Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip due to abnormal formation of the hip joint during their early stages of fetal development. Another name for this condition is “developmental dysplasia of the hip.” This instability worsens as your child grows. The ball-and-socket joint in their hip may sometimes dislocate. This means that the ball will slip out of the socket with movement. The joint may sometimes completely dislocate. According to American Family Physician, one out of every 1,000 infants is born with a dislocated hip.
The cause of CHD is unknown in many cases. Contributing factors include low levels of amniotic fluid in your womb, breech presentation, which occurs when your baby is born hips first, and a family history of the condition. Confinement in the uterus may also cause CHD or contribute to it. This is why you’re baby is more likely to have this condition if you’re pregnant for the first time. Your uterus hasn’t been previously stretched.
CHD is more common in girls than in boys. However, any infant can have the condition. This is why your child’s doctor will routinely check your newborn for signs of hip dislocation and why they’ll continue to examine your child’s hips at well-baby checkups throughout your child’s first year of life.
There may be no symptoms of CHD, which is why your child’s doctor and nurse will routinely test for the condition. If your child has symptoms, they may include:
- legs that turn outward or appear to differ in length
- limited range of motion
- folds on their legs and buttocks that are uneven when their legs extend
- delayed gross motor development, which affects how your child sits, crawls, and walks
The screening for CHD occurs at birth and throughout the first year of your child’s life. The most common screening method is a physical exam. Your child’s doctor will gently maneuver your child’s hip and legs while listening for clicking or clunking sounds that may indicate a dislocation. This exam consists of two tests:
- During the Ortolani test, your child’s doctor will apply upward force while they move your child’s hip away from your child’s body. Movement away from the body is called abduction.
- During the Barlow test, your child’s doctor will apply downward force while they move your child’s hip across your child’s body. Movement toward the body is called adduction.
These tests are only accurate before your child is 3 months old. In older babies and children, findings that indicate CHD include limping, limited abduction, and a difference in leg lengths if they have a single affected hip.
Imaging tests can confirm a CHD diagnosis. Doctors examine ultrasounds for babies younger than 6 months old. They use X-rays to examine older babies and children.
If your baby is younger than 6 months of age and diagnosed with CHD, it’s likely they’ll be fitted for a Pavlik harness. This harness presses their hip joints into the sockets. The harness abducts the hip by securing their legs in a froglike position. Your baby may wear the harness for 6 to 12 weeks, depending on their age and the severity of the condition. Your baby may need to wear the harness full time or part time.
Your child may need surgery if treatment with a Pavlik harness is unsuccessful or your baby is too big for the harness. Surgery occurs with general anesthesia and may include maneuvering their hip into the socket, which is called a closed reduction, or lengthening their tendons and removing other obstacles before positioning the hip, which is called an open reduction. After your baby’s hip is placed into position, their hips and legs will be in casts for at least 12 weeks.
If your child is 18 months or older or hasn’t responded well to treatment, they may need femoral or pelvic osteotomies to reconstruct their hip. This means a surgeon will divide or reshape the head of their femur, which is the ball of the hip joint, or the acetabulum of their pelvis, which is the hip socket.
You can’t prevent CHD. It’s important to bring your child to regular checkups so their doctor can identify and treat the condition as soon as possible. You may want to verify that their doctor examined your newborn for signs of hip dislocation before you leave the hospital following delivery.
Complicated or invasive treatment is less likely to be necessary when your doctor identifies CHD early and gives treatment with a Pavlik harness. It’s estimated that between 80 and 95 percent of cases identified early receive successful treatment, depending on the severity of the condition.
Surgical treatments vary in their success rates. Some cases only need one procedure, and others require many surgeries and years of monitoring. CHD that’s not successfully treated in early childhood can result in early arthritis and severe pain later in life that might require total hip replacement surgery.
If your child’s CHD is successfully treated, they’ll likely continue to regularly visit an orthopedic specialist to make sure the condition doesn’t return and that their hip is growing normally.