Before it was called congenital hip dislocation and now we know it by the name of hip dysplasia or evolutionary or developmental hip dysplasia.
It is one of the most frequent lower limb malformations in newborns. It occurs in approximately three out of every thousand children, it is more common in girls and, curiously, more in the left hip than in the right.
To detect it, the pediatrician controls the position of the baby's hips on the first checks after delivery and on routine medical check-ups.
Hip dysplasia consists of an abnormal development of the joint between the head of the femur and the hip cavity, causing an outward movement of the head of the femur, the upper leg bone.
When the head of the femur and the cavity where it should stay do not fit perfectly, the bone tends to leave the hip intermittently, but in the most severe cases the bone is placed outside its natural position permanently. It is what is known as a dislocated hip.
Why hip dysplasia occurs in the baby is not entirely clear, but some possible causes such as poor posture of the fetus in the womb, a low level of amniotic fluid, family history, a post-term pregnancy, the born by caesarean section or dislocation during labor.
In Babies and morePorting your baby: a wonderful and unforgettable experience that will "hook you"Also considered as predisposing factors are high baby weight, breech position, the first child, multiple pregnancy, maternal hypertension and macrosomia of the baby.
Ortolani and Barlow maneuvers
They are the maneuvers that are performed to detect hip dysplasia. They consist of a series of movements performed by the pediatrician flexing and gently opening the baby's legs.
They are performed with the child lying on his back and as relaxed as possible. It is done first on one hip and then on the other.
The Ortolani maneuver allows you to check if there is dislocation by performing rotations of the joint, while the Barlow maneuver allows you to check if there is a possibility that dislocation may occur.
Half of the cases of hip dysplasia are detected in the neonatal period thanks to these maneuvers.
The pediatrician also observes the shape of the folds of the baby's leg. It is a less accurate sign at these ages, but an asymmetry of folds could be suspected hip dysplasia.
If, when performing the maneuvers, the doctor thinks there may be dislocation, an ultrasound is performed to confirm the diagnosis.
The diagnosis of hip dysplasia
Early diagnosis is essential in these cases because it allows a more effective treatment before the baby begins to crawl and stand up.
From the three months of the baby, the aforementioned maneuvers are practically negative in all cases, so we resort to the observation of other signs such as the asymmetry of folds or if there is shortening of one of the extremities.
Although they are the least, in some cases, until the child does not start walking, symptoms of dislocation are not detected despite having been negative in pediatric reviews.
A delay in the beginning of gait, lameness when walking or an unstable way of walking (more unstable than normal in a baby who begins to walk) may indicate a dislocation.
If hip dysplasia is not treated before the child begins to walk, it can lead to more serious problems such as irreversible lameness, bone injuries, asymmetry of the legs or early hip osteoarthritis.
In Babies and more How to wrap the newborn to avoid hip dysplasiaTreatment of hip dysplasia in the baby
Before six months, it is not necessary that all cases be treated orthopedically. Newborns with positive maneuvers should be re-screened in subsequent reviews. If the suspicion persists, it should be confirmed and treated.
The treatments vary depending on the severity of the case and the age of the child. In the milder ones, a postural treatment is recommended, such as taking the baby astride and sleeping on their backs with their legs open to try to get the bone back naturally into place.
To the extent that the disease worsens, certain types of soft or more rigid prostheses or other treatments such as the Pavlik harness are usually used, which consists of straps that keep the hips flexed at one hundred degrees to reduce dislocation.
If dislocation is not corrected even with orthopedic treatments, surgery may be the last solution.
