Congenital Dislocation of the Hip

Question 1

Indications for USS of hips

Answer 1

Family history

Breech presentation

Screening

Question 2

Define congenital dislocation of the hip

Answer 2

Structural abnormality caused by abnormal development of foetal bones during pregnancy

Instability in hips

Tendency/potential for subluxation or dislocation

Question 3

Risk factors for congenital dislocation of the hip

Answer 3

First degree family history

Breech presentation from 36/40 onwards

Breech presentation at birth if 28/40 onwards

Multiple pregnancy

Question 4

Screening for congenital dislocation of hip

Answer 4

Screened on neonatal exam at birth and at 6-8weeks

Question 5

Exam findings that may suggest congenital dislocation of the hip

Answer 5

Different leg lengths

Restricted hip abduction on one side

Significant bilateral restriction in abduction

Difference in the knee level when the hips are flexed

Clunking of the hips on special tests (clicking is common and US will be normal)

Question 6

Special tests for congenital dislocation of the hip

Answer 6

Ortolani - baby on back, hips and knees flexed, abduct hips and apply pressure behind legs to see if hips will dislocate anteriorly

Barlow - abby on back, hips adducted and flexed, knees flexed, gently pressure on knees to see if femoral head dislocates posteriorly

Question 7

Investigations for congenital dislocation of hip

Answer 7

USS to help establish diagnosis

All children with RFs or suggestive exam findings to have USS

X-rays in older infants

Question 8

Complications of congenital dislocation of the hip

Answer 8

Potential to persist into adulthood

Weakness, recurrent subluxation, abnormal gait, early degenerative changes