Congenital dislocation of the hip

Question 1

Define congenital dislocation of the hip?

Answer 1

abnormal development of the hip joint causing the hip to be

• dislocated
• or dislocatable

Question 2

What are the risk factors for congenital dislocation of the hip (CDH)?

Answer 2

• Female (6x increase!)
• Fhx
• breech presentation
• neuromuscular disorders, skeletal dysplasias and talipes (club foot)

Question 3

Neonatal checks are done and they check for CDH.

At what neonatal ages are baby checks done?

Answer 3

• within 72 hrs of birth (3 days)
• then again at 8wks (post natal checks - as some conditions can take a while to develop)

Question 4

Ortolani and barlows tests are done during neonatal checks to check for CDH.

Which test is does this describe?

• Assesses whether hip is dislocated
• hip is flexed & abducted, femoral head levered UP,
  
  • if it is dislocated it will relocate into the acetabulum with a palpable chunk

Answer 4

Ortolani’s test

Question 5

Ortolani and barlows tests are done during neonatal checks to check for CDH.

Which test is does this describe?

• assesses whether the hip is dislocatable
• hip is flexed & abducted, femoral head pushed DOWN,
• if the hip is dislocatable the femoral head will be pushed posteriorly out of the acetabulum (& you can feel that i assume)

Answer 5

Barlows test

e.g. BarLOW- pressing the femoral head DOWN

Question 6

What other signs are there in neonates for CDH except from ortolani or barlow tests?

Answer 6

• asymmetry of the skin folds of the groin and thigh

or Dx can be made during an USS which is carried out on all high risk neonates at some centres

Question 7

A child presents with limp, limitation of abduction on one side and shortening of that limb, what do you suspect?

Answer 7

concenital dislocation of the hip (includes dislocatabiltiy too)

there is limited abduction on the affected side

Question 8

How do you diagnose CDH?

Answer 8

USS of hip joint

• do the USS if you suspect risk factors e.g. Breech - even if normal exam

USS or X-ray can be used to monitor the progress of the joint during treatment

Question 9

What is the first line treatment for CDH and how does it work?

Answer 9

• Use a Pavlik harness
• for 1-3 months
• maintains 60o abduction & 90o flexion of the hip,
• redirecting the femoral head back into the acetabulum.

Question 10

is a pavlik harness is unsuccesful after 3 months. What can be done?

Answer 10

if unsuccessful then require:

1. traction,
2. splints or
3. open reduction and de-rotation femoral osteotomy