Congenital hip dislocation causes symptoms complications and is it dangerous

Developmental dysplasia of the hip (DDH), also known as congenital hip dislocation, is one of the conditions that can worry any mother from the moment it is detected. This is because it is directly related to a child’s movement, normal growth, and future ability to walk properly.Although the name may sound alarming, the reality is that this condition has different degrees of severity, and in many cases it can be completely treated if it is detected early and managed correctly. The main challenge is that symptoms are often mild or not clearly noticeable during the first months of life, which makes early diagnosis extremely important.With advances in modern medicine, effective treatment options are now available, including the use of braces or harnesses in mild cases, and surgical intervention in more severe cases depending on the child’s age and the severity of the condition. In most cases, the outcomes are very reassuring when treatment is started early. we will explore all the important details about congenital hip dislocation, including its causes, symptoms that parents should watch for, possible complications, and when the condition becomes serious enough to require urgent medical intervention.

What is developmental dysplasia of the hip (DDH) surgery?
Developmental dysplasia of the hip (commonly known as congenital hip dislocation) surgery is a surgical procedure aimed at placing the head of the femur back into its normal position inside the hip socket. It is used to treat instability or complete dislocation of the hip joint in children.

The operation usually takes between 1.5 to 3 hours. In many cases, the success rate can reach around 90%, especially when the condition is diagnosed and treated early. After surgery, the child can usually start walking within 4 to 6 weeks, depending on the rehabilitation program and adherence to physical therapy.

Is congenital hip dislocation dangerous?

Yes, it can be serious if left untreated or diagnosed late, or if the child is not properly followed up by a specialist.

Possible complications include:

Severe hip joint pain
Difficulty or delay in walking
Unequal leg length

How can you tell if a child has hip dislocation?

Some signs that may indicate a hip problem include:

Unequal leg length
Difficulty or resistance when changing diapers
A “clicking” or popping sound when moving the hip
Reduced movement in one leg compared to the other

Can congenital hip dislocation be cured?

Yes, it can be treated successfully, especially when detected early and managed promptly.

Medical studies show that the recovery rate can exceed 90% when the condition is diagnosed early, particularly in newborns up to 6 months of age, when treatment is most effective and simpler.

Does the child feel pain during the surgery?

No, the child does not feel any pain during the operation because it is performed under general anesthesia.

After surgery, pain is usually mild and can be controlled with appropriate pain medications prescribed by the doctor.

Does the child need a cast after surgery?

Yes, in most cases the hip joint needs to be stabilized after surgery using a cast known as a spica cast.

It is applied from the chest down to the legs and usually remains in place for 6 to 12 weeks, depending on the child’s condition and recovery progress.

When can the child walk after surgery?

The time varies depending on the severity of the condition and treatment plan, but generally:

In mild cases: walking may begin within 3 to 6 months
In more complex cases: it may take longer

Usually, the child starts walking gradually after the cast is removed, along with physical therapy sessions.

Can hip dislocation return after surgery?

Recurrence is rare if the condition is treated properly under careful medical supervision.

However, it may happen in some cases such as:

Movement or improper fitting of the cast
Missed follow-up appointments or poor adherence to medical instructions

Does the surgery affect the child’s growth?
No, the main goal of the surgery is to support the normal growth of the hip joint and improve its function.

However, regular follow-up with the doctor is very important to ensure that bone and joint development continues normally.

Why is surgery used instead of a brace?

A hip brace is usually used in the early stages of life when the joint is still flexible and can be corrected easily.

In late or fixed cases of dislocation, the brace is no longer effective, so surgery becomes the only option to return the joint to its normal position.

Can the surgery be delayed?

No, delaying the surgery is not recommended because it may lead to:

Increased difficulty in repositioning the joint
The need for more complex surgical procedures later
Reduced treatment success compared to early intervention

What is the difference between closed and open reduction?

Closed reduction:
The joint is repositioned without open surgery, under general anesthesia, using imaging guidance (like X-rays).
Open reduction:
A surgical incision is made to clean the joint, remove any obstacles, and place the femoral head back into its proper position.

The choice depends on the child’s condition and the severity of the dislocation.

Why is a cast applied after surgery?

A cast is used after surgery for several important reasons:

To keep the hip joint in the correct position
To prevent the dislocation from coming back
To help the bones grow and shape properly

How does the child sleep after surgery?

The child is usually advised to sleep on their back, with the legs fixed inside the cast according to the doctor’s instructions, to avoid pressure or accidental movement of the hip joint.

How to handle diaper changes while the cast is on?

Care must be taken when changing diapers:

Change the diaper from the sides without moving the legs
Avoid bending or straightening the legs inside the cast
Use larger-sized diapers for easier handling

Can there be a difference in leg length?

In some cases, a very slight difference in leg length may appear, but it is usually not noticeable.

With early diagnosis and regular medical follow-up, long-term effects on leg growth and walking can be minimized.

