Materiały źródłowe

• #1 Developmental Dysplasia of the Hip | Columbia Orthopedic Surgery

  https://www.columbiaortho.org/patient-care/specialties/pediatric-orthopedics/conditions-treatments/developmental-dysplasia-hip

  Developmental dysplasia of the hip, or DDH, is a musculoskeletal condition in children in which the bones of the hip joint, which is a ball-and-socket joint, do not form or grow together properly. […] If untreated, the joint may become dislocated, in which the ball sits completely outside of the socket. […] There are usually no major symptoms of DDH, because it is often detected in infants soon after birth and treated without complications. […] DDH is generally completely painless in children. […] Approximately 1 out of every 100 children is born with DDH (in some form), and around 1 out of 1000 children has a dislocated hip at birth. […] The incidence of the DDH is higher than normal for children with the following characteristics, known as risk factors: First-born children, Positive family history, Female sex, Premature birth, Breech position, Oligohydramnios at the time of labor, Children born with specific other musculoskeletal conditions.

• #2 Hip Dysplasia | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/hip-center/conditions-treated/hip-dysplasia/

  Hip dysplasia can occur before or after birth and affects one or both hips. Approximately 1 in 1,000 babies in the U.S. are born with the condition each year. […] The goal of treatment for hip dysplasia in babies is to get the ball of the hip in the socket and keep it there, so the joint can grow normally. Treatment is typically provided by a pediatric orthopedic surgeon and can vary based on the severity of the condition and other factors, including age. Treatment options include bracing, closed reduction and casting, or an open reduction (surgery) and casting. […] Bracing is the most common treatment method for babies younger than 6 months. It involves using a brace called a Pavlik harness that pulls the baby’s legs into a position that guides the ball of the hip joint into the socket. Treatment generally takes 6 to 12 weeks, with checkups and ultrasounds every 1 to 3 weeks to ensure progress and adjust the harness as needed. The harness is often enough to correct the dislocation without further treatment.

• #3 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Congenital Hip Dysplasia Nursing Care Plans and Nursing Diagnosis […] In this nursing care plan guide for congenital hip dysplasia nursing diagnosis, well discuss the interventions, and management for this condition. Learn about interventions like orthopedic devices, physical therapy, and patient education that can improve hip development and manage symptoms such as pain and mobility issues. […] Nursing care planning goals for a child with congenital hip dysplasia include improving physical mobility, providing appropriate family and social support, providing patient and family education on self-care and safety, and avoiding complications (e.g., compartment syndrome and hip dislocation). […] The following are the nursing priorities for patients with congenital hip dysplasia: […] Promote optimal hip development and stability

• #4 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  A Patient’s Guide to Developmental Dysplasia of the Hip in Children […] Introduction […] Developmental dysplasia of the hip (DDH), previously known as congenital hip dysplasia is a common disorder affecting infants and young children. The change in name reflects the fact that DDH is a developmental process that occurs over time. It develops either in utero (in the uterus) or during the first year of life. It may or may not be present at birth. […] In this condition there is a disruption in the normal relationship between the head of the femur and the acetabulum (hip socket). DDH can affect one or both hips. It can be mild to severe. In mild cases called unstable hip dysplasia the hip is in the joint but easily dislocated. More involved cases are partially dislocated or completely dislocated. A partial dislocation is called subluxation.

• #5 Hip Dysplasia | Dayton Children’s Hospital

  https://www.childrensdayton.org/patients-visitors/services/orthopedics/conditions-we-treat/hip-dysplasia

  Developmental dysplasia of the hip (DDH) is a problem with the way a baby’s hip joint forms. […] Treatment depends on the child’s age and the severity of the condition. It focuses on keeping the ball in the right spot in the socket so that the hip joint can develop normally. […] Infants up to six months of age are placed in a soft brace called a Pavlik Harness. This harness allows the baby to move his or her legs while keeping the hip joint properly aligned. […] In some cases, a hard cast may be used. If these methods are not successful or if the child is diagnosed at a later age, surgery followed by casting may be required to realign the hip joint. […] An early diagnosis of DDH yields good long-term outcomes for the child. When found early and treated, children will develop a normal hip joint. However, if DDH is diagnosed later in life or if left untreated, it can lead to pain, a difference in leg lengths and arthritis in early adulthood.

• #6 Hip Dysplasia (DDH): Symptoms, Testing and Treatment

  https://www.nationwidechildrens.org/conditions/hip-dysplasia

  Ideally, DDH is detected by routine history and physical exam in the neonatal period. […] Clinical screening is the gold standard for diagnosis with dynamic hip examinations carried out at birth and at subsequent pediatrician visits throughout childhood. […] The Ortolani test and Barlow maneuver should be done at each exam. […] With an unstable, Ortolani positive hip, early treatment is required. […] Reduced hips are positioned in flexion and mild abduction to stimulate normal joint development, most commonly performed via the Pavlik harness, a dynamic brace which positions the thighs to allow and maintain hip reduction. […] Infants are followed bi-weekly for strap adjustment. […] Progress is monitored and reduction verified with subsequent US evaluations. […] Pavlik treatment continues until US parameters have normalized and the hip stabilized on exam, on average 2-3 months later. […] Follow-up through skeletal maturity is then emphasized. […] Treatment success depends on the child’s age and the success of repositioning. […] Many cases treated in the first 6 months of life with a Pavlik harness recover and develop normally with no long-term problems.

• #7 Hip dysplasia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hip-dysplasia/symptoms-causes/syc-20350209

  Healthcare professionals will check your baby for signs of hip dysplasia shortly after birth and during well-baby visits. […] If hip dysplasia is diagnosed in early infancy, a soft brace can usually correct the problem. […] In older children and young adults, surgery may be needed to move the bones into the proper positions for smooth joint movement. […] Hip dysplasia care at Mayo Clinic.

