Hip Dysplasia -Treatment-Outcomes-Recovery-Complications

■When DDH is detected at birth, it can usually be corrected with the use of a harness or brace.

■If the hip is not dislocated at birth, the condition may not be noticed until the child begins walking. At this time, treatment is more complicated, with less predictable results.

■ Infants are typically treated with full-time braces, such as

the Pavlik harness.

■ Young children can be treated with a closed reduction and

cast immobilization.

■ The initial treatment for primary acetabular dysplasia with-

out hip instability or residual acetabular dysplasia following

treatment for instability is observation.

■ As long as the acetabular index continues to improve and

the hip remains concentrically reduced, observation can be

continued.

■ If hip subluxation develops or the acetabular index fails

to improve over a 12-month period, operative treatment is

indicated.

■ Neuromuscular patients with a migration index less than

25% can be observed as long as their abduction remains greater

than 45 degrees. Patients with migration indexes over 50% gen-

erally will benefit from surgical treatment of their dysplasia,

which can include a femoral or pelvic osteotomy.

Treatment methods depend on a child's age as well as the severity of the DDH.

 

Newborns. The baby may be placed in a soft positioning device, called a Pavlik harness, for 1 to 3 months to keep the thighbone in the socket. This special brace is designed to hold the hip in the proper position while allowing free movement of the legs and easy diaper care. The Pavlik harness helps tighten the ligaments around the hip joint and promotes normal hip socket formation.

 

 

 

Parents play an essential role in ensuring the harness is effective. Your doctor and healthcare team will teach you how to safely perform daily care tasks, such as diapering, bathing, feeding, and dressing. It is very important to attend all of your baby's scheduled clinic visits so the doctor can check the hip and the fit of the Pavlik harness.

 

1 month to 6 months. Similar to newborn treatment, a baby's thighbone is repositioned in the socket using a harness or similar device. This method is usually successful, even with hips that are initially dislocated.

 

How long the baby will require the harness varies. It is usually worn full-time for at least 6 weeks, and then part-time for an additional 6 weeks.

 

If the hip will not stay in position using a harness, your child's doctor may try an abduction brace made of firmer material that will keep your baby's legs in position.

 

In some cases, a closed reduction procedure is required. Your child's doctor will gently move your baby's thighbone into proper position, then apply a body cast (spica cast) to hold the bones in place. This procedure is done while the baby is under anesthesia.

 

Caring for a baby in a spica cast requires specific instruction. Your child's doctor and healthcare team will teach you how to perform daily activities, maintain the cast, and identify any problems.

 

6 months to 2 years. Older babies are also treated with closed reduction and spica casting. Skin traction may be used for a few weeks prior to repositioning the thighbone. Skin traction prepares the soft tissues around the hip for the change in bone positioning. This may be done at home or in the hospital.

 

6 months to 2 years. If a closed reduction procedure is not successful at putting the thighbone in its proper position, open surgery is necessary. In this procedure, an incision is made at the baby's hip that allows the surgeon to clearly see the bones and soft tissues.

 

In some cases, the thighbone will be shortened to properly fit the bone into the socket. X-rays are taken during the operation to confirm that the bones are in position. Afterward, the child is placed in a spica cast to maintain the proper hip position.

 

Older than 2 years. In some children, the looseness worsens as the child grows and becomes more active. Open surgery is typically necessary to realign the hip. A spica cast is usually applied to maintain the hip in the socket.

 

In many children with DDH, a body cast and/or brace is required to keep the hip bone in the joint during healing. The cast may be needed for 2 to 3 months. Your child's doctor may change the cast during this time period.

 

X-rays and other regular follow-up monitoring are needed after DDH treatment until the child's growth is complete.

 

Children treated with spica casting may have a delay in walking. However, when the cast is removed, walking development proceeds normally.

The Pavlik harness and other positioning devices may cause skin irritation around the straps, and a difference in leg length may remain. Rarely, positioning in the Pavlik may also cause nerve compression in the leg, with loss of motion. The nerve almost always recovers if the harness is removed or adjusted. 

Growth disturbances of the upper thighbone are rare, but may occur due to a disturbance in the blood supply to the growth area in the thighbone.

Even after proper treatment, a shallow hip socket may persist, and surgery may be necessary in early childhood to restore the normal anatomy of the hip joint.

If diagnosed early and treated successfully, children are able to develop a normal hip joint and should have no limitation in function. Left untreated, DDH can lead to pain and osteoarthritis by early adulthood. It may produce a difference in leg length or decreased agility.

 

Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life. This is especially true when treatment begins after the age of 2.

 

To assist doctors in the management of pediatric developmental dysplasia of the hip, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Pediatric Developmental Dysplasia of the Hip - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org)

 

IN This Artical

next page: