Treatment | Hip dislocation in the baby

Treatment

Acute treatment of hip luxation in babies involves rapid reduction, i.e. repositioning of the hip. Initially, this treatment is attempted in a conservative manner, in which the femoral head is pressed back into the acetabulum by means of certain maneuvers under anesthesia and in the baby’s paralyzed musculature. If this does not succeed, surgery may be necessary.

In the long term, treatment of the hip dysplasia should then follow. The aim of this treatment is to eliminate the cause of the hip dislocation in the baby. The growth of the malformed acetabulum, which is the roofing of the femoral head and thus provides stability, can be promoted and controlled in such a way that a physiological function in the joint is achieved again.

Here, too, a decision must be made between conservative treatment and surgery. In mild cases, it is sufficient to adjust the leg with wraps and bandages so that the leg is slightly bent and spread out in the hip joint. In this position the leg is held for about 6 weeks, which stimulates the growth of cartilage and bone in the baby above the femoral head.

In more severe cases, spreader pants or orthoses are indicated, which must be worn slightly longer for up to 3 months. In some cases, a cast must be put on the baby, and as a last option, surgery is available to correct the conditions at the joint. In addition to bandages and orthoses, a plaster cast is available as an option when treating hip luxation in babies.

The plaster is usually used when a reduced hip luxation is followed by significant instability in the baby’s hip joint and a further hip luxation cannot be satisfactorily prevented by bandages, diapers or splints.Any further popping out of the femoral head in the baby would further damage the joint and delay healing, which can be effectively prevented by a cast. In this form of treatment, the cast is also applied in such a way that the leg is slightly bent at the hip and spread outwards, depending on the extent of the dysplasia. In this position, there is again sufficient contact between the femoral head and the acetabulum to promote the growth of the joint in the baby to physiological conditions.

The cast is applied over a period of 4-12 weeks. It is of course important to check the cast regularly to ensure that it is in the correct position and that no vessels or nerves are squeezed out of the baby by a cast that is too tight. The progress of the treatment should also be checked regularly by ultrasound examinations.

In most cases a hip luxation in the baby is well treated by conservative treatment, so that satisfactory results can be expected within the first year of life. In some cases, however, the extent of hip luxation or dysplasia and thus the risk of permanent hip luxation in the baby is greater or was detected too late. In this case, the possibility of surgery must be considered.

There are several methods to treat this malposition with surgery. An acute hip luxation in a baby requires surgery if manual reduction is not possible. This may be the case if, for example, obstacles such as bone splinters or tendons in the joint space prevent the hip from sliding back.

This open reduction by means of surgery only rarely needs to be used. A long-term treatment for hip luxation in babies with surgery consists of reshaping the bones involved in the hip in such a way that there is sufficient “roofing” of the femoral head by the acetabulum. Procedures for this are the intertrochanteric varus osteotomy, the osteotomy according to Salter or the triple osteotomy according to Tönnis, which is used in older patients. In principle, all procedures have in common that by inserting or removing pieces of bone at the hip above the joint, the joint roof becomes flatter and thus better embraces the femoral head. This provides better stability and the femoral head no longer slides out of the joint.