• #8 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Teach parents and the child to utilize devices or aids for mobility and ADL. Helps the safe use of aids and equipment and increased protection. […] Children with congenital hip dysplasia who do not receive proper treatment for their condition, or whose treatment is incorrect, may be at risk for hip dislocation or other hip injuries. This can lead to long-term complications and impaired physical mobility, which can have a significant impact on their overall quality of life. […] Assess infants up to 2 months of age for frank breech birth, cesarean birth, hipjoint laxity or dislocation (Ortolani or Barlow test), degree of dysplasia or dislocation, shortened limb on the affected side (telescoping), broadened perineum, asymmetry of the thigh and gluteal folds with an increased number of folds, and flattened buttocks. Provides information about the presence and degree of dysplasia; may be preluxation, subluxation, or dislocation (luxation) and involve a laxity of the capsule or an abnormal acetabulum; identification of the presence of the deformity at this age results in the highest success rate in complete correction.

• #9 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  Special tests are performed by the doctor while the infant is still in the nursery, The doctor is trying to look for signs of an unstable hip. The two most reliable physical exam tests are Ortolani’s maneuver and Barlow’s test. These tests are designed to detect if the hip is sliding in and out of the acetabulum. To perform these tests, the doctor places the infant on a table in a supine position (on his or her back). The doctor then abducts the hips by moving the bent hips and knees apart. If the hip feels like it can be pushed out the back of the socket, this is considered abnormal. This is called a positive Barlow’s Test and is a sign of instability in the hip. As the hip is abducted further, the doctor might feel the ball portion (the femoral head) slide forward as it slips back into the socket. This is called a positive Ortolani Maneuver and is also a sign of hip instability. If either one of these tests are positive, the child will be watched closely or immediate treatment with a brace may be considered.

• #10 Developmental dysplasia of the hip in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/developmental-dysplasia-of-the-hip-in-neonates

  The longer the hip is left in abnormal position the more the anatomy changes, developing abnormalities of the proximal femur and acetabulum. After 18 months, both bones may need surgical correction to provide joint congruity and stability. […] Since DDH can develop over time, all infants (both high and low risk) with normal newborn examinations should have their hips regularly re-examined during the first year of life. […] High-risk infants in whom examination is normal should have ultrasonography performed at about six to 12 weeks after birth or at six to eight weeks corrected age if born prematurely. […] There is no 'gold standard’ diagnostic test for DDH. The Ortolani and Barlow tests are widely used for screening. […] X-rays are unhelpful in assessment at birth as the femoral head is cartilaginous until six months of age.

• #11 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  For the infant three months or older, Galeazzi’s or Allis’ test can be performed. The child is placed in the supine position with the hips and knees bent and the feet flat. The examiner looks for any unevenness between the knees. If one knee is lower than the other, there may be a dislocated hip on the lower side. […] Since DDH can develop over time, repeated exams are advised. Well-baby check-ups should include repeated hip examination. This is done until the child begins to walk normally with no sign of a limp or altered gait (walking) pattern. The doctor also looks for changes in hip range of motion, uneven skin folds around the thighs and buttocks, and a difference in leg length from side to side. […] Treatment […] What treatment options are available? […] The goal of treatment is to keep the femoral head in good contact with the acetabulum. A stable hip encourages the development of a normally shaped socket and rounded head of the femur. The proper hip position must be maintained for enough time to stabilize the joint. The hip should be flexed to 95 degrees and abducted (apart) at least 90 degrees. This position keeps the ball (the femoral head) in the best position and allows the ligaments and joint capsule to tighten up.

• #12

  https://www.shrinerschildrens.org/en/news-and-media/news/2021/12/displasia-de-cadera-causas-y-tratamiento

  Hip dysplasia can be detected with an ultrasound before the age of 3 months, or with an X-ray after that age. […] If hip dysplasia is detected before the age of 6 months, it is possible to proceed with a conservative treatment that does not require surgery. Currently, the most-used treatment is the Pavlik harness, which helps keep children’s legs open, which in turn helps the hip socket to enter into its place. In this case, a follow-up with ultrasound and X-rays is necessary. […] When the patient has had to undergo surgery, he/she must be immobilized for six to 12 weeks, after which a rehabilitation process is required that can last from two to six months. In some cases, a second operation is required. […] In the event of any suspicion, it is necessary to take an X-ray and prevent the condition from progressing, since these are pathologies that require follow-up for the rest of the patient’s life if surgery is performed.

• #13 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  An operation called derotational osteotomy may be needed. In this surgical procedure, the femur is cut and rotated to make it easier to keep the femoral head inside the acetabulum. When this procedure is done, the soft tissues loosen up and the forces of the muscles tend to keep the femoral head reduced. Once again, the child is put in a spica cast for several months while the bone heals. A CT scan may be used to confirm successful reduction before removing the cast. A CT scan is a special type of x-ray that takes slices of the body. This allows a much better picture of the hip and acetabulum than plain x-rays. […] In children older than 18 months, the problem may require additional surgery to change the acetabulum (socket) in addition to the femur (thighbone). The problem has been present longer and the anatomy has grown more distorted over the longer period of time. Your doctor may recommend surgery to change the way that the acetabulum is aligned in this situation. There are many different types of pelvic osteotomies that have been designed and are still used.

• #14 Developmental dysplasia of the hip in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/developmental-dysplasia-of-the-hip-in-neonates

  Ultrasound examination of the hips has been advocated by some as the most effective method of screening for DDH. Although very sensitive as a screening tool, it has low specificity, is expensive and is operator dependent. For this reason, the American Academy of Paediatrics considers it an adjunct to clinical examination. […] There is no evidence to support the use of double or triple nappies until definitive treatment is instituted.

• #15 Nurses assessment of development hip dysplasia: A scoping review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35670703/

  Developmental hip dysplasia is an abnormality of the hip joint which is associated with an unstable or dislocatable hip. During infancy, hips should be screened to determine whether they are stable, unstable or dislocated. In Australia, this screening is often performed by nurses using physical assessment. Physical examination includes a number of assessments which seek to identify underlying abnormalities in hip joint anatomy and function. This scoping review outlines the physical assessments used by nurses in the screening and surveillance of developmental hip dysplasia. […] There were 18 physical assessments identified as being used by nurses in the screening process for developmental hip dysplasia. However, it is apparent that high quality research is required to examine the timing, specificity and sensitivity of the physical assessments identified.

