CONGENITAL HIP DYSPLASIA

(developmental hip dislocation / congenital hip dislocation)-A condition of abnormal development of the hip, resulting in hip joint instability and potential dislocation of the thigh bone from the socket in the pelvis.

Cause: unknown Predisposing Factors: Ligamentous laxity-bec. Of Hormonal changes within the mother during pregnancy and is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the womb Intrauterine position - higher in infants born by caesarian and breech position births Genetic factor/ family history of the disorder more females affected than males- possibly because the hip are normally more flaring in females and possibly bec. Maternal hormone relaxin causes the pelvic ligaments to be more relaxed. greater chance of this hip abnormality in the first born compared to the second or third child Oligohydramnios/Low levels of amniotic fluid during pregnancy

Degree of Dislocation: 1.Subluxation/predislocation -incomplete dislocation -Most common; more difficult to detect -If untreated , it may result in complete dislocation 2. Congenital dislocation -refers to case in which there is an actual complete dislocation Occurs during interuterine life or result from untreated subluxation sometimes after birth

SIGNS OF CONGENITAL HIP DYSPLASIA

Different (asymmetric) leg positions

Reduced movement on the side of the body with the dislocation

Figure 3.3. The technique of performing the Barlow maneuver.

clicking sound when the baby's legs are moved apart Figure 3.2. The technique of eliciting Ortolani s sign

Shorter leg on the side with the dislocation

Uneven folds of thigh fat/asymmetry of skin folds

Common adult symptoms include: Pain in the groin region that radiates to the outer buttock or thigh Weakness in the leg Difficulty walking, possibly limping Loss or limitation in the joint's range of motion Feeling a grinding sensation in the joint Hearing a click or clunk sound Sensation of giving way, catching or locking

Diagnostic Procedure

X-ray films can be helpful in detecting abnormal findings of the hip joint. X rays may also be helpful in finding the proper positioning of the hip joint for treatments of casting

UltrasoundWhere the physical examination is positive, ultrasound assessment should be undertaken to assess the anatomical position of the cartilaginous femoral head relative to the acetabulum.

Treatment

Pavlik Harnessused on babies up to 6 months of age The harness places the femur in the socket at the correct angle and keeps the legs apart. A doctor will put the harness on in order to get the proper fit and will likely recommend that the baby wear it 24 hours a day for 6 to 12 weeks. success rate is 85 to 95 percent for infants under 6 months old.

Traction and CastTraction is the application of a force to stretch certain parts of the body in a specific direction. purpose :to stretch the soft tissues around the hip and to allow the femoral head to move back into the hip socket. used only when the Pavlik harness has been unsuccessful or when hip dysplasia has been diagnosed later than 6 months of age.

Surgery and Casting If the other methods are not successful if DDH is diagnosed after the age of 2 years, surgery may be required to put the hip back into place manually, also known as a "closed reduction".

Nursing management placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position Pavlik harness, which has straps that allow the baby to move about freely while holding the hip in place and preventing movements that would make the condition worse. ROM exercise to unaffected Tissue Meticulous skin care around the immobilized tissues Immobilization of hips in less than 60-degrees abduction per hip

Cast care instructions: Keep the cast clean and dry. Check for cracks or breaks in the cast. Rough edges can be padded to protect the skin from scratches. Do not scratch the skin under the cast by inserting objects inside the cast. Use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast. Do not put powders or lotion inside the cast. Cover the cast during feedings to prevent spills from entering the cast. Prevent small toys or objects from being put inside the cast. Elevate the cast above the level of the heart to decrease swelling. Do not use the abduction bar on the cast to lift or carry the baby.

Medical Management Anti-inflammatory diet anti-inflammatory medications Ice Physical therapy, massage and bodywork

Surgical Management redirects or salvages bone in order to preserve the natural joint for as long as possible total hip replacement (THR), replaces the entire joint and is used in cases of severe pain, considerably compromised mobility and cartilage that is so worn that replacement is necessary Children Osteotomies open reduction

Hip Replacement considered when pain from osteoarthritis, caused by the normal aging process, drastically affects quality of life. Hip dysplasia can speed up this wear on the cartilage, making a total hip replacement (THR)

Nursing Diagnosis: Deficient parental knowledge related to splint, halter,or cast correction for hip dysplasia as evidenced by inaccurate follow-through of instruction.