Some children suffer from this problem of dislocation or poor development of the hip joint on birth.
This may be detected at birth when it is easier to treat generally, or at a later data when the child starts to walk.
The parent may notice that the child’s diapers dont fit well or one of the legs appear shorter than the other.
This is usually more common in female children and in the first born children. Many of these cases occur without any know cause, however some of them may have reasons or group of signs called medically as “syndromes” associated with them .
The treatment for this depends on the extent to which the hip’s ball and socket joint is dislocated and whether one side / both the sides are involved.
Treatment should be started as early as possible.
The child needs to assessed and the dislocation hip should be put back into the socket as sson as possible. This gives the hip the best chance of developing properly.
The child is assessed clinically, x-rays are taken and also ultrasound is done to assess the geometry of the ball and socket joint and it developmental inadequacies.
In children in new born period the reduction of the hip can be accomplished by using Pavlik harness.
Once the child is older, he / she may need aid of anaesthesia to put back / reduce the joint into proper position. To verify whether the joint is in the proper position a procedure called “arthrogram” is done at the same time. Here a dye is injected into the hip joint and this helps to outline the soft cartilage that is otherwise not visible on the x-ray. This is done in the operation theatre while the child is under anaesthesia. After confirming that the joint is reduced, the child is then placed in a plaster from abdomen to the ankle. This plaster is called Hip Spica.
If a child is old the tissues contract and does not allow the hip to be put in place even under anaesthesia. In such cases, a procedure to reduce the hip called “Open Reduction” is done. This is a surgical procedure where the hip joint is opened and the loose covering of the ball and socket joint is tightened after the ball is reduced back into the socket. In some cases the child will in addition have a condition called acetabular dysplasia. This is like a poor roof cover the the ball resulting in a shallow cup. As a result the ball or the femoral head does not stay inside. It tends to pop out. This may need additional surgical procedure called Pelvic osteotomy. After these operations, the child will need to be in plaster – Hip spica for up to 10 weeks to allow the tissues to heal and the joint to stabilise.