This condition refers to malformation of the hip joint during fetal development. In this condition, the head of the thighbone or femur, does not sit properly in the socket of the pelvis.
Joints and bones usually grow normally during fetal development. However, in a small percentage of newborns, the pelvis has not formed its usual deep socket. Therefore, the head of the thighbone can slip partially or completely out of the socket.
This condition can be caused by the way the legs of the fetus are positioned in the womb. It is more likely to occur in people with a family history of the disorder. It also affects girls more often than boys. It is three times more likely to occur in the left hip than the right. It is more common after a breech delivery, among large babies and in twins. Congenital hip dislocation is frequently associated with other conditions such as spina bifida, sternomastoid torticollis, or Down syndrome.
Symptoms vary according to the severity of the problem and the age of the person. An infant will often have no symptoms or pain. The common symptom found with congenital hip dislocation is a "click" that is heard near the hips as the hips are moved during the newborn exam.
Signs that there might be a problem include:
As the person grows older, especially in adulthood, the chances of arthritic hip pain increases.
Most of the time, a healthcare provider can detect this condition when examining a newborn's hips. The healthcare provider may do a Ortolani test, in which the thighs are spread apart, or the Barlow test, where the knees are brought together, to listen for the characteristic "click" that is heard with congenital hip dislocation.
Less evident cases can be confirmed by joint x-rays. These x-rays can be performed with the injection of dye into the hip joint. Detection can also be made by doing special tests, such as ultrasound or MRI. The earlier the diagnoses is made the better are the chances for normal hip function.
There is no way to prevent this condition.
It is possible that the hip joint will continue to develop poorly. This can result in a short leg, a limp, restricted motion of the joint, and painful arthritis.
There are no risks to others.
Treatment is directed toward the development of a normal hip joint. The head of the femur and the socket of the pelvis tend to develop more normally when they are correctly positioned next to one another. This can be achieved by using extra diapers, a harness, a brace, or a cast.
If these methods don't work, the orthopedic surgeon may recommend an operation on the hip, ligaments, and tendons, called a corrective wedge osteotomy.
A cast will be placed afterward to seat the hip properly. Follow-up joint x-rays can determine the degree of success. In young children, it may be necessary to operate on the pelvis to redirect the structures.
Side effects include possible discomfort from a brace or cast. If surgery is needed, side effects can include nausea and vomiting from the anesthesia, and infection from the surgery site.
If treatment has begun within the first 3 months of life treatment is usually successful and no further treatment is necessary. The older a child is the more complicated and lengthy treatment may be. Treatment may involve multiple operations and braces. Satisfactory hip function is difficult to restore if a child is older than 5.
Possible complications include:
Periodic checkups with the healthcare provider are helpful.
Author:John A.K. Davies, MD
Editor:Smith, Elizabeth, BA
Reviewer:Eileen McLaughlin, RN, BSN