Best treatment for Congenital dislocation of the hip or developmental dysplasia of Hip One Or both hip Joints are out of their socket since birth Or Head of femur bone is dislocated out from the acetabulum cavity of the pelvic bone.
Congenital Hip dislocation
one of the commonest congenital musculoskeletal problems in kids.
DDH or CDH means developmental dysplasia of the hip or Congenital dislocation of the hip.
2 per 100 livebirth occurrence.
More common in female.
Ocassionally it can be bilateral.
-Signs and symptoms of DDH varies with age.
-In the younger age group (neonatal period), it is important to get screened by an expert Paediatric orthopedic surgeon because there are very subtle clinical signs to be noticed.
-Signs parents can notice at home to know whether their child has DDH or not.
-Abnormal thigh folds on affected side
-Shorter leg
-The reduced spread of leg (Can be noticed when changing the diapers of the kid).
-Once the child affected with DDH grows up and reaches walking age, he or she will walk with a painless limp and an unstable gait.
Usually Diagnosis is clinical but investigations are needed to confirm the diagnosis and to monitor the treatment.
USG, Xray, and MRI are the investigations that might be needed for a child with DDH.
USG is usually done in early infancy up to 3-4 months of age. It helps in documenting the Condition and measures the grade of dysplasia. It also helps in monitoring the progress of conservative treatment using Pavlik Harness.
Xrays are needed when the proximal femur starts ossifying and measuring the acetabular dysplasia.
MRI is sometimes needed in cases where dislocated is suspected to be after the sequel of joint infection and xray shows an absent femoral head.
Treatment of DDH depends on many factors like Age at presentation, Previous treatment history, and associated other Problems like Clubfoot, Or Congenital knee dislocation.
If DDH is diagnosed within a few months of birth, the treatment of choice would be Pavlik Harness. It’s a kind of belt that is custom-made for the child and has to be worn as per the doctor s Instructions. The doctor may advise you to monitor the progress using serial ultrasound examination on a weekly or fortnightly basis.
If Pavlik harness treatment fails or the child presents late i.e. between 6 months to 18 months of age. A trial of closed reduction is done.
Close reduction of the hip joint is a surgical procedure in which a radio-opaque dye is injected into the joint and examination is done under General anesthesia. This Procedure is known as Arthrogram. The reducibility of the joint and stability is checked. If needed adductor tendon tenotomy is added to increase the safe zone of reduction.
Closed reduction is usually successful in cases where there are no intraarticular blocks to reduction. To know more about Close reduction book an appointment with our expert.
Closed reduction should be done under arthrography guidance. Very few surgeons are familiar with the procedure. You should contact to an expert pediatric orthopaedic surgeon to assess the child clinically. If Closed reduction is failed or not possible child will need an open reduction of the hip joint.
Open reduction of the hip joint for Developmental dysplasia of Hip or congenital hip dislocation.
Open reduction may not be sufficient to reduce and stabilize the hip. And might also require acetabuloplasty or pelvic osteotomy and femoral osteotomy.
The need for additional procedures is best judged by the operating surgeon on the operating table.
Yes after any surgical intervention for DDH, (whether closed reduction or Open reduction) a Hip spica cast is applied. ( we call it Half body plaster) . to protect the hip and healing of soft tissues. Spica cast is usually kept for a total of 3 months, usually changed under anesthesia at 6 weeks.
Yes, of course, the procedure intends to place the dislocated hip joint back to its desired space is an acetabular cavity of the hip joint which is the socket for the ball of the femur head. It helps to stabilize the joint, improve the walking pattern, and make the hip joint long-lasting.
Yet there are certain challenges that might come in the future. To lose a few are. Infection, Joint stiffness, Joint redislocation or subluxation, and Avascular necrosis of the femoral head due to the intrusion of blood supply of the femur head.