The congenital incongruence between the bones constituting the hip joint is called “developmental dysplasia of the hip.” Conditions ranging from a simple incongruence between the bones to the very later stage in which a hip dislocation is seen fall within the developmental dysplasia of the hip.
This condition, which was defined as the congenital hip dislocation in previous years, is called ‘Developmental Dysplasia of the Hip (DDH), which is a broader definition made as a result of the studies conducted in the 80s, in which it was determined that not only the hip dislocation was seen in children but also problems resulting from the incongruence of the joint in the hip were observed in most of the children.
Risk Factors
There are some risk factors for the developmental dysplasia of the hip. Problems such as breech birth, multiple pregnancies, troubles related to the excess or lack of amniotic fluid, the first delivery, and the position of the baby in the womb increase the risk. On the other hand, girls are more likely to develop developmental dysplasia of the hip as their ligaments are more flexible.
In addition to the risks related to the birth, there are also some wrong applications made after the birth. Among these are primarily swaddling the newborn as a traditional method. Studies have shown that swaddling increases the developmental dysplasia of the hip significantly. In the traditional swaddling, the infant’s legs are wrapped such that they are straight, are parallel to each other and do not allowed to move. In fact, the legs should be free to ensure the natural development of the hip.
Today, there are methods of carrying and wrapping, which are not like the traditional swaddling, wrap the infant only from the body and leave the legs free. They are different from traditional swaddling as they leave the legs free.
Diagnosis
When a baby is born, the hip is also examined during the first examination by a pediatrician. In the meantime, if a dislocation is noticed, then the baby is treated immediately. In addition, the difference in height between the legs, and the presence of an asymmetry in the skin layers of the baby’s thighs should point out the hip dislocation.
In addition, a hip ultrasound which is recommended to be performed in the postpartum period between 4 and 6 weeks is extremely important for detecting a possible problem. If an ultrasound scan cannot be performed during these weeks, an x-ray examination is performed instead of an ultrasound for the children if they are at the age of above 6 months. It should be kept in mind that the earlier the developmental dysplasia of the hip is diagnosed, the more successful the treatment is.
Determination of the type of the treatment
The aim of all screening methods is to treat children who have been found to have a problem with a special bandage called ’Pavlik harness.” The Pavlik harness is an easier application as compared to the casting, and has a high success rate. The child should wear this harness for 24 hours and not remove it until the next doctor’s check. There is no problem for changing the diaper and the clothes on the legs while the harness is worn, however the clothes on the upper body cannot be changes due to the harness. When the baby will have a hip ultrasound, the harness can be removed under the supervision of the doctor, and the clothes of the baby can be changed. The family is told what should be done when the clothes of the baby is very dirty and should be changed. However, it is more suitable for the harness to be removed by the pediatrician during the check, unless necessary. Both the appearance of the harness on the baby and the no chance for changing the clothes may cause problems for some families, and they may discontinue treatment by removing the harness. This is an extremely wrong behavior as it will cause the problem to get bigger and increase the likelihood of applying more difficult treatments in the future.
An ultrasound control is performed with a three-week interval during the treatment with the Pavlik harness. The harness should be worn for up to 6 – 8 months. In the case that the problem is not at an advanced level, the effect of the treatment can be seen over a period of 2-3 months.
While the Pavlik harness is a solution for the infants, who have been found to have a problem at an age of below six months, only casting is performed if there is no hip dislocation, but when the dysplasia is noticed after six months, or when the treatment fails, the hip is first reduced by the closed methods, then the casting is applied. Casting application is a more troublesome process as compared to the Pavlik harness. It should be replaced with a new one one month and half after the application as the child will grow during this period.
When the problem in the hip is discovered at a later stage, the closed reduction may not be useful after the age of one year. In this case, an open reduction should be used. The joint is reached through a small incision, the structures inside the joint are cleaned, the hip is reduced and then the casting is applied.
If the problem is noticed too late, or the desired benefit from the treatment is not obtained, corrective bone operations are decided to be performed after 3-4 years of age. This shows us that the sooner the diagnosis is made, the easier and more successful the treatment will be. Therefore, families should not discontinue the Pavlik harness treatment even if it is uncomfortable for them and forget that the next stages may be extremely troublesome.