Rehabilitation of congenital hip dislocation

This article is professionally consulted by Resident Doctor, Doctor Nguyen Hung Tien - Resident Doctor of Pediatrics - Neonatology - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital. The doctor has more than 8 years of experience in the field of Pediatrics - Neonatology.

Congenital hip dislocation is on the list that needs to be checked and diagnosed early, when the femoral head of one or both sides of the hip is dislocated from the normal position of the hip joint.

Congenital hip dislocation is a condition in which the femoral head of one or both sides of the hip joint is dislocated from the normal position of the upper, lower, posterior superior, posterior inferior or central joints. Hip dislocation can be detected soon after birth or a few weeks after birth.
Newborns may have hip dislocation alone or in combination with other congenital malformations of the motor system such as: congenital stiffness, congenital clubfoot, hydrocephalus, spina bifida..
Performing rehabilitation for congenital hip dislocation is based on different levels such as:
Unstable hip: The highest percentage (over 60%), due to tendons, muscles and ligaments. Subdislocation of the hip: Partial dislocation of the femoral head from the socket, usually without deformity in the femoral head, femoral neck or at the socket. Total hip dislocation: The femoral head lies completely outside the socket with deformities of the femoral head and the socket. Some causes of congenital hip dislocation can be mentioned as: Chromosomal mutations. Children with congenital multi-joint stiffness (club foot, club hand, knee stiffness, elbow stiffness, shoulder stiffness, hip dislocation... ); Maternal infection during pregnancy; Narrow uterine morphology causes abnormal fetal position.

To increase efficiency as well as reduce risks in rehabilitation of congenital hip dislocation, doctors need to intervene immediately after birth with measures of orthopedic braces, orthopedic casts.
In case the above methods do not achieve the desired results or the child is over 18 months old, surgery is needed.
The goals of the rehabilitation protocol are to:
Align the femoral head into the correct position in the socket. Maintain the femoral head in the correct position in the stable socket for a minimum of 12 weeks to stimulate concentric axis formation between the femoral head and the alveolus. Anti-rotation correction of the neck and femoral shaft: Due to a high rate of association between hip dislocation and anterior rotation of the neck and femoral shaft.

3.1. Hip Spica Cast Rehabilitation of hip with cast is indicated when:
Children are diagnosed with congenital hip dislocation before 6 months. Children with hip subluxation, sterile femoral head inflammation.. Contraindications:
Children with congenital hip dislocation over 36 months of age Children with many birth defects such as multi-joint stiffness, cerebrospinal hernia Casting:
Wrap the entire waist-hip-thigh area, or waist-hip-thigh-calf area with cotton bandages or toilet paper. Wrap the cast from the waist-hip-thigh area (Short Leg-Hip Spica Cast) or the waist-hip-thigh-leg and foot area (Long Leg-Hip Spica Cast). The patient was cast in the frog position with the hip joints flexed toward the abdomen and abducted. Hold the child's feet in this position until the dough dries. Fix the cast for 2 - 4 - 8 - 12 weeks (depending on the age at which the cast begins). Remove the powder, clean the child's feet, apply Betadine to sores and scratches. Follow-up after the cast at home: If the toes are swollen, purple, or the child has a fever and is crying for no reason, the cast should be removed immediately to check.
Casting time: 2 weeks/time, about 10-15 times. At the end of the session, a scan should be taken to check that the femoral head and the alveolus are in the correct position.
3.2. Orthopedic brace Types of splints commonly used:
Pavlik Harness splint: The most popular and widely used soft belt brace. Freijka knee brace: A convenient brace, indicated for cases of loose hip joints. Hard plastic brace to fix hip joint on both sides Hip splint is made of soft foam. 3.3 Time to wear the brace Day after birth to 12 months of age Continuous wear day and night for the first 6 months Wear the brace at night for the next 6 months. 3.4 Other treatments Surgery: If the alveolar ceiling is too steep, conservative treatment is certain to fail necessitating early surgical intervention
Keep the child in a wide hip and knee flexed position by:
Close sanitary diapers Carrying or slinging the baby Put the baby on his or her stomach to sleep.

>> See more: Ultrasound diagnosis of congenital hip dislocation - Post by Master, Doctor Lam Thi Kim Chi - Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Da International General Hospital Nang

Parents need to immediately take their child to a medical facility when experiencing some unusual signs such as swollen, purple, painful toes. Injury to soft tissues such as tendons, muscles, ligaments; Muscle atrophy and reduced mobility due to prolonged immobilization.
In addition, children need to be examined regularly, check hip every 3 months in the first 2 years.
Children and adults with congenital hip dislocation who do not receive early rehabilitation may have psychological problems that need psychological support.
Any questions that need to be answered by a specialist doctor as well as if you need to be examined and treated at Vinmec International General Hospital, please book an appointment on the website for the best service.