Hip Dislocation
According to the WHO (World Health Organisation), one in 33 newborns is born with some kind of congenital malformation. The most common congenital malformation affecting the musculoskeletal system is hip dislocation, which has a prevalence of about 1%. It can also develop in adulthood and is known as acquired hip dislocation. In this article, you can read authoritative medical information about the symptoms, diagnostics, treatment and prevention of hip dislocation.
Types of hip dislocation
Hip dislocation can be congenital or acquired.
Congenital hip dislocation
We talk about congenital hip dislocation when the hip joint develops abnormally in the womb. This typically causes it to dislocate during or after childbirth. It is five to ten times more common in girls than in boys and is also more common in babies with breech presentation.
Congenital hip deformities can be of different severities and types:
- Loose hip joint
In this case, the head of the femur does not leave the joint socket in the pelvis, but can be pushed outwards from it. This is not yet a specific dislocation. - Dislocated (unstable) hip
If the joint capsule is too loose, the head of the femur can be pushed out of the joint cavity and a jarring sound can be heard. It is also called a variable hip dislocation. - Dislocation (luxation)
In this case, the head of the femur is outside the joint socket even at rest, i.e. it is dislocated. The femur may be reinserted into the socket, but may dislocate again. - Subluxation
The diaphragm only partially covers the femur. This is also called an incomplete hip dislocation. - Teratological hip dislocation
In this case, the hip dislocation is not formed at birth, but in utero. Usually at this time, the head of the femur cannot be put back in the right position and surgery is required.
Acquired hip dislocation
Acquired hip dislocation is when the hip joint was intact at birth and develops a hip dislocation as a result of some injury or other abnormality during the course of life.
Causes of hip dislocation
We don’t know the exact cause of congenital hip dislocation, but we know of several factors that contribute to its development. Hereditary factors play a major role, as indicated by familial cumulation (within a given family, the incidence of the disease is generally higher between ascendants and descendants). Hip dislocation is much more common in girls than in boys. This is due to the production of joint-loosening hormones in the mother to facilitate childbirth, which has a stronger effect on female foetuses. There are also environmental effects. For example, the optimal development of the hip joint is hindered if the baby is breech, if there is little amniotic fluid or if the foetus is too large. Postnatal causes include incorrect swaddling and failure to have hip screenings.
Acquired hip dislocation can also be caused by several factors. It is typically caused by injuries and certain diseases of the central nervous system.
Symptoms of hip dislocation
Babies often have no obvious symptoms of hip dislocation, which is why it is very important to take your baby for a hip screening. That said, there are some signs that may indicate a problem. For example, if the skin folds on the baby’s thighs are not symmetrical, or if the baby holds his legs in different positions when sleeping. In a slightly older child, a limp is a warning sign.
If hip dislocation is not detected and treated in infancy, it can cause more serious problems by adulthood. Symptoms may include limping, hip pain, reduced weight bearing, among others.
Diagnosis of hip dislocation
Congenital hip dislocation is diagnosed at a hip screening in infancy. It is very important for all babies to have this test, as it can detect abnormalities that are not currently causing symptoms, but if left untreated can develop into serious lesions that can affect adults.
Hip screening is carried out by a specialist in pediatric orthopedics. It involves moving the hip joints to assess the condition of the joints. An ultrasound hip screening may also be done to check that the joints are properly developed. The test does not cause any pain to the baby.
Even in the case of an acquired hip dislocation, a specialist in pediatric orthopedics should be consulted for a diagnosis.
Treatment of hip dislocation
Treatment of hip dislocation in the pediatric orthopedics specialists who will recommend a personalised treatment plan for the condition.
Dr. Nikolett Gáti
Orthopedic – Traumatology Specialist
Specialist treatment
Hip dysplasia, or mild hip dislocations, in babies are most often treated by immobilising their legs in a spread position using a so-called hip brace. The joint needs this constant position correction to avoid inappropriate loads and to develop the right depth of joint socket and thus a healthy hip joint. For more severely diagnosed hip dislocations, wearing a so-called Pavlik stirrup can provide a solution. This special device prevents the baby from making movements that cause the dislocation, but allows all other movements, so that the hip can develop under the right conditions and stabilise and the dislocated femur can be put back in place. The Pavlik stirrup does not cause any pain to the baby.
In general, the above solutions can successfully treat hip dislocation, but if they do not produce good results, surgery may be needed to cure the dislocation. The aim of the intervention is to correct the position of the bones and to make the head of the femur as overlapping and stable as possible.
Adult hip dislocation can also be resolved with conservative therapy or surgery.
Hip dislocation treatment with physiotherapy
Physiotherapy is not a substitute for, but a very good complement to, hip dislocation position correction and supports the healthy development of movement in young children. Physiotherapy consists of a special hip exercise, taught by a physiotherapist to parents, which should be done at nappy changing time. The physiotherapist will also help you learn how to carry and hold your baby with hip dislocation.
Treatment of hip dislocation at home
It is not recommended to treat hip dislocations with home methods. Even if you do not make the joint worse, failure to seek proper medical treatment can cause serious problems. However, medical treatment also requires regular home care. The use of positioning devices and physiotherapy also requires perseverance on the part of parents.
Dr. Gyula Domos
Pediatric orthopedics specialist, assistant professor
How can hip dislocations be prevented?
Hip screening is the most important tool in preventing hip dislocation in babies. If the screening reveals that the baby has an unstable or dysplastic hip joint, the right treatment can prevent hip dislocation with almost 100% effectiveness.
What are the possible complications of hip dislocation?
Failure to treat a hip dislocation early can lead to serious symptoms that can affect the child for the rest of their life. The hip joint becomes overloaded and premature cartilage degeneration develops, which can lead to very severe pain and limited mobility.
At the Budapest Musculoskeletal Private Outpatient Clinic, we pay special attention to the healthy development of children’s movement, as the development of bones, muscles and joints has an impact on the whole life. We also provide our patients with high quality care for adult hip dislocation. In our private outpatient clinic for pediatric orthopedics, our highly skilled and experienced doctors use the most modern and effective treatment methods.
If you have a musculoskeletal complaint, would like to take your child for a musculoskeletal screening or would like to make a specialist appointment for yourself, please call +36 (1) 44-33-433