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Congenital Hip Dislocation Care Pune
Get specialized congenital hip dislocation treatment in Pune with expert pediatric surgeons providing advanced hip stabilization and mobility restoration.
Overview
Congenital hip dislocation, now commonly called Developmental Dysplasia of the Hip (DDH), is a condition that affects babies where the ball of the upper thighbone (femoral head) doesn’t properly fit into the hip socket (acetabulum). This condition can range from a slightly shallow socket to complete dislocation of the hip.
The hip joint is designed as a ball-and-socket joint that allows smooth movement and supports body weight. In DDH, the socket may be too shallow, or the ball may be partially or completely out of place. The term “developmental” is preferred because the condition may not always be present at birth and can develop as an infant grows.
Early detection and treatment are essential to prevent long-term problems. If left untreated, DDH can lead to abnormal hip growth, hip pain, walking difficulties, and early-onset osteoarthritis later in life. Many cases are found during routine newborn checkups, which is why regular well-baby visits are so important.
Symptoms
Detecting DDH in babies can be challenging because it typically doesn’t cause hip pain in infants. However, doctors and parents can look for certain warning signs during routine examinations.
Common symptoms of DDH include:
- Limited movement: Difficulty moving one or both legs through their full range of motion
- Uneven appearance: Asymmetric skin folds on the thighs or buttocks, where one side looks different from the other
- Different leg lengths: One leg may appear shorter than the other, particularly noticeable when both knees are bent
- Hip sounds: A clicking or clunking sensation when the hip is moved, though not all clicks are concerning
- Walking problems: In older babies who start walking, you may notice a limp or unusual walking pattern like waddling
- Discomfort: While rare in babies, older children with undiagnosed hip dysplasia may experience hip pain or groin discomfort
It’s important to note that many babies with DDH show no obvious symptoms, which is why routine screening by healthcare professionals is crucial.
Causes
The exact causes of DDH are often unknown, but it results from abnormal formation of the hip joint during early development in the womb or after birth. Proper hip development depends on the ball and socket being in contact with each other, and any disruption to this can lead to problems.
Several factors contribute to DDH:
Before Birth:
- Limited space in the womb: In the final month before birth, tight space can cause the femoral head to move out of position, making the socket shallower
- Baby’s position: When babies are in unusual positions in the womb, it can affect hip development
- Hormonal effects: Maternal hormones can make a baby’s ligaments extra stretchy, which may cause hip instability
During Birth:
- Delivery complications: Difficult deliveries may sometimes contribute to hip problems, though this is less common
After Birth:
- Improper positioning: How babies are positioned after birth, including swaddling practices, can influence hip development
Risk Factors
Several risk factors for DDH make some babies more likely to develop the condition:
- Being female: Girls are 5-9 times more likely to have DDH than boys, likely due to hormonal effects
- First-born children: Being the first baby carries a slightly higher risk, possibly due to tighter uterine space
- Breech position: Babies born bottom-first have a much higher risk of DDH
- Family history: Having a parent or sibling with DDH increases the risk by about 6%
- Low amniotic fluid: This condition limits space for the baby to move in the womb
- Large babies: Higher birth weight can contribute to crowding in the uterus
- Improper swaddling: Tight swaddling that keeps legs straight and together can increase DDH risk
- Other birth conditions: DDH sometimes occurs alongside other conditions like torticollis or clubfoot
Diagnosis
Early diagnosis of DDH is critical for successful treatment and preventing complications. Healthcare professionals routinely check for hip dysplasia at birth and during regular baby checkups throughout the first year.
Physical Examination: The primary screening involves gentle tests of the baby’s hips and legs:
- Ortolani maneuver: The doctor gently moves the baby’s thigh while checking if a dislocated hip can be moved back into place. A “clunk” feeling suggests the hip was out of place but can be relocated
- Barlow maneuver: This test checks if a hip that seems normal can be pushed out of place. A “clunk” during this test suggests an unstable hip
These tests work best in babies younger than 3-4 months, as the tissues around the hip become tighter in older infants.
Imaging Tests: When physical examination suggests problems or risk factors are present, imaging helps confirm the diagnosis:
- Ultrasound: Recommended for babies under 6 months old because most of the hip is still soft cartilage not visible on X-rays. This test shows the shape of the socket and how well the ball fits
- X-rays: More useful after 4-6 months when the bones start to harden and become visible on X-rays
Types
Developmental Dysplasia of the Hip includes several different types of hip problems rather than just one condition:
Hip Instability: The ligaments are loose, and the hip feels unstable but may not be completely dislocated. Many mild cases improve on their own.