• #16 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Assess muscle mass, strength, tone; ability to move, and activity level in performing ADL. Provides data about the condition and function of the musculoskeletal system. […] Assess the sensory and motor function of extremities; the presence of surgical correction of musculoskeletal abnormalities. Provides data about conditions or treatments that affect mobility. […] Assess activity restrictions, bed rest status, and imposed immobility by braces, casts, traction, and splints. Keep rest during acute stages to promote healing and restoration of health. […] Allow all age-appropriate activities that promote mobility, and encourage the infant to crawl. Facilitates mobility based on the constraints of illness and provides an opportunity to vent frustration due to imposed immobility. […] Discourage activity restrictions unless ordered; allow and assist if possible in performing daily activities; administer pain medication prior to the activity. Supports mobility and activity compatible with health and life; allows for independence and control for normal development.

• #17 AI aided workflow for hip dysplasia screening using ultrasound in primary care clinics | Scientific Reports

  https://www.nature.com/articles/s41598-023-35603-9

  Developmental dysplasia of the hip (DDH) is a common cause of premature osteoarthritis. […] The purpose of our study was to evaluate the feasibility of having non-expert primary care clinic staff perform DDH ultrasound using handheld ultrasound with artificial intelligence (AI) decision support. […] Initial scans were done by nurses or family physicians in 3 primary care clinics, trained by video, powerpoint slides and brief in-person. […] Real-time AI decision support and a simplified portable ultrasound protocol enabled lightly trained primary care clinic staff to perform hip dysplasia screening with FU and case detection rates similar to costly formal ultrasound screening, where the US scan is performed by a sonographer and interpreted by a radiologist/orthopedic surgeon. […] We found that DDH screening at primary-care clinics, performed by clinic staff using automated AI diagnosis from images obtained by handheld portable ultrasound, was feasible when integrated with routine well-baby visits, whether performed by RN, LPN or physicians.

• #18 AI aided workflow for hip dysplasia screening using ultrasound in primary care clinics | Scientific Reports

  https://www.nature.com/articles/s41598-023-35603-9

  Our recall rate to internal FU and our DDH treatment rate, 14% and 2% respectively, are similar to the 17% and 3% observed in the 'general screening’ arm in a well-known Norwegian study of~12,000 neonates using conventional DDH ultrasound performed by expert physician. […] Crucially, we note that 4/6 infants we detected with DDH had no risk factors and may not have been detected at all without our screening program. […] Our study had limitations. This was a small pilot study. […] Overall, we found that an AI app evaluating cine-sweep hip ultrasound enabled primary-care clinic staff with only brief training to routinely perform DDH screening with recall and detection rates similar to conventional ultrasound applied by highly-trained expert users in a tertiary-hospital setting. […] Integrating AI decision support with point-of-care ultrasound offers a practical approach to population screening for DDH that has the potential to shift the cost-benefit balance in favor of universal US screening and may be a model for other uses of ultrasound with AI decision support in primary care.

• #19 Developmental dysplasia of the hip (DDH) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/developmental-dysplasia-hip-ddh

  Developmental dysplasia of the hip (DDH or hip dysplasia) is a relatively common condition in the developing hip joint. It occurs once in every 1,000 live births. The hip joint is made up of a ball (femur) and socket (acetabulum) joint. In DDH, this joint may be unstable with the ball slipping in and out of the socket. […] The goal of treatment is to put the femoral head back into the socket of the hip and to deepen the socket so that the hip can develop normally. Treatment options vary for babies and may include: […] The Pavlik harness is used on babies up to 6 months of age to guide the hip into place, while allowing the legs to move to some extent. The harness is put on by your baby’s physician and is usually worn full time for several weeks, then part-time for an additional number of weeks.

• #20 Hip dysplasia treatment – Louisville | Norton Children’s

  https://nortonchildrens.com/services/orthopedics/conditions/hip/hip-dysplasia/

  How to Care for Hip Dysplasia […] If your child has hip dysplasia, our providers can work with you to come up with a treatment plan that will support your child every step of the way. The treatment goal is to put the head back into the socket of the hip and to make sure the socket is deep, so the hip can develop normally. […] Treatment plans will be based on: […] Treatment options may include: […] Pavlik harness (for babies up to 6 months old) […] Abduction brace (6 months old and older) […] Body casting, also called spina casting […] Surgery, such as VDRO or Salter pelvic osteotomy.

• #21 Hip dysplasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hip-dysplasia/diagnosis-treatment/drc-20350214

  Our caring team of Mayo Clinic experts can help you with your hip dysplasia-related health concerns […] Hip dysplasia treatment depends on the age of the affected person and the extent of the hip damage. Infants are usually treated with a soft brace, such as a Pavlik harness, that holds the ball portion of the joint firmly in its socket for several months. This helps the socket mold to the shape of the ball. […] The brace doesn’t work as well for babies older than 6 months. Instead, the healthcare professional may move the bones into the proper position and then hold them there for several months with a full-body cast. Sometimes surgery is needed to fit the joint together properly. […] If the dysplasia is more serious, the position of the hip socket also can be corrected. In a periacetabular (per-e-as-uh-TAB-yoo-lur) osteotomy, the socket is repositioned in the pelvis so that it matches up better with the ball. […] Hip replacement surgery might be an option for older people whose dysplasia has severely damaged their hips over time, resulting in debilitating arthritis.

• #22 Hip Dysplasia

  https://www.massgeneral.org/orthopaedics/children/conditions-and-treatments/hip-dysplasia

  Developmental dysplasia of the hip is an abnormal formation of the hip joint in which the ball at the top of the thighbone (femoral head) is not stable in the socket (acetabulum). […] Once the diagnosis if DDH has been made, the treatment will depend on the age of the child and the degree of instability. […] If the ultrasound shows that the hip is subluxating, dislocated, or that the acetabulum is shallow (decreased femoral head coverage), the initial treatment may consist of a Pavlik harness. The Pavlik harness is often used as the initial treatment of hip dysplasia in infants. […] The Pavlik harness is successful in approximately 90-95% of infants with hip dysplasia. […] The Pavlik harness will initially be adjusted at frequent intervals. […] If there is no improvement in the hip dysplasia with the Pavlik harness, the baby will most likely require a closed reduction and spica casting in the operating room. […] If the hip dysplasia cannot be corrected with the Pavlik harness or closed reduction and casting, it may be necessary to proceed with open reduction and spica casting. […] Generally follow-up appointments occur at 6 months, 12 months, 2 years and 4-5 years.

