Congenital dislocation of the hip (CDH), also known as Developmental Dysplasia of the Hip (DDH), is a condition where the femoral head is not properly seated in the acetabulum of the pelvis at birth. It can be partial (subluxation) or complete dislocation and may affect one or both hips.
Epidemiology
- More
common in females (6:1 ratio).
- Left hip is more
commonly affected than the right.
- Common in breech
deliveries and firstborn children.
Etiology (Causes)
1. Genetic Factors
- Family
history increases the risk.
- More
common in certain ethnic groups.
2. Hormonal Factors
- Increased relaxin
hormone in the mother during pregnancy leads to laxity of the
ligaments of the baby’s hip.
3. Mechanical Factors
- Breech
presentation – Abnormal intrauterine positioning.
- Oligohydramnios – Less
amniotic fluid leads to restricted fetal movement.
Pathology
- The acetabulum
is shallow and femoral head is displaced.
- The capsule
of the hip joint is stretched and lax.
- Shortening
of the limb due to improper positioning.
Clinical Features
Neonatal Examination (at Birth)
- Barlow’s
Test (Dislocation Test) – The hip is adducted
and gently pushed posteriorly. A "clunk" sound
indicates dislocation.
- Ortolani’s
Test (Relocation Test) – The hip is abducted
while applying gentle anterior pressure. A "click"
indicates reduction of the dislocation.
Signs in Infants & Older
Children
- Asymmetry
of gluteal folds.
- Shortening
of the affected limb.
- Limited
hip abduction.
- Positive
Galeazzi’s Sign – When the child lies supine with knees flexed, the affected
knee appears lower.
- Trendelenburg
Gait – Waddling gait due to weak hip muscles.
Diagnosis
1. Clinical Examination
- Barlow’s
& Ortolani’s Tests (in newborns).
- Galeazzi’s
Sign (in older children).
2. Imaging Studies
- Ultrasound
(USG) of the hip – Best for early diagnosis in infants <6 months.
- X-ray (AP
view of the pelvis, after 6 months):
- Displaced
femoral head.
- Shallow
acetabulum.
- Hilgenreiner’s
& Perkin’s Lines – Used to assess hip
position.
Treatment
1. Non-Surgical Treatment (for
Infants <6 months)
- Pavlik
Harness – A brace that keeps the hip in flexion and abduction to
help the femoral head remain in the acetabulum.
- Von Rosen
Splint – Similar to Pavlik harness, used in early cases.
2. Closed Reduction (6-18 months)
- Performed
under general anesthesia.
- Hip is
placed in a spica cast for 3 months.
3. Open Reduction (>18 months
or failed closed reduction)
- Surgery is
needed if conservative methods fail.
- Femoral or
pelvic osteotomy may be done to stabilize the hip.
Complications
- Avascular
necrosis of the femoral head.
- Persistent
hip dysplasia → Leads to arthritis in adulthood.
- Leg length
discrepancy.
- Trendelenburg
Gait (abnormal walking pattern).
Summary for Quick Revision
- Cause: Genetic,
hormonal, mechanical factors (breech delivery, oligohydramnios).
- Tests: Barlow’s
(dislocation), Ortolani’s (reduction), Galeazzi’s sign (limb shortening).
- Diagnosis:
Ultrasound (<6 months), X-ray (>6 months).
- Treatment: Pavlik
harness (infants), closed reduction with casting (6-18 months), surgery
(>18 months).
- Complications: Avascular
necrosis, arthritis, limb shortening.
Homeopathic Medicines:
1. Calcarea Phosphorica
- Slow bone
development, weak hip joints.
- Delayed walking
due to fragile bones.
- Pain in
hip joints, worse in damp and cold weather.
- Craving
for salty and smoked foods.
- Prone to
fractures and bone deformities.
2. Silicea
- Weak bones
and delayed growth in children.
- Difficulty
in standing and walking properly.
- Tendency
to develop abscesses near hip joints.
- Cold and
sweaty feet.
- Aggravation
from cold air, better in warm surroundings.
3. Rhus Toxicodendron
- Hip pain
and stiffness, worse at rest and first movement.
- Better
with continued movement and warmth.
- Inflammation
of joints, leading to dislocations.
- Pain
worsens in damp and cold weather.
- Restlessness,
difficulty in keeping the hip in one position.
4. Medorrhinum
- For
congenital joint deformities and inherited weakness.
- Weakness
in the lower limbs, difficulty standing long.
- Excessive
sweating, especially of feet.
- Pain in
hip joints, worse at night.
- Better by
stretching legs or lying on the stomach.
5. Thuja Occidentalis
- For
congenital bone and joint abnormalities.
- Weak hips,
tendency to dislocate easily.
- Pain and
stiffness in joints, worse in damp weather.
- Slow
development of bones in infants.
- Associated with warts, abnormal skin growths, or suppressed gonorrhea.