Shallow Socket (Acetabular Dysplasia): The hip socket hasn’t developed properly and may be too shallow or angled incorrectly.
Partial Dislocation (Subluxation): The ball is partially out of the socket but still has some contact. Without treatment, this can progress to complete dislocation.
Complete Dislocation: The ball is entirely out of the socket. This is the most severe form and typically requires more intensive treatment.
Treatment
Treatment of DDH aims to get the ball back into the socket and keep it there while the hip develops normally. Treatment options depend on the child’s age and how severe the hip dysplasia is. Earlier treatment is generally more successful and less invasive.
Non-Surgical Treatments:
Observation: Very mild instability in newborns may be monitored closely, as many cases resolve naturally in the first few weeks of life.
Pavlik Harness: This is the most common and successful treatment for babies under 6 months old. The Pavlik harness is a soft brace that holds the baby’s legs in a “frog-like” position, helping guide the femoral head into the socket. It’s typically worn 23 hours a day for 6-12 weeks, with success rates up to 90-95% when used early.
Other Braces: Various other bracing devices may be used depending on the specific situation and doctor’s preference.
Closed Reduction with Cast: If the Pavlik harness doesn’t work or for babies diagnosed between 6-18 months, doctors may perform a closed reduction. Under anesthesia, the hip is manually positioned back into place, then held there with a full-body cast for several months.
Surgical Treatments:
Hip surgery is usually needed when non-surgical treatments don’t work, when the condition is discovered late, or when there are obstacles preventing proper positioning.
Open Reduction: For children over 18 months or when closed reduction fails, surgery involves making an incision to directly see the hip joint, remove any blocking tissues, and place the ball back in the socket. A cast is applied afterward.
Bone Reshaping (Osteotomies):
- Socket surgery: Reshaping the socket to provide better coverage for the ball
- Thighbone surgery: Reshaping or shortening the upper thighbone to improve alignment
These procedures may be done along with open reduction or separately if problems remain after initial treatment.
Rehabilitation
After treatment with braces or casts, ongoing care is important for the best outcomes. While specific rehabilitation programs aren’t always needed, several aspects of follow-up care are crucial:
- Regular monitoring: Children need frequent check-ups with orthopedic specialists until they finish growing (around 16-18 years old)
- Physical therapy: May be recommended to address muscle imbalances or stiffness after treatment
- Activity guidance: Doctors may provide recommendations about appropriate activities as children grow
- Imaging follow-up: Regular X-rays help ensure the hip continues developing normally
Complications
Despite improvements in treatment of DDH, complications can occur, especially when the condition isn’t detected and treated early.
Major Complications:
- Avascular necrosis: This serious complication occurs when blood supply to the femoral head is disrupted, causing bone death. It can happen due to overly aggressive treatment or positioning
- Hip dislocation again: The hip may slip out of place again after treatment, requiring additional intervention
- Persistent shallow socket: Even after successful treatment, the socket may not develop normally, potentially requiring more surgery
- Early arthritis: Untreated or unsuccessfully treated DDH is a leading cause of early osteoarthritis in women under 40
- Chronic pain and limping: Long-term problems that can significantly impact quality of life
Less Common Complications:
- Nerve problems: Rare but possible with certain treatments
- Stiffness: May occur after surgery
- Infection: A risk with any surgical procedure
Prevention
Congenital hip dislocation cannot be completely prevented since its causes are often developmental or genetic. However, several strategies can help reduce risk and ensure early detection:
Early Detection:
- Ensure all newborns receive proper hip screening before leaving the hospital
- Attend all scheduled well-baby checkups during the first year
- Be extra vigilant if your baby has known risk factors
Safe Practices:
- Learn proper swaddling techniques that allow hips and knees to bend freely
- Avoid tight swaddling that forces legs straight and together
- Choose baby carriers that support healthy hip positioning
- Be aware of family history and inform healthcare providers
Awareness:
- Parents should know the signs and symptoms of DDH
- Early ultrasound screening may be recommended for babies with risk factors
Living With Developmental Dysplasia of the Hip
Living with Developmental Dysplasia of the Hip largely depends on when it’s discovered and how well treatment works. When DDH is found early and treated successfully, especially with non-surgical methods like the Pavlik harness, most children go on to live completely normal, active lives.