• #23 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Apply the Pavlik harness splinting device to infants up to 6 months of age to be worn continuously for 3 to 6 months to ensure hip stability; apply double or triple diapers or a Frejka pillow if this is treatment ordered. Maintains abducted, reduced position for maintaining the femur in the acetabulum; other options to correct unstable hip may be applied to stretch legs and keep abducted position depending on the extent of the deformity. […] Provide instruction on spica cast care including support of cast when moving, removing crumbs and small articles that may get into the cast, petal cast edges, avoiding the insertion of anything into cast to scratch, cleaning cast when needed, allowing to dry completely, protect cast from soiling and dampness from elimination or bathing; neurologic and circulatory assessment every 2 hours for color, warmth, sensation, peripheral pulse, capillary refill; nausea and vomiting resulting from cast syndrome. Maintains safe, effective immobilization to guarantee the permanent stability of the hip with the childs response to cast monitored for the cast syndrome as a result of tight spica cast compressing the superior mesenteric artery of the duodenum.

• #24 Developmental Dysplasia of the Hip (DDH) | Hip Dysplasia in Babies | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/hip-dysplasia/

  The main treatment for infants less than six months old is the Pavlik Harness. The harness is a nonsurgical treatment which allows for motion while treating the located hip. […] Another nonsurgical option is the Hip Abduction Orthosis (or brace). This is sometimes used if the Pavlik Harness does not stabilize the hip. Treatment is generally used either full or most of the time for a few months. Repeating clinical examinations and ultrasounds monitor the progress. The harness or brace maintains the hip in the correct position for stability. Surgical treatment options begin if there is no improvement after wearing the harness or brace. […] Management in the hospitalized patient includes stabilization from anesthesia, care and comfort, pain control, safe feeding and care giver education. The surgeon, nurse, case manager (if necessary) and a social worker (if necessary) can be involved in the discharge process. Caregiver discharge teaching includes: pain medication management, cast or splint care, appropriate bowel regimen, safe handling, skin care, incision site assessment, dressing care, gait training using equipment with a physical therapist, signs and symptoms of infection and other potential complications or issues associated with anesthesia and circumstances in which to call the orthopedic team. […] Our goal is to provide treatment programs that relieve symptoms and strive to keep the hip working well. We provide direct patient care and are also active in teaching and research for hip related disorders.

• #25 Developmental dysplasia of the hip

  https://www.nhs.uk/conditions/developmental-dysplasia-of-the-hip/

  Babies diagnosed with DDH early in life are usually treated with a fabric splint called a Pavlik harness. […] The harness needs to be worn constantly for 6 to 12 weeks and should not be removed by anyone except a health professional. […] Your hospital will provide detailed instructions on how to look after your baby while they’re wearing a Pavlik harness. […] Eventually, you may be given advice on removing and replacing the harness for short periods of time until it can be permanently removed. […] Surgery may be needed if your baby is diagnosed with DDH after they’re 6 months old, or if the Pavlik harness has not helped. […] Your child may need to wear a cast for at least 12 weeks after the operation. […] After this investigation, your child will probably wear a cast for at least another 6 weeks to allow their hip to fully stabilise.

• #26 Pavlik Harness for DDH

  https://www.rch.org.au/kidsinfo/fact_sheets/Pavlik_Harness_for_DDH/

  Your orthotist will usually arrange regular reviews to monitor the progress of your baby’s growth and adjust the orthosis as required. […] Contact your orthotist if you have any questions or concerns regarding your child’s treatment with a Pavlik Harness. […] Monitor your baby’s skin daily. Take care to clean your baby’s skin and if you notice any skin irritation or redness, contact the orthotist. […] Always try to keep your baby’s legs apart, especially when bathing with the harness off. […] Babies may cry a little or seem unsettled for the first couple of nights after the harness is fitted. This should settle down within a couple of days. […] The Pavlik Harness should be washed only if absolutely necessary and do not tumble dry. […] Make sure you vary the position of your sleeping baby to avoid plagiocephaly (misshapen head).

• #27 Developmental dysplasia of the hip (DDH) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/developmental-dysplasia-hip-ddh

  If the harness and/or brace are not successful, a procedure under anesthesia may be needed to put the hip back into place manually, also known as a closed reduction. If successful, a custom molded body cast (called a spica cast) is put on the baby to hold the hip in place. […] If a closed reduction is not successful, the next line of treatment is surgery in the form of an open reduction, to reposition the ball within the socket.

• #28 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Assess the childs shortened leg affected by telescoping; palpation of the femur when the thigh is extended and pushed toward the head and pulled in the distal direction; delayed walking and a limp that causes lurching toward the affected side; the downward tilt of pelvis toward unaffected side if weight-bearing on the affected side when standing (Trendelenburg sign); lordosis and waddling gait if both hips affected. Provides information about the presence of deformity in one or both hips in the older infant or toddler and preschool age group; usually identified when the child begins to walk or stand, and limb is shortened and adductor and flexor muscle contracture has occurred; requires closed reduction (traction and cast) or open reduction (surgery, cast splint) to correct. […] Maintain skin traction in the presence of abduction contracture in the infant up to 6 months of age and spica cast if applied following the traction; maintain skin traction for gradual reduction of the hip adductor and flexor muscles with a spica cast application for immobilization in child 6 to 10 months of age. Promotes hip abduction until stable; applies with a spica cast if unable to maintain stable reduction of the hip for 3 to 6 months; removal of the spica cast is followed by an abduction brace for protection.

