What is congenital hip dislocation?

Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It’s caused by abnormal formation of the hip joint during their early stages of fetal development. Another name for this condition is “developmental dysplasia of the hip.” This instability worsens as your child grows.

The ball-and-socket joint in the child’s hip may sometimes dislocate. This means that the ball will slip out of the socket with movement. The joint may sometimes completely dislocate. 

What causes congenital hip dislocation?

The cause of CHD is unknown in many cases. Contributing factors include low levels of amniotic fluid in the womb, breech presentation, which occurs when your baby is born hips first, and a family history of the condition. Confinement in the uterus may also cause CHD or contribute to it. This is why your baby is more likely to have this condition if you’re pregnant for the first time. Your uterus hasn’t been previously stretched.

Who is at risk for congenital hip dislocation?

CHD is more common in girls than in boys. But any infant can have the condition. This is why your child’s doctor will routinely check your newborn for signs of hip dislocation. They’ll also continue to examine your child’s hips at well-baby checkups during their first year of life.

What are the symptoms of congenital hip dislocation?

There may be no symptoms of CHD, which is why your child’s doctor and nurse will routinely test for the condition. If your child has symptoms, they may include:

  • legs that turn outward or appear to differ in length
  • limited range of motion
  • folds on their legs and buttocks that are uneven when their legs extend
  • delayed gross motor development, which affects how your child sits, crawls, and walks

How is congenital hip dislocation diagnosed?

Screening for CHD occurs at birth and throughout the first year of your child’s life. The most common screening method is a physical exam. Your child’s doctor will gently maneuver your child’s hip and legs while listening for clicking or clunking sounds that may indicate a dislocation. This exam consists of two tests:

  • During the Ortolani test, your child’s doctor will apply upward force while they move your child’s hip away from the body. A movement away from the body is called abduction.
  • During the Barlow test, your child’s doctor will apply downward force while they move your child’s hip across the body. A movement toward the body is called adduction.

These tests are only accurate before your child is 3 months old. In older babies and children, findings that indicate CHD include limping, limited abduction, and a difference in leg lengths if they have a single affected hip.

Imaging tests can confirm a CHD diagnosis. Doctors examine ultrasounds for babies younger than 6 months old. They use X-rays to examine older babies and children.

How is congenital hip dislocation treated?

If your baby is younger than 6 months of age and diagnosed with CHD, it’s likely they’ll be fitted for a Pavlik harness. This harness presses their hip joints into the sockets. The harness abducts the hip by securing its legs in a froglike position. Your baby may wear the harness for 6 to 12 weeks, depending on their age and the severity of the condition. Your baby may need to wear the harness full-time or part-time.

Your child may need surgery if treatment with a Pavlik harness is unsuccessful, or your baby is too big for the harness. Surgery occurs with general anesthesia and may include maneuvering their hip into the socket, which is called a closed reduction. Or the surgeon will lengthen your baby’s tendons and remove other obstacles before positioning the hip. This is called an open reduction. After your baby’s hip is placed into position, their hips and legs will be in casts for at least 12 weeks.

If your child is 18 months or older or hasn’t responded well to treatment, they may need femoral or pelvic osteotomies to reconstruct their hip. This means a surgeon will divide or reshape the head of their femur (the ball of the hip joint), or the acetabulum of their pelvis. 

How can I prevent congenital hip dislocation?

You can’t prevent CHD. It’s important to bring your child to regular checkups so their doctor can identify and treat the condition as soon as possible. You may want to verify their doctor examined your newborn for signs of hip dislocation before you leave the hospital following delivery.