s space to move is more limited, which affects hip development.
Other risk factors can be:
- Family history of developmental hip dysplasia or highly flexible ligaments.
- The position of the baby inside the uterus, especially the pelvic position.
- Associations with other orthopedic problems, such as metatarsus adductus , clubfoot malformation, congenital pathologies and other syndromes.
What symptoms can it trigger?
In newborn babies, the signs of congenital hip dislocation are very subtle and may go unnoticed by parents.
However, the examination of the hips is part of the routine of clinical examinations that pediatricians perform on newborns.
Some of the most characteristic symptoms of congenital hip dislocation in babies are:
- Detection of a click or hollow sound during the hip maneuver.
- Difficulty moving one leg in relation to the other.
- Asymmetry of the lower limb, noting one leg shorter than the other.
- Asymmetry in the creases that are normally seen in the groin of one leg relative to the other.
- Lameness when walking : that would be a late sign. It is usually detected in the first few months of a baby’s life, before he starts to walk.
- Scoliosis: is the formation of an abnormal curvature of the spine to try to compensate for the uneven distribution of weight between the two legs.
How can this problem be diagnosed?
The diagnosis can be made from the moment of birth, when the baby has its first physical exam. For this, a maneuver called Ortolani-Barlow is performed. When this maneuver is positive, the diagnosis is confirmed with ultrasound or radiography of the hip. Sometimes a consultation with a children’s orthopedic surgeon is also performed.
Treatment of congenital hip dislocation
Before 6 months, not all cases need to be treated orthopedically . Treatments vary depending on the severity of the case and the child’s age.
However, in lighter cases, a postural treatment is recommended, such as placing the baby in a mounted position (riding) or putting him to sleep on his back and with his legs spread, to try to make the bone return to the its natural position.
As the disease worsens, soft or rigid dentures and other treatments such as the Pavlik harness are used . This device consists of straps that keep the hips flexed 100 degrees to reduce displacement.
If even with orthopedic treatments is not possible to correct the dislocation, the surgery would be the ultimate solution.