What to Expect:
During Treatment:
- Treatment can be challenging for families, especially with braces or casts
- Regular medical appointments and monitoring are necessary
- Some temporary limitations on activities may be required
Long-term Outlook:
- Most successfully treated children have no ongoing problems
- Regular follow-up visits continue until the child finishes growing
- Normal physical activities and sports are usually possible
- A normal X-ray at age 2 is generally a good sign for the future
Ongoing Care:
- Even after successful treatment, lifelong awareness is important
- Any new hip pain, limp, or problems should be evaluated promptly
- Some people may need additional treatment if problems develop later
Managing Challenges:
- If complications occur, additional treatments may be needed
- For adults with severe problems from untreated childhood DDH, hip replacement surgery may eventually be necessary
Key Takeaways
- Congenital Hip Dislocation (DDH) is a condition where the hip joint doesn’t form or position correctly, ranging from mild instability to complete dislocation
- Early detection through routine screening is crucial since DDH rarely causes hip pain in babies but can lead to serious problems if untreated
- Key risk factors for DDH include being female, breech presentation at birth, and family history of the condition
- Diagnosis of DDH relies on physical examination using Ortolani and Barlow maneuvers for newborns, followed by ultrasound or X-rays when needed
- Treatment of DDH is most successful when started early, beginning with the Pavlik harness for young babies and progressing to more intensive treatments if needed
- Hip surgery may be necessary for complex cases or late diagnoses, potentially including open reduction and bone reshaping procedures
- Potential complications like avascular necrosis emphasize the importance of expert care and careful monitoring throughout treatment
- While not completely preventable, proper screening and early intervention lead to excellent outcomes for most children
At Sancheti Hospital, we understand that receiving a diagnosis of DDH can be overwhelming for parents, but we want to reassure families that with proper care, most children with this condition go on to live completely normal, active lives.
Our experienced pediatric orthopedic team specializes in the comprehensive management of Developmental Dysplasia of the Hip, offering the full spectrum of treatment options from Pavlik harness fitting and monitoring to complex hip surgery when needed.
We believe in family-centered care, which means we work closely with parents to ensure they understand their child’s condition and feel confident in the treatment plan. Our state-of-the-art imaging facilities allow for precise diagnosis of DDH and careful monitoring throughout treatment, while our skilled surgeons have extensive experience in both open reduction procedures and corrective osteotomies.
What sets us apart is our commitment to long-term follow-up care, recognizing that successful treatment of DDH requires ongoing monitoring until skeletal maturity. We also understand that each child’s journey is unique, and our multidisciplinary team is prepared to address any complications such as avascular necrosis should they arise.
At Sancheti Hospital, we’re not just treating a condition – we’re partnering with families to ensure the best possible outcomes and helping children achieve their full potential for an active, healthy life.
Meet Our Pediatric Orthopedic Specialists
Patient Stories & Experiences
The pain in my left knee left me feeling helpless for years. After my treatment here, I can finally say I'm pain-free.
Vinita Singh
The nerves were swollen, and the body went numb. But thanks to Sancheti Hospital, I got a second life!
Parvati
I finally could walk again, a relief I've only felt after the hip pain surgery. I thank the doctors at Sancheti Hospital for their help.
Balaji Kharat
I'm a police officer, and I'm extremely thankful to Sancheti Hospital for treating my fracture without surgery.
Shantilal
My life has completely changed after the knee replacement surgery at Sancheti Hospital. It's like I can finally live again!
Kalpana Lepcha
The knee pain I've carried for years finally went away with the help of Sancheti Hospital.
Karuna
I can't believe that I get to finally live a normal and happy life, all thanks to the knee surgery I had at Sancheti Hospital.
Kishore Bhosle
Frequently Asked Questions
Can my baby sleep normally while wearing a Pavlik harness?
Yes, babies can sleep comfortably in a Pavlik harness. The harness is designed to be worn 23 hours a day, including during sleep. Most babies adapt within a few days. Use a firm mattress and avoid loose bedding. Some parents find placing a small pillow under the baby’s knees helps with comfort.
Will my child be able to play sports normally after DDH treatment?
Most children with successfully treated DDH can participate in all sports and physical activities without restrictions. However, your doctor will monitor hip development during follow-up visits. In rare cases where complications occur, contact sports might be limited, but this affects very few children.
Is it normal for my baby to cry more when first wearing the harness?
Yes, it’s completely normal for babies to fuss for the first 3-5 days while adjusting to the Pavlik harness. The crying usually decreases as they get used to the new position. However, if crying persists beyond a week or seems excessive, contact your doctor to ensure proper fit.
Can DDH come back after successful treatment, and should I worry about my child's future?
DDH rarely returns after successful treatment, especially when monitored until skeletal maturity. However, there is a 6% chance your child may pass the condition to their future children due to genetic factors. Early screening of grandchildren is recommended, but this shouldn’t cause undue worry.
