Congenital hip dislocation is also known as congenital hip joint instability. This means that the ball can easily be moved out of its normal position. Sometimes one or both hip joints may be in the wrong position when the baby is born. The hip joints are examined on all newborn babies at BB.

What is it?

Congenital instability of the hip joints is due to increased elasticity of the joint capsule or the fact that the joint is too shallow.

It is an unusual condition but is more common in girls than in boys. Just over half of all children with hip joint instability are born with one or both hip joints out of joint. With others, the trail is so volatile that it can easily get out of its normal position. 

The risk of hip arthroplasty is greater in the case of childbirth. It is also more common in first-born children.

Some of the children who have hip joint instability have a sibling, cousin or another close relative who has been treated for congenital hip joint instability, which means that there is some heredity.

Surveys

All children born in many countries are examined by a pediatrician within the first two days. The pediatrician examines the stability of the hip joints and refers to the children who have unstable hip joints to an orthopedic surgeon for treatment.

The study may be uncomfortable when you look at it as a parent, but it is not performed with great force. It may feel uncomfortable for the child when someone is holding their legs, but it does not hurt.

It may feel the pain that the child must undergo examinations already in the first few days of his life, but the treatment then becomes more gentle and the end results better.

An ultrasound examination of the hip joints is sometimes performed.

Children adopted from other countries undergo hip joint examination during routine checks at BVC.

Read more about surveys at the child welfare center.

Treatment hip joint dislocation in newborn

The most common treatment is for the child to lie with his legs outwards in a so-called von Rosenskena for six to twelve weeks. How long it will depend on how volatile the trail is. The rail is placed directly around the body. You can put diapers and clothes on the outside. In some cases, the rail can be replaced by so-called freak pants after a number of weeks of treatment in the rail.

Only trained personnel should put on the rail so that it sits properly. You must not take the child out of the rail and put the child back. Then there is a risk that the rail will not sit properly and the femur will not lie right in the hip joint. The child usually comes to the orthopedic clinic to bathe, and for the doctor to be able to check that the rail fits. As the child grows, the rail may be changed to a larger one.

Practical advice

  • Use a size larger clothing than otherwise for the rail to fit. Clothes that are easy to put on and off are good.
  • Sit or half-sit with the child in his arms instead of lying down if you are breast-feeding.
  • The child can ride in a car seat provided that the legs fit in the chair.

What happens next?

After completion of treatment, a follow-up is done as the doctor checks the position of the hip joint during a body examination. The hip joint is also often x-rayed, for example at the age of four and twelve months. The reason why the baby is not x-rayed already when it is newborn is that the skeleton contains too little lime for it to be clearly visible on the x-ray.

When the rail is removed permanently, the child lies with his legs folded, but eventually, it corrects itself. So you should not stretch and try to get your legs together and the child should not receive physical therapy.

Late-onset hip arthroplasty

Although all children are examined at BB, the condition may only be discovered later. This may be because the hip joint was stable for the first time when the child was examined at BB.

When the child is a few months old, the joint capsule tissue is stabilized, making it more difficult to detect the instability. The doctor at the child care center, therefore, investigates whether the child’s legs are different in length or whether the child has reduced hip mobility, especially if it is difficult to fold the leg outwards. This may be a sign that the hip joint is not right. The vast majority of children who are diagnosed with a hip joint late diagnosis are nevertheless diagnosed before the age of one year, which usually gives a good end result.

In these cases, the child may be left in a strait for a while. Then it must lie on your back in a bed with a special position that keeps the leg stable. A small procedure is usually done when the tendons in the groin are extended, then the hip joint is put in place and the child may have hip plaster for up to six months. The length of time that the leg is allowed to stay is longer than if the baby is placed in the rail immediately after birth. If the hip joint cannot be put in place, the child needs surgery.

Complications and sequelae

The child’s motor development is not affected or delayed by treatment with rail during the newborn period. There is also no indication that children are hurt emotionally or develop in any negative way because of rail.

The younger the child is when diagnosed, the better the end result will usually be, especially if the condition is already detected on BB. Then it will almost always be a good result without any future complications.

It leads to a rocky walk if both hip joints are out of joint, and the heel if only one hip joint is out of joint while the child is growing up.

In infancy and during adulthood, the child does not usually have pain, but eventually, it starts to hurt more or less because the joint is not in the right position.

Different types of surgery can be done if the condition is detected late, but common to all is that the result is worse and the operations become larger the older the child is when the operation is done.

Ehtisham Nadeem

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