From the Guidelines
Hip dislocation in newborns, also known as developmental dysplasia of the hip (DDH), requires early detection and treatment for optimal outcomes, with creases in hips being one of the signs that aid in identification, alongside limited hip abduction, apparent leg length discrepancy, and a "clunk" sensation during physical examination with Barlow and Ortolani maneuvers. The signs of DDH include:
- Asymmetric skin folds on the thighs
- Limited hip abduction
- Apparent leg length discrepancy
- A "clunk" sensation during physical examination with Barlow and Ortolani maneuvers Diagnosis involves physical examination by pediatricians during well-baby visits, with ultrasound being the preferred imaging method for infants under 6 months and X-rays for older babies, as recommended by the American Academy of Pediatrics 1. Treatment depends on the age at diagnosis and severity, with the goal of promoting proper socket development and preventing long-term complications such as early arthritis, pain, and mobility issues. For newborns and infants under 6 months, a Pavlik harness is typically used for 6-12 weeks, keeping the hips in a flexed and abducted position to promote proper socket development, as supported by the American Academy of Orthopaedic Surgeons 1. The harness is worn 23 hours daily, with regular follow-up appointments to monitor progress. For older infants or those who don't respond to harness treatment, closed reduction under anesthesia followed by spica casting for 3-6 months may be necessary. In severe cases or for children diagnosed after walking age, surgical intervention might be required. Early treatment is crucial as it leads to better outcomes and reduces the need for invasive procedures, as highlighted by the most recent and highest quality study 1. Untreated DDH can lead to early arthritis, pain, and mobility issues later in life. Parents should ensure proper positioning during swaddling, avoiding tight wrapping that keeps the legs straight and together.
From the Research
Signs of Hip Dislocation in Newborns
- Creases in hips, also known as asymmetric skin folds, can be an indicator of hip dislocation in newborns, but their clinical significance is debated 2, 3, 4
- Other signs include gluteal asymmetry, limb-length discrepancy, limitation of hip abduction, and click/clunk of the hip 2
- The Barlow and Ortolani tests are used to examine for hip dislocation in newborns 5, 6
Diagnosis of Hip Dislocation in Newborns
- Early neonatal assessment for hip dislocation includes an examination using the Barlow and Ortolani tests 5
- Later examinations include assessment of gluteal folds, knee height, and the degree of hip abduction 5
- Radiographs, ultrasound scanning, hip arthrography, computed tomography, and magnetic resonance imaging can be helpful in making the diagnosis 6
- The presence of asymmetric skin folds in the medial thigh is often used as a screening item, but its clinical relevance is limited 2, 4
Treatment of Hip Dislocation in Newborns
- The preferred treatment is the use of the Pavlik harness, an outpatient treatment regime that provides effective reduction in 90 percent of the cases 5
- 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 5
- If the 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 5
- Open reduction and recasting are also options, and in rare cases, total hip replacement is necessary in later life 5