• #29 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Provide traction care including correct alignment of extremities, the right amount of weights, free hang of weights, perfectly functioning pulleys with secure knots, and neurologic and circulatory assessment every 2 hours for warmth, color, and sensation. Maintains safe, effective traction to affected hip(s) with the childs response to traction monitored. […] Provide diaper changes frequently and as needed; use disposable diapers or plastic protection over a diaper. Maintains clean harness brace, or cast. […] Educate parents about the type and extent of deformity and cause and treatment plan for correction and prognosis by reinforcing physician information; inform of suggested surgical reduction in an older child or if obstruction of joint development by soft tissue is present in the young child. Provides information about the deformity, its classification, and pharmacological or surgical regimen that is determined based on age and severity of the deformity.

• #30 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  Once the hip can be put back in the socket easily, the child is put in a hip spica cast from waist to toe. This cast holds both legs so that the hip joint remains in one position – in the socket while the soft tissues around the hip tighten to hold the hip reduced. The cast may be needed for several months to hold the hip in place. The cast usually is replaced every two weeks to one month while it is needed. Each time the cast is changed, the child is taken to the operating room and placed under general anesthesia. This treatment is called a closed reduction. […] Surgery may be needed when the hip cannot be stabilized and kept in the socket. Surgery is more likely required in the child older than 18 months. Before the surgery, the child may be placed in traction to loosen the soft tissues around the hip. Then the child is put in a full hip spica cast from waist to toe. The cast may be needed for several months to hold the hip in place. An open reduction is a surgical procedure used most often in children two years old or older when hip dysplasia has not been corrected. During this operation, the surgeon removes any abnormal tissues that are keeping the femoral head from fitting inside the acetabulum and cuts any tight ligaments in the joint capsule around the hip joint. The surgeon may perform a tenotomy during the surgery to cut the tightly contracted tendons or muscles in the hip area. This relaxes the tight structures around the hip joint and allows the hip to be placed in the socket. These tissues grow back with scar tissue as the child heals. The child is usually placed in a spica cast after this type of surgery and will need to wear this cast for several months.

• #31 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  An operation called derotational osteotomy may be needed. In this surgical procedure, the femur is cut and rotated to make it easier to keep the femoral head inside the acetabulum. When this procedure is done, the soft tissues loosen up and the forces of the muscles tend to keep the femoral head reduced. Once again, the child is put in a spica cast for several months while the bone heals. A CT scan may be used to confirm successful reduction before removing the cast. A CT scan is a special type of x-ray that takes slices of the body. This allows a much better picture of the hip and acetabulum than plain x-rays. […] In children older than 18 months, the problem may require additional surgery to change the acetabulum (socket) in addition to the femur (thighbone). The problem has been present longer and the anatomy has grown more distorted over the longer period of time. Your doctor may recommend surgery to change the way that the acetabulum is aligned in this situation. There are many different types of pelvic osteotomies that have been designed and are still used.

• #32 Adolescent Hip Dysplasia | University of Iowa Health Care

  https://uihc.org/services/adolescent-hip-dysplasia

  Anti-inflammatory medicines (like ibuprofen) and injectable steroid medicines can reduce hip pain and inflammation. […] Our physical therapists can teach you exercises to improve your hip strength, flexibility, and range of motion. We can also help you strengthen nearby muscle groups, which creates extra hip support. […] If nonsurgical treatments dont help, or your hip dysplasia has caused cartilage damage, your provider may recommend surgery. […] If youre in your 20s or 30s or you have a teen with hip dysplasia, having surgery can help you stay active. It can also help you avoid (or delay the need for) a hip replacement later in life. […] With hip dysplasia surgery, we often have two goals: […] During an open procedure called periacetabular osteotomy (PAO surgery), your surgeon cuts into your pelvis. Theyll free the socket from its original position and move it higher or lower. This allows the rounded head (ball) of your thigh bone to fit better inside. If necessary, theyll also reshape the ball (femur osteotomy).

• #33 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  Several different types of osteotomies are used to tilt the acetabulum in a more horizontal angle to the floor. By doing this, the femoral head is less likely to slide up and out of the socket with weightbearing. These include the Steele, the Salter and the Pemberton osteotomies. […] In the Chiari osteotomy, the bone of the pelvis just above the acetabulum is cut to allow the bone to slide out and form a new roof over the hip joint. This can stop the femoral head from sliding up and out of the socket. Over time this shelf of bone above the acetabulum remodels and forms a deeper acetabulum. […] The Staheli osteotomy uses a bone graft placed just above the hip joint to create a new, wider roof, or shelf over the acetabulum. This keeps the femoral head from sliding up and out of the socket and, as it heals, makes a larger weightbearing surface to spread out the weight that needs to be transferred from the femoral head to the acetabulum and pelvis. The Dial osteotomy is not as common. In this procedure, the entire acetabulum is cut free of the pelvis and moved or dialed at the best angle and then allowed to heal in that position.

• #34 Adolescent Hip Dysplasia | University of Iowa Health Care

  https://uihc.org/services/adolescent-hip-dysplasia

  Many people with hip dysplasia develop a cartilage injury called a torn labrum. If you also need cartilage repair, which uses a minimally invasive technique called hip arthroscopy, well take care of it at the same time as your PAO surgery. […] In older adults or in cases where hip dysplasia has already progressed to osteoarthritis, we may need to perform hip replacement surgery instead of PAO surgery. […] No matter which approach we use, you can feel confident in our team. As a regional referral center for hip dysplasia, we treat people from several nearby states. In fact, we perform more than 300 hip dysplasia surgeries every year. […] People with hip dysplasia are prone to other hip problems. To that end, our hip dysplasia specialists often partner with other hip experts.

• #35 4 Congenital Hip Dysplasia… – Planning Nursing Care – NCPFacebookShared with Public

  https://www.facebook.com/PlanningNursingCare/posts/4-congenital-hip-dysplasia-nursing-care-planshttpsplanningnursingcareblogspotcom/156435569355051/

  4 Congenital Hip Dysplasia Nursing Care Plans […] Nursing care planning goals for a child with congenital hip dysplasia include improving physical mobility, providing appropriate family and social supports, educating and involving parents in ADL’s, and avoiding complications (e.g., compartment syndrome).

