Congenital hip dysplasia is a condition of abnormal development of the
hip, resulting in hip joint instability and potential dislocation of the
thigh bone from the socket in the pelvis. This condition has been in the
early 2000s been termed developmental hip dysplasia, because it often
develops over the first few weeks, months, or years of life.
Congenital hip dysplasia is a disorder in children that is either present
at birth or shortly thereafter. During gestation, the infant's hip
should be developing with the head of the thigh bone (femur) sitting
perfectly centered in its shallow socket (acetabulum). The acetabulum
should cover the head of the femur as if it were a ball sitting inside of
a cup. In the event of congenital hip dysplasia, the development of the
acetabulum in an infant allows the femoral head to ride upward out of the
joint socket, especially when the infant begins to walk.
In the United States, approximately 1.5 percent of all infants have
congenital hip dysplasia. Though the worldwide incidence of congenital hip
dysplasia varies, researchers estimate the global incidence to be
approximately 1 percent.
Clinical studies show a familial tendency toward hip dysplasia with a
greater chance of this hip abnormality in the first born compared to the
second or third child. Infants with siblings who have been diagnosed with
congenital hip dysplasia or who have parents with the defect are at an
increased risk. Females are affected four to eight times more than males,
and in children with congenital hip dysplasia, the left leg in more often
affected. This disorder is found in many cultures around the world.
However, statistics show that infants in colder climates have a higher
incidence. It is speculated that this increase may be due to the practice
of swaddling which can place the infant's legs in an extreme
straightened or adducted position, forcing the hips closer together. The
incidence of congenital hip dysplasia is also higher in infants born by
cesarean and in breech position births.
Causes and symptoms
Hormonal changes within the mother during pregnancy result in increased
ligament looseness or laxity and are thought to possibly cross over the
placenta and cause the baby to have lax ligaments while still in the womb.
Other symptoms of complete dislocation include a shortening of the leg and
limited ability to abduct the leg, or move it outward.
Because the abnormalities of this hip problem often vary, a thorough
physical examination is necessary for an accurate diagnosis of congenital
hip dysplasia. The hip disorder can be diagnosed by moving the hip to
determine if the head of the femur is moving in and out of the hip joint.
One specific method, called the Ortolani test, begins with each of the
examiner's hands around the
infant's knees, with the second and third fingers pointing down
the child's thigh. With the legs abducted (moved apart), the
examiner may be able to hear a distinct clicking sound, called a hip
click, with motion. If symptoms are present with a noted increase in
abduction, the test is considered positive for hip joint instability. It
is important to note this test is only valid a few weeks after birth.
The Barlow method is another test performed with the infant's hip
brought together with knees in full bent position. The examiner's
middle finger is placed over the outside of the hipbone while the thumb is
placed on the inner side of the knee. The hip is abducted to where it can
be felt if the hip is sliding out and then back in the joint. In older
babies, if there is a lack of range of motion in one hip or even both
hips, it is possible that the movement is blocked because the hip has
dislocated and the muscles have contracted in that position. Also in older
infants, hip dislocation may be present if one leg looks shorter than the
X-ray films can be helpful in detecting abnormal findings of the hip
may also be helpful in finding the proper positioning of the hip joint
for treatment. Ultrasound has been noted as a safe and effective tool for
the diagnosis of congenital hip dysplasia. Ultrasound has advantages over
x rays, as several positions are noted during the ultrasound procedure.
This is in contrast to only one position observed during the x ray.
The objective of treatment is to replace the head of the femur into the
acetabulum and, by applying constant pressure, to enlarge and deepen the
socket. In the past, stabilization was achieved by placing rolled cotton
diapers or a pillow between the thighs. The child may be dressed in two or
three diapers, called double or triple diapering. Both these techniques
keep the knees in a frog-like position. In the early 2000s, the Pavlik
harness and von Rosen splint are commonly used in infants up to the age of
six months to spread the legs apart and force the head of the femur into
the acetabulum. A stiff shell cast, called a splint, may be also used to
achieve the same purpose. In some cases, older children between six to 18
months old may need surgery to reposition the joint. Also at this age, the
use of closed manipulation may be applied successfully, by moving the leg
around manually to replace the joint. Operations are performed to reduce
the dislocation of the hip and to repair a defect in the acetabulum. A
cast is applied after the operation to hold the head of the femur in the
correct position. As of 2004 the use of a home traction program was more
common. However, after the child is eight years of age, surgical
procedures are primarily done for
reduction measures only. Total hip surgeries may be inevitable later in
Nonsurgical treatments include
programs, orthosis (a force system, often involving braces), and
medications. A physical therapist may develop a program that includes
strengthening, range-of-motion exercises, pain control, and functional
activities. Chiropractic medicine may be helpful, especially the
procedures of closed manipulations, to reduce the dislocated hip joint.
Unless corrected soon after birth, congenital hip dysplasia can cause a
characteristic limp or waddling gait in children. If left untreated, the
child will have difficulty walking and may experience life-long pain. If
diagnosed early, congenital hip dysplasia treatment is highly effective.
Children who have received casting, bracing, or surgery, usually go on to
have normal hip and leg development. In individuals for whom the diagnosis
is made later, the prognosis is not as positive. These children may
require more extensive surgery. After surgery, however, the prognosis for
normal development of the hip and leg is excellent.
Prevention includes proper prenatal care to determine the position of the
baby in the womb. This may be helpful in preparing for possible breech
births associated with hip problems. Avoiding excessive and prolonged
infant hip adduction, or forcing the legs in a straight position close
together for periods of time (as in swaddling) may help prevent strain on
the hip joints. Early diagnosis remains an important part of prevention of
congenital hip dysplasia.
—Turning away from the body.
—The large cup-shaped cavity at the junction of pelvis and femur
—Movement toward the body.
—Using orthopedic devices to hold joints or limbs in place.
—The displacement of bones at a joint or the displacement of any
part of the body from its normal position.
—Abnormal changes in cells.
—The thigh bone.
—An external device, such as a splint or a brace, that prevents
or assists movement.
—The organ that provides oxygen and nutrition from the mother to
the unborn baby during pregnancy. The placenta is attached to the wall
of the uterus and leads to the unborn baby via the umbilical cord.
—A thin piece of rigid or flexible material that is used to
restrain, support, or immobilize a part of the body while healing takes
Rudolph, Colin D., and Abraham M. Rudolph, eds.
, 21st ed. New York: McGraw-Hill, 2003.
March of Dimes Birth Defects Foundation.
1275 Mamaroneck Ave., White Plains, NY 10605. Web site:
American Academy of Pediatrics, Committee on Quality Improvement,
Subcommittee on Developmental Dysplasia of the Hip. "Clinical
Practice Guideline: Early Detection of Developmental Dysplasia of the Hip
105, no. 4 (April 2000): 896–905. Available online at
http://www.aap.org/policy/ac0001.htm (accessed December 8, 2004).
Norton, Karen I., and Sandra A. Mitre. "Developmental Dysplasia of
, April 22, 2003. Available online at
http://www.emedicine.com/radio/topic212.htm (accessed December 8,