- Newborn to 3 months of life
- Between 3 months to 1 year or when you start walking
- After the child starts walking
- Complications of dysplasia
- Signs of improvement and worsening
Treatment for congenital hip dysplasia can be done using a type of brace, using a cast from the chest to the feet or surgery and should be guided by a pediatrician or orthopedist with experience in child treatment.
When dysplasia is discovered soon after birth, initially the treatment of choice is the use of a brace that can be maintained for 3 or 6 months, but if the discovery is made later, the orthopedist may choose another treatment such as positioning the femoral head within the joint through a specific maneuver, followed by the placement of plaster. In the latter case, the doctor may recommend hip surgery, but this is always the last option, because several surgeries may be necessary throughout life.
Congenital hip dysplasia is curable and the sooner it is diagnosed and treated the faster the cure can be achieved. This alteration is also known as congenital hip dislocation and the forms of treatment for dysplasia are described below, according to the age at which it is discovered:
When dysplasia is discovered shortly after birth, treatment should be performed as soon as the change is discovered and the first choice is the Pavlik brace that attaches to the baby's legs and chest. With this harness the baby's leg is always folded and open, but this position is ideal for the fossa of the acetabulum and the head of the femur to develop normally. This treatment cures about 96% of cases of dysplasia.
After 2 to 3 weeks of placing this brace, the baby should be reexamined so that the doctor can see if the joint is properly positioned. If not, the brace is removed and plaster is placed, but if the joint is properly positioned, the brace must be maintained until the child no longer has a change in the hip, which can happen in 1 month or even 6 months.
These suspenders must be maintained throughout the day and all night, and can be removed only to bathe the baby and must be put on again immediately afterwards.
The use of Pavlik braces does not cause any pain and the baby gets used to it in a few days, so it is not necessary to remove the brace if you think the baby is angry or crying because of it because it is unlikely to be true.
Failure to respect the doctor's guidance and remove the brace can have serious consequences such as the permanence of the injury and the need for surgery.
When dysplasia is only discovered when the baby is more than 3 months old and has congenital dysplasia, it can be treated with manual placement of the joint in place by the orthopedist and with the use of plaster immediately afterwards to maintain the correct positioning of the joint.
The plaster must be kept for 2 to 3 months and then it is necessary to use another device such as Milgram for another 2 to 3 months. After this period, the child must be re-evaluated to verify that the development is happening correctly. If not, the doctor may recommend surgery.
When the diagnosis is made later, after the child has started to walk, the treatment can be done with reduction or surgery that can be pelvic osteotomy or total hip arthroplasty. The use of plaster and Pavlik braces is not effective after 1 year of age and is therefore no longer used, but in the past the child could be cast in 1 year before being subjected to surgery, but there was still no guarantee that the dislocation would be completely reversed.
The diagnosis after that age is late and what draws the parents' attention is that the child is limping, walking only at the fingertips or does not like to use one of the legs. Confirmation is made by X-ray, magnetic resonance or ultrasonography that show changes in the positioning of the femur in the hip.
Find out the care that should be taken after a total hip arthroplasty and how physiotherapy can be done by clicking here.
Complications of dysplasia
When dysplasia is discovered late, months or years after birth, there is a risk of complications and the most common is that one leg is shorter than the other, which causes the person to always hobble, making it necessary to wear shoes made tailored to try to adjust the height of both legs.
In addition, the person may develop osteoarthritis of the hip in youth, scoliosis in the spine and suffer with pain in the legs, hip and back, in addition to having to walk with the aid of crutches, requiring physiotherapy for long periods.
Signs of improvement and worsening
The best way to verify that the treatment is being carried out correctly and that it is having an effect is through imaging exams such as X-rays and ultrasound that may indicate the normalization of the hip fitting. The exams must be performed periodically and always viewed and compared with previous exams.