• #36 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Ensure proper management of orthotic devices […] Support appropriate developmental milestones […] Provide psychosocial support […] Educate and support patients and families […] Collaborate with the healthcare team […] Nursing diagnoses provide a standardized method for recognizing, prioritizing, and addressing specific client needs and responses related to congenital hip dysplasia, including both actual and high-risk problems. They encompass the identification of current or potential health issues that can be effectively prevented or resolved through independent nursing interventions. Formulating nursing diagnoses becomes essential after conducting a thorough assessment to effectively address the patients current and potential health concerns related to congenital hip dysplasia. These diagnoses serve as a framework for developing and implementing personalized nursing interventions, aiming to optimize patient care.

• #37 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Goals and expected outcomes may include: […] The child will move self in bed with a traction bar; walk the length of the hallway and back twice a day. […] The child will maintain his or her traction; the Pavlik harness is applied properly; the skin is free of irritation in the spica cast. […] The child will maintain passage of soft, formed stool every 1 to 3 days without straining. […] The parent will stay with the infant and renders social interaction. […] The infant will respond positively to parental interaction. […] The child will be included in family activities. […] Therapeutic interventions and nursing actions for patients with congenital hip dysplasia may include: […] Children with congenital hip dysplasia may have a hip joint that is improperly formed or positioned, leading to decreased range of motion and instability. This can cause impaired physical mobility, making it difficult for a child to crawl, walk, and engage in other age-appropriate activities.

• #38 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Provide and apply harness and splint; use of aids including wheelchair, crutches, supportive reading, eating, and other aids for ADL as needed. Promotes autonomy and support in mobility and activities. […] Keep body alignment during bed rest, do position changes every two (2) hours or as needed; provide a drawing for the child to follow for the position and area to lie in bed. Avoids contractures and physical deformity. […] Encourage and assist the child in muscle-strengthening exercises and passive stretching exercises as appropriate. Conserves muscle strength or prepares for the use of mobility aids. […] Facilitates rest with periods of mobility. Avoids fatigue and maintains energy. […] Teach parents and the child about complications brought about by immobility. Promotes compliance with the program to maintain mobility and understanding of the effects of immobility.

• #39 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Teach parents and the child to utilize devices or aids for mobility and ADL. Helps the safe use of aids and equipment and increased protection. […] Children with congenital hip dysplasia who do not receive proper treatment for their condition, or whose treatment is incorrect, may be at risk for hip dislocation or other hip injuries. This can lead to long-term complications and impaired physical mobility, which can have a significant impact on their overall quality of life. […] Assess infants up to 2 months of age for frank breech birth, cesarean birth, hipjoint laxity or dislocation (Ortolani or Barlow test), degree of dysplasia or dislocation, shortened limb on the affected side (telescoping), broadened perineum, asymmetry of the thigh and gluteal folds with an increased number of folds, and flattened buttocks. Provides information about the presence and degree of dysplasia; may be preluxation, subluxation, or dislocation (luxation) and involve a laxity of the capsule or an abnormal acetabulum; identification of the presence of the deformity at this age results in the highest success rate in complete correction.

• #40 4 Congenital Hip Dysplasia Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/congenital-hip-dysplasia-nursing-care-plans/

  Educate parents to apply splint or harness properly over the diaper and shirt, utilize disposable diapers or waterproof undergarments to protect appliance; on the removal of harness for bathing if allowed or sponge bathing child with harness in place, padding shoulder straps, changing position every 2 hours; to prevent adjusting the harness. Promotes and maintains hip reduction to correct the deformity. […] Educate parents about traction care including reason and purpose for traction, amount of allowable movement, doing a neurovascular assessment and what to report, exact weight for the amount and hanging with pulleys and knots if present, and maintaining body alignment. Assures accurate traction for the gradual reduction of the hip and/or preoperative if surgery is expected. […] Educate parents about spica cast care including reason and purpose; keeping the cast clean and dry and shielding it from stool and urine using waterproof tape or plastic cover; providing cast support during movement; padding cast edges; doing lifting through crossbar; forbidding small objects or crumbs to enter cast; cast signatures without leaving white space between writing; Provide instruction in diapering or bedpan/toilet use; use of a diaper tucked into the perineal opening on the cast; feeding an infant in a supine position with the head elevated or while being held in an upright position on a lap or in a car seat; notify parents that specially made car seats for infants with casts/harness are available and must be applied if the child rides in a car; refer to a social worker if financial constraints prevent access to the seats. Guarantees correct cast care for immobilization of the hip following a surgical hip reduction; traction or surgical correction may be used for acetabulum reduction or reconstruction. […] Refer parents to community agencies supporting disabled children. Provides information and support services to the child and family.

• #41 Pavlik Harness for DDH

  https://www.rch.org.au/kidsinfo/fact_sheets/Pavlik_Harness_for_DDH/

  Developmental dysplasia (or dislocation) of the hip (DDH) is an abnormal development of the hip joint. In DDH, the ball at the top of the thigh bone is not stable within the hip socket and the ligaments of the hip joint may also be stretched and loose. […] Babies with DDH often need to wear a brace. The Pavlik Harness is one type of brace used to treat DDH. It has straps that are fastened around the baby’s legs and held up by shoulder and chest straps. This holds the hips and knees up with the legs apart. This is the best position for the hip joint to be in. It allows contact between the thigh and hip bones and helps strengthen the muscles and ligaments while the hip is developing. […] Your baby’s orthotist will make sure the harness fits your baby correctly, and will show you how to put it on and how to check that it is positioned properly.

• #42 Pavlik Harness for DDH

  https://www.rch.org.au/kidsinfo/fact_sheets/Pavlik_Harness_for_DDH/

  Monitor your baby’s skin daily. Take care to clean your baby’s skin and if you notice any skin irritation or redness, contact the orthotist. […] Your baby can wear normal nappies under the Pavlik Harness. When changing the nappy, do not hold your baby’s feet together as this will move the hips from the correct position. Loose-fitting clothes that do not pull the knees together should be worn over the harness. […] You will be able to continue breastfeeding when using the Pavlik Harness. You might need to try some different positions until you find one that is comfortable for both you and your baby. […] Your baby will be sleeping on their back with the harness on. […] The Pavlik Harness should be washed only if absolutely necessary. […] Femoral nerve palsy is a very rare problem that can happen when using a Pavlik Harness. If you notice that your baby stops kicking, contact the orthotist as soon as possible.

