A variety of methods exist for correcting hip joints in children. The child's age and the severity of symptoms will determine the best course of treatment. If dysplasia is detected at birth, the prognosis is favorable, and there are a variety of nonsurgical options. There are also surgical interventions, which we'll discuss later.
The Pavlik harness is used on babies up to 6 months of age. It's a chest strap, two shoulder straps and two stirrups made of canvas, Velcro and buckles. The harness places the femur in the socket at the correct angle and keeps the legs apart. A doctor will put the harness on in order to get the proper fit and will likely recommend that the baby wear it 24 hours a day for 6 to 12 weeks. For babies with dislocated hips, the harness may be worn for a shorter period. The success rate of the Pavlik harness is 85 to 95 percent for infants under 6 months old.
Traction uses weights attached to ropes that pull the child's legs. This was once a common treatment for hip dysplasia, but today it's typically used only when the Pavlik harness has been unsuccessful or when hip dysplasia has been diagnosed later than 6 months of age. If the femur is dislocated, the muscles tighten around the dislocation, making it impossible for the femur to return to the socket. Traction gently stretches the muscles over time so the doctor can realign the femur. Without traction, muscles can pull the femur out of the socket, even in a body cast. The length of traction varies from a few days to a few weeks, for 24 hours a day with short breaks. This process is uncomfortable but not painful.
If these methods are not successful, or if the child grows and dislocation recurs, a doctor may need to manually replace the femur into the socket. This is called a closed reduction. This procedure does not require cutting into the hip. However, some cases require a tenotomy -- the surgeon makes an incision and cuts tight tendons to help increase the hip's mobility. The hip is then externally manipulated to bring the head of the femur back into the acetabulum. A spica cast is applied to stabilize the hip.
The spica cast immobilizes the joint and allows the bones and tendons to heal. The cast is made out of plaster or fiberglass and usually has a cotton liner for comfort. In some instances, a surgeon may use Gore-Tex to try to keep the skin dry. There are several types of spica casts. They typically begin at the chest and cover one or both hips, or they can come down the leg on one side and stop at the hip or knee on the other. The surgeon will determine the best cast to use. A spica cast is worn for up to 4 months, but a doctor typically changes it every 6 weeks to allow for growth and to help with hygiene.
Some doctors will also use braces or splints at different times or in different orders. Ultimately, it's up to the parent to understand the doctor's instructions and reasoning for using specific braces. Braces and splints will vary in their materials as well as their instructions for care and use. A brace can be the next step up from a Pavlik harness, and it's also sometimes used after a spica cast is removed. In some cases, a child does not need a brace after cast removal. The surgeon will decide this based on the outcome of the reduction and cast. The general term for all of these braces is an abduction orthosis.
Since hip dysplasia is a developmental bone disorder, it will continue to deteriorate over time if left untreated. Regardless of when the dysplasia is diagnosed, it will still require regular review and re-assessment throughout life. Next, we'll look at the nonsurgical treatments available for adults.