Embed Doc
Copy Link
Readcast
Collections

CommentGo Back

Download

Congenital hip dysplasia

A malformation of the hip joint that is present at birth. Genetic factors likely play a rolein this disorder. Features include hipdislocation, asymmetry of leg positions, asymmetricfat folds, and diminished movement on the affected side. Some children will exhibit littleor no features and must be diagnosed by physical examination of the hip joints.

Causes of Congenital hip dysplasia

Clinical studies show a familial tendency toward Congenital hip dysplasia, with morefemales affected than males. This disorder is found in many cultures around the world.However, statistics show that the Native American population has a high incidence of hipdislocation. This has been documented to be due to the common practice of swaddlingand using cradleboards for restraining the infants. This places the infant's hips intoextreme adduction (brought together). The incidence of congenital Congenital hipdysplasia is also higher in infants born by caesarian and breech position births. Evidencealso shows a greater chance of this hip abnormality in the first born compared to thesecond or third child. Hormonal changes within the mother during pregnancy, resulting inincreased ligament laxity, is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the womb. Other symptoms of completedislocation include ashorteningof the leg and limited ability to abduct the leg.

Treatment of Congenital hip dysplasia

The objective of treatment is to replace the head of the femur into the acetabulum and, byapplying constant pressure, to enlarge and deepen the socket. In the past, stabilizationwas achieved by placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position. More recently the Pavlik harness and von Rosensplint are commonly used in infants up to the age of six months. A stiff shell cast may beused, which achieves the same purpose, spreading the legs apart and forcing the head of the femur into the acetabulum. In some cases, in older children between six to 18 months,surgery may be necessary to reposition the joint. Also at this age, the use of closedmanipulation may be applied successfully, by moving the leg around manually to replace joint. Operations are not only performed to reduce the dislocation of the hip, but also torepair a defect in the acetabulum. A cast is applied after the operation to hold the head of the femur in the correct position. The use of a home traction program is now morecommon. However, after the age of eight years, surgical procedures are primarily donefor pain reduction measures only. Total hip surgeries may be inevitable later inadulthood.

dislocationProblem

The definition of developmental dysplasia of the hip (DDH) is not universally agreedupon. Typically, the term DDH is used when referring to patients who are born withdislocation or instability of the hip, which may then result in hip dysplasia.

A broader definition of DDH is simply abnormal growth of the hip. Abnormaldevelopment of the hip includes the osseous structures, such as the acetabulum and the proximal femur, and the labrum, capsule, and other soft tissues. This condition may occur at any time, from conception to skeletal maturity. The author prefers to use the term hipdysplasia because he believes this term is simpler and more accurate. Internationally, thisdisorder is still referred to as congenital dislocation of the hip.More specific terms are often used to better describe the condition; these are defined asfollows:

•

Subluxation – This is incomplete contact between the articular surfaces of thefemoral head and acetabulum.

•

Dislocation – This refers to complete loss of contact between the articular surfaceof the femoral head and acetabulum.

•

Instability – This consists of the ability to subluxate or dislocate the hip with passive manipulation.

•

Teratologic dislocation – This refers to antenatal dislocation of the hip.

Frequency

The overall frequency of developmental dysplasia of the hip (DDH) is usually reported asapproximately 1 case per 1000 individuals, although Barlow believed that the incidenceof hip instability during newborn examinations was as high as 1 case per 60 newborns.

According to his study, more than 60% of hip instability became stable by age 1 week,and 88% became stable by age 2 months, leaving only 12% (of the 1 in 60 newborns, or 0.2%) with residual hip instability.

Etiology

The etiology of hip dysplasia is not clear, but this condition does appear to be related to anumber of different factors.

One such factor is racial background; among NativeAmericans and Laplanders, the prevalence of hip dysplasia is much higher (nearly 25-50cases per 1000 persons) than other races, and the prevalence is very low among southernChinese and black populations.

7,8,9,10

An underlyinggenetic dispositionalso appears toexist in that a 10-fold increase in the frequency of hip dysplasia occurs in children whose parents had developmental dysplasia of the hip (DDH) compared with those whose parents did not.

Other factors possibly related to DDH includeintrauterine positioningand sex, and someof these are interrelated. Female sex, being the first-born child, and breech positioning areall associated with an increased prevalence of DDH. An estimated 80% of persons withDDH are female,

and the rate of breech positioning in children with DDH isapproximately 20% (compared with 2-4% in the general population).

13,14

The prevalenceof DDH in females born in breech position has been estimated to be as high as 1 case in15 persons in some studies.