Chapter 18: Hip Problems

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HealthWiki > Disabled Village Children > Chapter 18: Hip Problems

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In this chapter:

 

In this chapter:

Dislocated Hips

The hip joint is where the ball-shaped top of the thigh bone meets a socket-like indentation in the pelvis. These parts need to fit together well for the hip to work smoothly. A hip is dislocated when the thigh bone is out of its socket at the hip. Some babies are born with one or both hips already dislocated. Sometimes these babies have no other problem. With early treatment, the problem can often be corrected easily, and the child will be able to walk without a limp.

NOT DISLOCATED HIP: The round head of the thigh bone is inside the hip socket.

DISLOCATED HIP: The head of the thigh bone often lies above the socket.

For this reason it is important to examine all babies when they are 10 days old to see whether they have dislocated hips.

1. Compare the 2 legs. If one hip is dislocated, that side may show these signs:

the upper leg partly covers this part of the body

there are fewer skin folds

the leg may seem shorter, or the knee/foot is pointing outwards

	2. Hold both legs with the knees bent, like this,		If one leg stops early or makes a jump or click when you open it wide, the hip is dislocated.
	and open them wide, like this.

3. To test a slightly older child, bend the knees and compare their height.

If one knee is lower, the hip on that side is probably dislocated.

Treatment

Keep the baby’s knees high and wide apart. There are several ways to do this.

	The best option is a Pavlik Harness. This is specifically used to gently hold a baby’s hips in the correct position for hip development. It is worn 24 hours a day and is only removed for bathing. For more information, see Other Resources.
	If you do not have access to a Pavlik Harness, use 2 to 3 diapers (nappies) at the same time to hold the baby’s hips in the correct position.	You can also carry the baby with legs apart on your hips or back.

Some children with the conditions listed here are born with dislocated hips.

• Down syndrome
• spina bifida
• arthrogryposis
• cerebral palsy
• club feet

Therefore, it is essential to examine these children carefully a few days after birth, to make sure there are no dislocations.

Many (but not all) dislocated hips can be corrected in the ways we described in "Hip Problems". Keeping the legs wide apart during the first months of the child’s life helps to improve the shape of the socket.

Dislocated hips with other orthopedic conditions

CAST

bottle to catch urine

BRACE

The stick here helps to keep the legs apart.

If it is difficult to keep the legs apart, you may need to use casts or make special braces.

The casts should be used for 2 to 4 months or longer, depending on the child’s age (longer for older children) and the amount of the deformity. (Use a cloth or bottle to catch the baby’s pee, so it does not run inside the cast.)

Not all dislocations can be corrected in these ways. Some need surgery, and in some cases the dislocation cannot be corrected due to the other condition, even with surgery.

With spina bifida, if one hip is dislocated, surgery may help. But if both hips are dislocated, hip surgery usually will not help the child to walk any better.

Dislocated hips can also occur after the child is born, either from an accident or as a complication of some other disability—especially polio (due to weakness in the muscles and cords that hold the hip joint together) or cerebral palsy (due to spasticity and contractures).	DISLOCATED HIP
		The spasticity and contracture of this muscle cause dislocation of the hip. legs crossed like scissors

THE TELESCOPE TEST

To find out if the hip is dislocated or can easily be pulled out of joint, place the child on his back.

Pull up on his knee, and then push it down, like this.

At the same time, feel his hip with your other hand, like this.

If the thigh bone moves in and out like a telescope, the hip is probably dislocated.

Dislocations that are complications of polio or cerebral palsy can seldom be corrected without surgery. But because polio involves the muscles and cerebral palsy affects the nervous system, the operations are not always successful, and the children who have the possibility of walking will walk in spite of the dislocated hips.

This page was updated:25 Nov 2024