• #43 Hip Dysplasia | Dayton Children’s Hospital

  https://www.childrensdayton.org/patients-visitors/services/orthopedics/conditions-we-treat/hip-dysplasia

  Following surgery for DDH to manipulate the hip bone into place, the child will be put into a spica cast for 6-12 weeks to help stabilize the hip and ensure proper development of the hip joint. […] Children who are potty trained may regress slightly in a cast so it’s important to use a diaper, just in case! […] It is very important that the cast stays dry. […] Physical therapy will show you how to carry your child safely when they are in a spica cast.

• #44 Developmental Dysplasia of the Hip in Children (Discharge Care)

  https://www.drugs.com/cg/developmental-dysplasia-of-the-hip-in-children-discharge-care.html

  Developmental dysplasia of the hip (DDH) is a condition that prevents parts of your child’s hip joints from fitting together correctly. […] Your child needs rest to heal. Quiet play will keep your child safely busy. Have your child read or draw quietly when he or she is awake. Follow instructions for how much rest your child should get while he or she heals. […] Talk to your child’s healthcare provider about exercise and play for your child. Together you can plan the best exercise program for your child. It is best to start slowly and do more as he or she gets stronger. Exercise will help make his or her bones and muscles stronger. […] Take your child to physical and occupational therapy as directed. A physical therapist teaches your child exercises to help him or her improve movement and strength. An occupational therapist teaches your child skills to help with his or her daily activities.

• #45 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  Young children have incredible powers of healing. Because the skeleton is still forming, many of the changes created at surgery will remodel dramatically and create a hip socket that will serve the child well into adulthood with minimal problems. All children that require surgery to address a dysplastic hip have a higher risk of developing wear and tear arthritis of the hip as they age into adulthood. Many will age well into their 40s and 50s before experiencing significant problems with the hip. Some may never have any additional problems. […] Rehabilitation […] What should I expect after treatment? […] Nonsurgical Rehabilitation […] The child in a Pavlik harness benefits from as much motion in the hip as possible – while still keeping the hip reduced. Motion allows for nutrition of the developing bone and cartilage inside the hip joint. The therapist will review positions to avoid such as sidelying with the top leg down toward the other leg past the midline. The harness must be used continuously until the hip is stable. Use may be gradually decreased to just nighttime wear before finally stopping.

• #46 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  After Surgery […] The child who has surgery will not be able to walk afterwards because of the spica cast. A special hole is cut open to allow the older child to go to the bathroom. Younger children remain in diapers. Your physical therapist will help the family with any special equipment needed for daily tasks and transportation. Special tips for positioning and handling will be reviewed as well. […] Special care must be taken not to get the cast wet with water or urine. The cast may be removed and replaced only if the child grows and there are signs that the cast is too small or if there is evidence of skin breakdown. The child should be checked several times each day for changes in skin color or sensation. Leg or foot pain, cool or numb toes, or loss of motion in the feet must be reported to the physician right away. […] Physical and occupational therapy is important during the postoperative period in the cast. Opportunities to move and develop gross motor skills are limited. The therapist will closely monitor overall gross and fine motor skills normally occurring during this time.

• #47 Tips for Parents – International Hip Dysplasia Institute

  https://hipdysplasia.org/infant-child/tips-for-parents/

  Make sure the diagnosis is correct: […] Learning more about hip dysplasia can make going through treatment less confusing and help calm fears. […] Talk to other parents who have children being treated, or who were treated themselves for hip dysplasia. […] Hip dysplasia can be successfully treated in most cases. Good results should allow your child to participate in active play and in sports as he or she gets older. […] Hip dysplasia (DDH) isn’t usually painful for babies and young children even when the hip is unstable or dislocated. […] It’s likely that your child’s hip dysplasia has been discovered in time to do something about it. […] Hip dysplasia is a pretty common condition with various degrees of involvement so most doctors are familiar with the problem. […] Hip dysplasia is usually an isolated problem so there’s not much worry that something else might be wrong with your child.

• #48 Developmental Dysplasia of the Hip (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/ddh.html

  Developmental dysplasia of the hip (DDH) is a problem with the way a baby’s hip joint forms. […] A pediatric orthopedic surgeon (a specialist in children’s bone conditions) cares for babies and kids with DDH. The goal of care is to get the ball of the hip in the socket and keep it there, so the joint can grow normally. […] Treatment for babies younger than 6 months old usually is a brace. The brace used most often is a Pavlik harness. It has a shoulder harness that attaches to foot stirrups. It puts the baby’s legs into a position that guides the ball of the hip joint into the socket. […] Kids will have regular checkups with their orthopedic specialist until they’re 16-18 years old and done growing. These help make sure the hip develops well.

• #49 Developmental dysplasia of the hip (DDH) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/developmental-dysplasia-of-the-hip-ddh

  If a baby is diagnosed with a dislocated hip when they are six months old or more, then an anaesthetic will be required before the hip is manipulated into its proper position. An operation may also be needed. […] A hip cast applied after surgery helps to keep the hip joint in place, and subsequent x-rays will track the hip joint’s progress. […] Most babies born with successfully treated DDH don’t have any hip problems in later life. However, some may develop arthritis in the affected joint in their later years.

• #49 Developmental dysplasia of the hip (DDH) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/developmental-dysplasia-of-the-hip-ddh

  Developmental dysplasia of the hip (DDH), or DDH, means that the hip joint of a newborn baby is dislocated or prone to dislocation. […] Treatment includes special harnesses, or operations and casts, depending on the age of the child at diagnosis. […] A baby born with a dislocated hip can be successfully treated with a Pavlik harness. This device holds the joint in place while the baby’s skeleton grows and matures. […] In some babies, the ligaments around the hip joint are loose, which in most circumstances, corrects during the first few months of life. […] Research has shown that tight wrapping with the legs held straight can lead to hip dysplasia and dislocation. […] When wrapping your baby, always remember to leave enough room in the wrap for the legs to move freely. Your baby’s legs should be able to bend at the hips with their knees apart.

