CONGENITAL DISLOCATION OF HIP

Introduction:-

Developmental dysplasia of the hip (DDH) is a hip problem a baby is born with or that happens in the first year of life. … In a normal hip , the thighbone fits tightly into a cup-shaped socket in the pelvis, and it is held in place by muscles, tendons, and ligaments.


Cause:-
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.

Symptoms:-
Signs and symptoms in infants, you might notice that one leg is longer than the other. Once a child begins walking, a limp may develop. During diaper changes, one hip may be less flexible than the other.


Nonsurgical Treatment:-

Treatment methods depend on a child’s age.

Newborn The baby is placed in a soft positioning device, called a Pavlik harness, for 1 to 2 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.
Newborns are placed in a Pavlik harness for 1 to 2 months to treat DDH.
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 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 doctor will gently move your baby’s thighbone into proper position, and 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 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. In most cases, skin traction is 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. It may be done at home or in the hospital.

However, patients with hip dysplasia may also be advised to visit a physiotherapist before undergoing surgery. A therapist can prescribe exercises which should make the surgery and rehabilitation process more tolerable.

The stronger joint and surrounding area is before the surgery the easier the rehab should be done.

PHYSIOTHERAPY EXERCISE:-
Post surgical-
Patients require skilled therapy once the hip joint has been corrected through surgery.

The first stage is known as gait training where patients are taught how to use a walker and/or crutches.

After approximately six to eight weeks the muscles will have reattached and the bone will be healed. The condition will then need to be treated by a physiotherapist with procedures such as heat, ice, massage therapy, ultrasound and possibly traction.

 

Light strengthening exercises will be prescribed to help mobilize your hip and regain its range of motion. At this stage it’s important for the therapist to identify any weak muscles and work on them.

This is also an ideal time for patients to get used to using a walker or crutches and for the therapist to let them know what exactly they’ll be facing in the weeks after the procedure.

The traditional physical therapy includes ball catching, ball bouncing, target throwing, kicking, balance beam activities, gait and stairs and unleveled terrain, running and jumping as well as sensory integration activities including swiss ball, vestibular swing tasks and scooter board.

 

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