Congenital Hip Dislocation

Congenital hip dislocation, now more commonly referred to as developmental dysplasia of the hip (DDH), is a condition where a child’s hip joint is improperly formed. This can range from a slightly shallow socket to a completely dislocated hip.It develops  at birth or develops during infancy.it is  More common in girls, first-born children, and breech births.it Can affect one or both hips, often the left hip.

Causes:

• Genetic factors
• Intrauterine positioning
• Hormonal influences affecting ligament laxity
• Swaddling practices that force the legs straight

Types:

• Subluxation: The head of the femur is loose in the socket.
• Dislocation: The femoral head is completely out of the socket.
• Instability: The hip can be dislocated with manipulation.

Symptoms:

• Asymmetrical skin folds on the thighs or buttocks
• Limited range of motion in the affected hip
• Limb length discrepancy
• Limping or toe-walking in older children

Diagnosis:

• Physical exam (Ortolani and Barlow maneuvers in newborns)
• Ultrasound (especially in infants under 6 months)
• X-ray (used after 6 months when bones are more developed)

Physiotherapy management

Physiotherapy plays an important role in the management of developmental dysplasia of the hip (DDH)—both after medical or surgical interventions and in some mild or borderline cases. However, physiotherapy is typically a supportive treatment, not the primary one in infants (where devices like the Pavlik harness are first-line).

Goals of Physiotherapy in DDH:

• Restore hip joint mobility and muscle strength
• Promote normal gait and motor development
• Prevent compensatory movement patterns
• Support post-operative recovery (if surgery is done)
• Educate caregivers on safe handling and positioning

Physiotherapy in Infants (Post-Harness or Post-Surgery):

1. After Harness or Casting:

Gentle Range of Motion (ROM) exercises for the hip and knee

• Positioning education for parents (to promote hip-safe handling and avoid extension/adduction)
• Tummy time and motor development facilitation
• Monitoring developmental milestones

2. Post-Surgical Physiotherapy:

• Mobilization post-immobilization (after spica cast removal)
• Progressive ROM and strengthening exercises
• Gait training when weight-bearing is permitted
• Hydrotherapy can be useful for gentle strengthening

 In Older Children (Mild/Undiagnosed DDH):

• Muscle strengthening (glutes, hip abductors)
• ROM maintenance, especially in abduction and external rotation
• Gait correction
• Balance and proprioception training
• Functional movement training for climbing, squatting, etc.

3. Home Program and Parent Involvement

• Daily exercises as prescribed
• Correct positioning during sitting, carrying, and sleep
• Encourage age-appropriate play that promotes hip-safe movement

4. Outcome Monitoring

• Regular reassessment of:
  • Hip range of motion
  • Muscle strength
  • Gait and posture
  • Motor development milestones