Degrees of developmental dysplasia of the hip (DDH)

Type I – Normal hip

The hip joint is completely normal
The femoral head is in the correct position
No abnormality in structure
✔️ No treatment is needed

Type II – Mild dysplasia (immature hip)

The joint is present but not fully developed
The hip socket (acetabulum) is shallow
Mild looseness in the joint may be present

Type III – Partial dislocation

The femoral head is partially out of place
Noticeable joint instability
Significant looseness in the joint
⚠️ Treatment is necessary at this stage and may include braces, casting, or medical intervention depending on the case

Type IV – Complete dislocation

The femoral head is completely outside the socket
The joint is not in its normal position
This is the most severe form
⚠️ Requires urgent treatment to prevent complications such as walking difficulties or delayed motor development

Causes of congenital hip dislocation

1. Pregnancy-related factors

Breech position (baby positioned feet or buttocks first)
Low amniotic fluid, limiting fetal movement
Uterine pressure (e.g., twin pregnancy or tight space in the womb)

2. Hormonal factors

During pregnancy, maternal hormones loosen ligaments in preparation for birth. In some cases, this may also affect the baby, increasing hip joint laxity and instability.

3. Post-birth factors

Incorrect swaddling (keeping legs straight for long periods)
Improper carrying positions that do not support natural hip flexion

4. Genetic factors

Family history increases the risk
Example: a parent or sibling with the same condition

5. Child-related factors

More common in females than males
More frequent in firstborn children
May be associated with higher birth weight
Sometimes linked with other minor congenital conditions (foot or spine issues)

Symptoms of congenital hip dislocation

Early symptoms (0–6 months)

At this stage, signs are often subtle and usually detected during medical examination:

1. Uneven skin folds

Asymmetry in thigh or buttock folds
One side may have more or deeper folds than the other
⚠️ This is only an indicator, not a definitive sign

2. Limited hip movement

Difficulty opening one leg outward
Noticeable resistance on one side compared to the other

3. Hip instability (clicking sound)

A mild “click” may be felt during examination
Indicates the femoral head slipping in and out of position
⚠️ This sign is usually detected by a doctor, not at home

4. Slight difference in leg length

One leg may appear slightly longer than the other.
This becomes more noticeable when the child is lying down with both legs extended.

5. Abnormal leg positioning

Difficulty opening one leg normally
The leg may turn inward or outward in an uneven way

Symptoms during crawling stage (6–12 months)

1. Delayed crawling or sitting

Noticeable delay compared to children of the same age
The child may rely more on one side than the other

2. Uneven use of legs

One leg is used more than the other during crawling
The child may avoid using the affected leg

3. Pelvic imbalance during movement

Tilting of the pelvis while moving
Lack of symmetry during crawling or sitting

Symptoms when starting to walk (after 1 year)

1. Limping while walking

The child walks with a limp on one side
Reduced weight-bearing on one leg

2. Unbalanced gait (waddling)

Side-to-side body sway while walking
Due to hip joint instability

3. Shortening of one leg

Clear difference in leg length
One side of the pelvis appears higher during walking

4. Asymmetry in hips or buttocks

Noticeable difference in pelvic level
One side may appear more elevated or lower than the other

Diagnosis of developmental dysplasia of the hip (DDH)

1. Clinical examination by a doctor

The physical exam is the first and most important step after birth or in early infancy:

1. Barlow test

The doctor gently tries to move the femoral head out of the socket.
If the joint is unstable, the bone may dislocate easily.
⚠️ This test helps detect early or unstable cases

2. Ortolani test

The doctor attempts to reposition the dislocated femoral head back into place.
A “click” sensation may be felt during repositioning, indicating instability or dislocation.
✔️ This is an important diagnostic sign

3. Hip movement assessment

Comparing movement in both legs
Checking for stiffness or limited abduction in one leg
The affected leg is usually less flexible

4. Body observation

Uneven skin folds in the thighs or buttocks
Slight difference in leg length
Asymmetry of the pelvis

2. Imaging tests

Ultrasound (sonography)

✔️ Best during early infancy (birth to 4–6 months)

Shows detailed hip joint structure
Identifies the position of the femoral head
Used for Graf classification
Safe and radiation-free

X-ray

✔️ Usually used after 4–6 months

Once bone ossification appears
Helps evaluate:
- Joint position
- Degree of dislocation
- Pelvic development

3. Determining the severity

After examination and imaging, the doctor classifies the condition as:

Normal hip
Mild dysplasia (immature hip)
Partial dislocation
Complete dislocation

Treatment is then chosen based on severity.

Treatment of DDH according to age

1. Infants under 6 months (early stage)

This is the easiest and most effective stage of treatment:

Use of a Pavlik harness, a special brace that keeps the hip in the correct position
Worn for several weeks or months under medical supervision
Success rate can exceed 90% when used early and correctly

2. Children 6–18 months

Used if early treatment fails or diagnosis is delayed:

Closed reduction under general anesthesia (no open surgery)
Followed by immobilization using a spica cast
Duration depends on the doctor’s evaluation

3. Advanced cases (after 18 months)

More complex cases requiring surgical intervention:

Open reduction surgery to reposition the femoral head
Possible bone reshaping of the pelvis or femur to improve stability
Post-surgery casting is used to maintain alignment

Comparison of treatment methods

Treatment method	Age group	Success rate	Advantages	Limitations
Pavlik harness	Birth – 6 months	90–95%	Non-surgical, easy use	Requires strict parental compliance
Closed reduction + cast	6–18 months	80–90%	Effective without open surgery	Requires general anesthesia and full cast
Open reduction surgery	After 18 months	70–85%	Treats advanced cases	Surgical with longer recovery
Physiotherapy	Throughout treatment	Supportive	Improves strength and mobility	Not a standalone treatment

Treatment of developmental dysplasia of the hip (DDH) using all surgical methods

1. Closed reduction

What is it?

