What is Congenital Hip Dislocation? Symptoms, Diagnosis, and Treatment
Congenital hip dislocation, also known as developmental dysplasia of the hip (DDH), is a condition characterized by a hip joint that is congenitally loose, poorly developed, or partially/completely displaced. With early diagnosis and appropriate follow-up, the hip health of most children can be returned to normal limits.
What is Congenital Hip Dislocation?
Developmental dysplasia of the hip (DDH) is a developmental problem where the alignment between the femoral head and the acetabulum (hip socket) is disrupted. It spans a spectrum ranging from mild looseness (instability) to complete dislocation.
Who is More Likely to be Affected?
The risk increases in female infants, first pregnancies, breech presentation at birth, those with a family history, and practices that keep the legs excessively straight, such as tight swaddling. It can be unilateral (one-sided) or bilateral (both sides).
Symptoms and Early Warning Signs
- Differences noticed during a hip examination
- Difference in leg length, asymmetry in skin folds
- Limited leg opening (abduction restriction)
- Late walking, limping, or a waddling gait (in cases detected later)
How is Diagnosis Made?
Diagnosis is made by a pediatrician or orthopedic specialist starting from the newborn period. The imaging age and method are selected according to the baby’s age:
- Hip ultrasound (up to the first 4–6 months)
- Anterior-posterior pelvis X-ray (after 4–6 months)
- Advanced imaging when necessary
Screening and Follow-up
In at-risk babies, an examination in the first few weeks of life and an ultrasound at the appropriate time are recommended. Even in babies with normal initial findings, re-evaluation is planned if suspicion persists.
Treatment Options
The goal of treatment is to ensure normal development by holding the femoral head securely in the correct position within the acetabulum. Options vary based on age and severity:
- Pavlik Harness (first choice, especially 0–6 months): Holds the hip in flexion and abduction.
- Abduction Orthoses: Used when the harness response is inadequate or in older infants.
- Closed Reduction and Casting: For more advanced cases or late presentation.
- Open Surgery (including osteotomies): For failures of closed methods or severe dysplasia.
Early diagnosis significantly increases success. Regular clinical and imaging check-ups, compliance with the device, and family education are crucial during treatment.
Home Care and Parent Recommendations
- Comply fully with device/orthosis usage instructions.
- Choose flexible diapers and clothing that do not restrict hip movement.
- Avoid tight swaddling that forces the hips to be straight.
- Do not skip follow-up appointments; share any changes with the physician.
Possible Complications
In untreated or late-treated cases, hip stiffness, restricted movement, leg length discrepancy, pain, and early arthritis (osteoarthritis) in adulthood may occur. Regular monitoring reduces these risks.
Correct Swaddling and Carrying Position
Ergonomic carriers that support the “M” leg position, where the hips are bent and spread sideways, should be preferred. Excessively straight and tight positions are detrimental.
When Should You See a Doctor?
Schedule an appointment with your pediatrician if there is a restriction in hip movement, fold asymmetry, a difference in leg length, delayed walking, or a family history. Do not delay newborn check-ups.
Frequently Asked Questions About Developmental Dysplasia of the Hip (DDH)
Are congenital hip dislocation and developmental dysplasia of the hip the same thing?
Yes. In current usage, the term developmental dysplasia of the hip (DDH) covers the entire spectrum of the condition, ranging from looseness to complete dislocation.
Which signs should parents look out for?
Warning signs include restricted leg opening (abduction), **asymmetry in skin folds**, a **difference in leg length**, and **limping** when walking.
When should screening be performed?
For at-risk babies, an examination in the first few weeks of life and an ultrasound starting at 4–6 weeks are recommended at the appropriate time. An X-ray is preferred for older babies.
How long is the Pavlik harness worn?
It is generally planned gradually over **weeks to months** under the physician’s supervision. The duration varies based on the baby’s age, response, and imaging findings.
Will the harness/orthosis bother my baby?
Babies quickly adapt when the fit is appropriate and used correctly. Consult your physician if you notice **redness**, **pressure sores**, or **fussiness**.
How should bathing and diaper changes be done while using an orthosis?
Follow the specific instructions given by your physician. In most cases, the diaper can be changed without removing the device; alternative cleaning methods may be suggested for bathing.
Is surgery always necessary?
No. Most infants diagnosed **early** are treated without requiring surgery. Surgery may be considered in late-diagnosed or advanced cases.
What happens if treatment is delayed?
Delay can lead to poor development of the hip socket, **permanent deformities**, and **early arthritis (osteoarthritis)** in adulthood.
Can children play sports?
Children who achieve successful treatment and normal development can be as active as their peers with a physician’s approval. A check-up is recommended when starting **high-impact sports**.
Is swaddling entirely harmful?
Tight swaddling that keeps the legs straight is harmful. A loose swaddling position that allows the hips to be bent and spread sideways (the “M” position) is **safe**.
What should I do if there is a family history of hip dislocation?
Do not skip newborn check-ups, get an ultrasound at the time recommended by the physician, and attend regular follow-up appointments.
References
- Mayo Clinic
- NHS
- WebMD
- OrthoInfo AAOS
- WHO