What Is Congenital Hip Dislocation?
Congenital hip dislocation (CHD) occurs when a child is born with
an unstable hip due to 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 their hip may sometimes dislocate. This means that the
ball will slip out of the socket with movement. The joint may sometimes completely
dislocate. According to American Family Physician, one out
of every 1,000 infants is born with a dislocated hip.
What Causes Congenital Hip Dislocation?
The cause of CHD is unknown in many cases. Contributing factors
include low levels of amniotic fluid in your 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 you’re 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
CHD is more common in girls than in boys. However, any infant can
have the condition. This is why your child’s doctor will routinely check your newborn
for signs of hip dislocation and why they’ll continue to examine your child’s
hips at well-baby checkups throughout your child’s first year of life.
What Are the Symptoms of Congenital Hip
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
- 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?
The 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:
the Ortolani test, your child’s doctor will apply upward force while they
move your child’s hip away from your child’s body. Movement away from the body
is called abduction.
the Barlow test, your child’s doctor will apply downward force while they
move your child’s hip across your child’s body. Movement toward the body is
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 their
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 lengthening their tendons and removing other
obstacles before positioning the hip, which 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, which
is the ball of the hip joint, or the acetabulum of their pelvis, which is the
How Can I Prevent Congenital Hip
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 that their doctor examined your newborn for
signs of hip dislocation before you leave the hospital following delivery.
What Is the Long-Term Outlook?
Complicated or invasive treatment is less likely to be necessary
when your doctor identifies CHD early and gives treatment with a Pavlik
harness. It’s estimated that between 80 and 95 percent of cases identified early receive
successful treatment, depending on the severity of the condition.
Surgical treatments vary in their success rates. Some cases only
need one procedure, and others require many surgeries and years of monitoring.
CHD that’s not successfully treated in early childhood can result in early
arthritis and severe pain later in life that might require total hip
If your child’s CHD is successfully treated, they’ll likely
continue to regularly visit an orthopedic specialist to make sure the condition
doesn’t return and that their hip is growing normally.