My Approach:
Hip problems caused congenitally and at birth need to be treated early and appropriately. Non- surgical management is most important. How the harness, brace or cast is applied is critical. I perform my own sonograms (ultrasounds) and avoid x-rays (ionizing radiation) in infants. Hip problems caused by poor development of the hip, hip dislocations and partial dislocations (subluxations) may present as pain or a limp from infancy to individuals in their fifties. This section will discuss infancy and early childhood. I utilize all forms of bracing in an attempt to avoid surgery. When needed, surgery requires a full armamentarium of treatment options for the surgeon to be successful.
More Information:
Hip dislocation or Developmental Dysplasia of the Hip (DDH) occurs in one in one thousand births. Dysplasia (shallow hip) or subluxation (partial dislocation) may occur in up to one in one hundred births. This is quite common. Left untreated, it may lead to pain and arthritis in the involved hip as well as a limp and shortened lower extremity.
Cause:
While there is no direct cause of the spectrum of DDH it is more common in females, first born children, pregnancies with low amniotic fluid (oligohydramnios), when the infant was in a breech position and when it runs in the family.
Diagnosis Methods:
Physical examination of the limb and hip is often diagnostic with the hip clunk (Ortolani Test) or being dislocatable (Barlow Test). Sonogram and rarely x-rays are utilized to confirm the diagnosis.
Treatments:
Hip Dislocations are often diagnosed in infancy and early childhood. They can be treated with non-surgical bracing (Pavlik harness) and/or casting. When bracing fails, which should be less than 10 percent of the time, surgery is indicated. First, simply putting the child under anesthesia and gently reducing the hip without incisions is attempted. A cast is then applied.
Open surgery is reserved for the children where all else has failed or if there is a long delay in diagnosis, beyond eight to twelve months of age. Surgery, if needed, can be successful if performed in a timely and correct manner. This surgery includes loosening tendons that are causing the hip to dislocate, removing any structures from the joint blocking relocation of the hip and, at times, repositioning the femur bone by cutting and fixing the bone (osteotomy) and/or deepening the socket (pelvic osteotomy). An artificial ligament can be utilized to hold the hip in the joint to avoid casting.
Hip Dysplasia in Early Childhood characterized by a shallow socket can be treated with a surgical procedure to deepen the socket. This is successful when done early and can help to avoid pain and arthritis later in life.