It is a procedure used mostly for children between 6 months and 2 years old.
The femoral head is returned to its normal position inside the hip joint without open surgery, under general anesthesia.

Procedure steps:

Imaging (X-ray) is performed during the operation, and sometimes contrast dye is injected into the joint
The doctor carefully guides the femoral head back into place using controlled movements
Stability of the joint is checked to ensure proper positioning

After the procedure:

A spica cast is applied from the chest down to the legs
Immobilization usually lasts 6 to 12 weeks
⚠️ If the joint is unstable or blocked by soft tissue, open reduction is performed instead

2. Open reduction

What is it?

It is a surgical procedure used in delayed cases or when closed reduction fails.

Procedure steps:

A surgical incision is made in the hip area to access the joint
Tight tissues or fibrous structures that block the joint are removed
The femoral head is repositioned into the socket
The joint is checked for stability
The surgical wound is closed

After the procedure:

A spica cast is used for 6 to 12 weeks
Gradual physiotherapy begins after cast removal

3. Corrective bone surgeries (Osteotomies)

These surgeries are used when there are bone deformities or a shallow hip socket even after repositioning the joint.

1. Femoral osteotomy

Goal:

To improve the angle of the femur so it fits better with the hip joint.

Procedure:

A section of the femur is cut
The bone angle is corrected
Fixed using plates and screws

After surgery:

Casting or external fixation is applied
Gradual physiotherapy follows

2. Pelvic osteotomy

Goal:

To improve the shape of the hip socket so it better covers the femoral head.

Salter osteotomy:

Suitable for young children
A part of the pelvic bone is cut and repositioned
Fixed with metal plates

Pemberton osteotomy:

Deeper reshaping of the socket
Used in younger children
Often requires minimal fixation

Dega osteotomy:

Partial reshaping to improve femoral head coverage
Used in moderate cases

4. Pre-surgical traction

Goal:

Prepare the joint before surgery
Reduce muscle tightness around the hip

Method:

The legs are gently pulled using light weights
Continued for several days or weeks depending on the case

5. Arthroscopic surgery

Used in some advanced medical centers
Minimally invasive procedure
Helps evaluate the joint or remove minor obstacles
⚠️ It is not the primary treatment for DDH in young children

6. Post-operative casting

Almost all surgeries require immobilization using:

Spica cast:

Extends from the chest to the legs
Keeps the hips in the correct position
Usually worn for 6 to 12 weeks depending on the case

7. Physiotherapy after surgery

After cast removal, rehabilitation begins and includes:

Strengthening thigh and hip muscles
Improving joint range of motion
Gradual training for standing and walking
Regular follow-up with imaging to ensure joint stability

⏱️ Recovery time:

Mild cases: 2–3 months
Moderate cases: 3–6 months
Complex cases: may take longer depending on procedures

Treatment using a hip brace

Early treatment of DDH is often done using a hip brace, especially in infants under 6 months old. In older ages, treatment depends on severity.

The most common device is the Pavlik harness, which holds the hips in the correct position to keep the femoral head inside the socket.

Duration and follow-up:

Usually used for 6 to 12 weeks
Follow-up every 1–3 weeks
Ultrasound is used to monitor progress
Adjustments may be made during visits

In rare cases:

If the harness fails, the doctor may proceed with:

Closed reduction under anesthesia + casting
Open surgical reduction + casting

Tips to speed up recovery after DDH surgery

1. Strict adherence to immobilization

Do not move or adjust the cast
Keep it clean and dry
Watch for pressure or redness under the cast
⚠️ Improper handling may delay healing or cause recurrence

2. Proper positioning of the child

The child should usually lie on their back
Avoid pressure on the hip area
Use supportive pillows if needed
Avoid carrying the child in positions that strain the legs

3. Hygiene care (especially with a cast)

Keep the diaper area clean
Change diapers frequently and safely
Use protective creams if needed
Ensure no leakage under the cast

4. Proper nutrition

Regular breastfeeding or formula feeding
Age-appropriate calcium and vitamin D intake
Monitor normal growth and weight
Avoid malnutrition

5. Regular medical follow-up

Do not miss scheduled appointments
Perform imaging (X-ray/ultrasound) on time
Monitor hip development continuously
Report any unusual symptoms immediately

6. Avoid common mistakes

❌ Do not remove or adjust the cast at home
❌ Avoid herbal or non-medical treatments
❌ Do not encourage early standing or walking
❌ Do not ignore persistent crying or signs of discomfort