Hip dislocation ( Developmental Hip Dysplasia)

In DDH, the harmonious relationship of the socket (acetabulum) that forms the hip joint and the femoral head that fills it is disrupted. As a result, developmental disorders occur in the hip joint. Depending on the severity of the deterioration of the harmony between the two structures, a range of disorders can be seen in the hip joint, ranging from mild joint developmental delay to a completely dislocated joint.

It is more common in girls, babies with a family history of hip dislocation, and after breech births. Since it can be seen together with different orthopedic problems (congenital clubfoot (PEV), metatarsus adductus, scoliosis, torticollis, etc.), more careful evaluation should be made in babies with such problems.

DDH is an orthopedic problem for which early diagnosis is very important. In patients with early diagnosis, treatment is easier and treatment results are more satisfactory.

In this regard, it is very important for all families to comply with the DDH screening program carried out by the Ministry of Health.

Completing ultrasound scanning in the first 2 months of life is very important, especially in infants with risk factors for DDH.

In patients who are not diagnosed and treated early;

• Disruption
• Limitation of movement
• Hip pain
• Hip calcification
is likely to be seen.

The most commonly used methods in diagnosis are ultrasound and direct radiographs. Ultrasound evaluation of the hip in the first 6 months of life is very helpful in diagnosing DDH and planning the treatment. After six months, direct radiographs are sufficient.

Treatment

One of the main criteria that determines the path to be followed in the treatment of DDH is the age at which the child was diagnosed. While treatments that do not require the application of a body cast, such as a Pavlik bandage/abduction orthosis, usually give successful results in children younger than 6 months, older children may need to replace the hip joint with closed or open methods and apply a body cast. Placing the joint in place with the closed or open method and applying a plaster are procedures performed under operating room conditions and under general anesthesia.

Pavlik Bandage Treatment

Developed by an orthopedic doctor named Arnold Pavlik (1902-1962), this bandage is particularly effective in the treatment of DDH in infants younger than 6 months. Studies have shown that its effectiveness is even higher in infants younger than 3 months. Therefore, diagnosis of DDH and initiation of treatment in the first 3 months of life increase the chances of success.

It is very important that the Pavlik bandage is applied to the patient by an orthopedic doctor who has been trained in this subject and that the patient’s family obeys the doctor’s warnings. The most basic features that will determine the effectiveness of the applied bandage are the correct application of the bandage by the doctor and the patient’s family strictly complying with the doctor’s recommendations. Improperly applied bandage or non-compliance with the family’s recommendations may result in treatment failure as well as damage to the child’s hip.

How long the Pavlik bandage treatment will continue is one of the most frequently asked questions by families. There is no clear answer to this question. This period varies in each patient, depending on the severity of the hip problem in the baby and the speed of the hip returning to normal. The patient should be followed up regularly by the doctor applying the Pavlik bandage, and the duration of the treatment should be decided by evaluating the baby’s hip with ultrasound. This period can vary between 3 weeks and 3 months.

Closed/Open Treatments

The replacement of the hip joint in babies older than 6 months is performed with closed or open methods under anesthesia. Although open methods usually come to the fore after one year of age, open surgery may be required for every hip joint that cannot be replaced with a closed procedure, regardless of age.

Whether the hip joint is closed or not is decided in the operating room while the baby is under anesthesia. There are different radiological evaluation methods applied for this and it is the responsibility of the doctor who performs the procedure to make this decision. If the closed procedure is judged to be unsuccessful, open surgical procedures will be required. In order to replace the hip joint with open methods, it is necessary to reach the hip joint by making a skin incision in the front of the hip or in the groin area.

Body plaster should be applied to the baby so that the hip joint, which is placed in its place by applying closed or open methods, does not move after the procedure. This plaster extends from the child’s breast level to both ankles and is applied under anesthesia. The plaster period is usually 3 months.

Late Treatments

Treatments applied in children older than 16-18 months can be called late treatments. In the treatments performed during this period, it is recommended to correct the bone structure disorders that occur. These surgeries include pelvic osteotomies applied to correct the growth retardation of the socket in the pelvis (acetabulum); There are thigh bone surgeries (femoral osteotomies/femoral shortening) applied to correct the deformity of the thigh bone. While it is possible to decide on some of these surgeries before the surgery, some of them need to be decided during the surgery and this decision is the responsibility of the physician performing the surgery.