Congenital Hip Dislocation: The Importance of Early Detection and Comprehensive Treatment

Hip dislocation is the musculoskeletal condition most commonly missed during neonatal examination. Failure to diagnose the condition can lead to long-term disability and is a common target in pediatric legal suits concerning damage the musculoskeletal system. Early neonatal assessment for hip dislocation includes an examination using the Barlow and Ortolani tests. Later examinations include assessment of gluteal folds, knee height and the degree of hip abduction. The preferred treatment is use of the Pavlik harness, an outpatient treatment regime that provides effective reduction in 90 percent of the cases. The harness uses flexion and free abduction to direct the femoral head into the acetabulum; it uses time, gravity and motion to position the hip in a reduced position. The harness requires three to six months of continuous wear for the hip to become radiographically stable. Health care providers are instrumental diagnosing congenital hip dislocation and teaching families how to promote the infantʼs physical and psychosocial well-being. If this condition is not detected until after the infant is 6 weeks old, or the harness is ineffective after three weeks, skin traction, closed reduction and spica-cast application may be needed. Open reduction and recasting are also options. In rare cases, total hip replacement necessary in later life.