• #50 Preventing Developmental Hip Dysplasia | NYU Langone Health

  https://nyulangone.org/conditions/developmental-hip-dysplasia/prevention

  Most children with developmental hip dysplasia are born with this condition, in which the top of the thigh bone does not fit snugly into the socket of the hip joint. However, damage to the cartilage and bones can occur if a newborns legs are in a straightened position for long periods of timefor example, by improper swaddling, which is a method of calming newborns that involves tightly wrapping the legs and body in a blanket or cloth. […] If you swaddle your infant, make sure his or her hips can move freely. Avoid swaddling so snugly that the babys legs are pulled tightly together. His or her legs should be slightly bent and spread apart, similar to the position in the womb. […] Instead of swaddling, some parents use a sleep sack, which is a wearable blanket or sleeping bag for infants. Be sure to select one that has a loose pouch for the babys legs and feet and allows the hips to move freely.

• #51 Hip Dysplasia: Why Parents Should Swaddle with Care

  https://www.hss.edu/pediatrics-hip-dysplasia-parents-swaddle-baby-with-care.asp

  Swaddling a baby is a common practice. […] However, if not done properly, swaddling could affect an infants tiny hips. […] Wrapping a baby too tightly puts a newborn at risk of developing a condition known as hip dysplasia, according to Dr. Emily Dodwell, a pediatric orthopedic surgeon at HSS. […] We now know that tightly wrapping an infants legs could lead to hip dysplasia, so we recommend a newer, better way of swaddling, she adds. […] The safe way is to use a sleep sack that leaves lots of room for the legs, or, if using a blanket, we advise parents to keep it loosely folded around the babys legs so theres room for them to bend and move apart. […] If a baby has untreated hip dysplasia, it could cause more serious problems as they get older, Dr. Dodwell says. […] Dr. Dodwell emphasizes that its best for the baby if dysplasia is diagnosed and treated early on. Timely treatment gives the babys hip the best chance of developing normally.

• #52 Developmental dysplasia of the hip in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/developmental-dysplasia-of-the-hip-in-neonates

  All newborn infants should have the hips tested for instability or dislocation. […] Early detection of hip dysplasia is vital. […] The longer the hip is in an abnormal position, the more likely surgical correction will be required. […] If DDH is left untreated the hip joint develops abnormally and surgical reduction is required. By contrast, early conservative management with splinting (for example, Denis-Browne splint) or Pavlik harness allows the hip joint to develop normally and avoids the need for surgery in most cases. […] Infants in whom either test is positive should be assessed by an experienced clinician prior to discharge and fitted with a splint/harness. In the absence of an experienced clinician at your health service, referral to an orthopaedic specialist is desirable.

• #53 Early Intervention for Childhood Hip Dysplasia – The Pediatric Orthopedic CenterAccessibility ToolsIncrease TextDecrease TextGrayscaleHigh ContrastNegative ContrastLight BackgroundLinks UnderlineReadable FontReset

  https://pediatricorthopedics.com/early-intervention-for-childhood-hip-dysplasia/

  A key to preventing hip problems later in life—and a hip replacement—is to diagnose the deformity as early as possible so that treatment can begin as soon as possible. Early intervention may also mean that more conservative, non-surgical treatments, can be employed. […] In our practice, we pursue non-surgical treatment options first. For infants, the first course of treatment is the use of a Pavlik harness or brace that holds the child’s hip out to the side. Because an infant’s hip socket is still soft, the harness can help the femur mold to the shape of the socket. Babies are typically required to wear the harness or brace full-time for eight to 18 weeks. More than 90% of infants undergoing this treatment will resolve their hip dysplasia, underscoring the benefits of early diagnosis and treatment.

• #54 Common Questions About Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p843.html

  Developmental dysplasia of the hip is a common musculoskeletal condition in newborns. Infants with developmental dysplasia of the hip, whether treated or untreated, have a higher incidence of early-onset hip osteoarthritis in adulthood. […] Treatment generally involves flexion-abduction splinting. The benefits of treatment are unclear, and there are risks to treatment, most notably an increased occurrence of avascular necrosis of the femoral head. […] Infants younger than six months with overtly dislocated or dislocatable hips are usually treated with flexion-abduction splinting using a device such as a Pavlik harness. […] The most important adverse effect of DDH treatment is avascular necrosis of the femoral head. The major complication of avascular necrosis is early-onset osteoarthritis and the need for hip replacement surgery. Femoral nerve palsy, pressure ulcers, and musculotendinous contracture are additional risks of splinting and surgical treatment.

• #55 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/e3c3833f547486915b8e6413512eec9d

  For the infant in a harness, care must be taken not to set the harness in too much abduction. Abduction is the motion when the thighs are pulled away from one another. The Pavlik harness is designed to hold the legs bent at 95 degrees at the hip and abducted, or pulled apart, about 45 degrees each. The harness can be tightened too much, pulling the legs apart too much. Too much force into abduction can block the blood supply to the femoral head causing a condition called avascular necrosis. This is a serious complication that can prolong the treatment of the hip and may lead to other problems. Your surgeon or physical therapist should instruct you on how to correctly adjust the Pavlik harness. Make sure you understand how to do this properly. Ask questions if you do not feel you understand.

• #56

  https://www.shrinerschildrens.org/en/pediatric-care/hip-dysplasia

  Families put their trust in Shriners Childrens for early diagnosis and effective treatment of hip dysplasia. […] Our specialized expertise in non-surgical and surgical treatments for hip dysplasia gives children the best outcome. […] Hip dysplasia is treatable, but early detection and treatment is very important. […] The right diagnosis and the right care, at the right time, is critical in reducing your child’s risk of pain and disability in adulthood. […] We know parents and caregivers will have many questions about treatment and quality of life. […] We’ve seen children with hip dysplasia successfully progress through childhood, meeting milestones, becoming active athletes, and confidently navigating their teen years. […] Every hip dysplasia treatment plan is as unique as your child.

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