The joy of having a newborn baby is accompanied by health-related worries about their well-being. Many parents remain unaware of the fact that hip problems represent a common concern for their babies.
Your baby’s hip development receive regular examination by The best pediatric orthopedic doctor in India by routine checkups.
Special tests called Barlow and Ortolani tests form part of these examinations. The straightforward tests enable healthcare providers to identify hip problems at an early stage when treatment is more effective.
Early diagnosis leads to superior medical results along with reduced health complications that develop during adulthood. The article describes hip tests for babies and their importance, and congenital hip dislocation treatment procedures when babies require medical intervention.
Understanding Congenital Hip Dislocation
What Is Congenital Hip Dislocation?
Developmental dysplasia of the hip (DDH) or congenital hip dislocation occurs when the hip joint of a newborn forms improperly. A secure fit between the ball portion of the hip (the top of the thigh bone) and the socket (the pelvic section) does not exist. This condition appears as either mild joint instability or total joint separation.
Why Does It Happen?
A combination of different elements raises the likelihood that a baby will develop hip problems.
- Being a firstborn child
- The risk for girls surpasses that of boys when it comes to hip problems (DDH).
- Family history of hip problems
- The positioning of a fetus with its bottom leading instead of its head in the birth canal constitutes breech position during pregnancy.
- Tight swaddling with legs straight and together
Why Early Detection Matters
It is vital to detect hip problems at an early stage. Medical professionals can treat most hip conditions detected early in infancy through simple device applications.
Children who receive late warning signs of hip problems might require surgical intervention, which could lead to various complications, such as:
- Limping
- Pain when walking
- Different leg lengths
- Early arthritis
What Is the Barlow Test?
The Barlow test identifies whether your baby’s hip joints can be dislocated from their normal position. The medical examination allows doctors to detect unstable hips, which have the potential to dislocate. Healthcare providers conduct this test both at the newborn checkup and follow-up visits.
How Is the Barlow Test Performed?
When the doctor performs this test:
- Your baby will lie on their back with legs bent at the knees and hips.
- The doctor gently holds your baby’s thigh with their middle finger over the hip joint.
- They then push the thigh backward while moving it slightly outward.
- If the hip moves out of the socket or “clunks,” it suggests instability.
What Does a Positive Barlow Test Mean?
A “positive” Barlow test means the doctor can push the hip out of place. This doesn’t always mean your baby has a problem that needs treatment, but it does need watching and possibly more tests.
Know About Ortolani Test
What Is the Ortolani Test?
The Ortolani test functions together with the Barlow test. The Barlow test determines whether a physician can push the hip out of place, but the Ortolani test detects when a dislocated hip can be successfully reduced with an audible “clunk”.
How Is the Ortolani Test Performed?
For this test:
- Your baby lies on their back, just like with the Barlow test.
- The doctor holds your baby’s thigh with their middle finger over the hip joint.
- They gently lift the thigh while moving it outward.
- If the hip was dislocated and moves back into place, the doctor feels or hears a “clunk”.
Interpreting Ortolani Test Results
A “positive” Ortolani test means the doctor felt the hip move back into place. This usually confirms there’s a problem that needs attention. Both tests together give doctors a good picture of your baby’s hip stability.
Assessing Infant Instability: Defining Degrees of Unsteadiness
Types of Hip Instability
Hip instability in babies can be classified in different ways:
- Dislocatable Hip: The hip is in place but can be pushed out during the Barlow test.
- Dislocated Hip: The hip is already out of place but can be put back in with the Ortolani test.
- Fixed Dislocation: The hip is out of place and cannot be put back easily.
How Doctors Grade Hip Instability
Doctors often use a grading system to describe hip instability:
Grade 1: Mild instability with minimal movement.
Grade 2: Moderate instability where the hip moves but doesn’t fully dislocate.
Grade 3: Severe instability where the hip fully dislocates.
Grade 4: Fixed dislocation that can’t be reduced with gentle manipulation.
Understanding these grades helps doctors decide what kind of treatment your baby might need.
Hip Dysplasia in Infants: Presentations in Babies 2 Months and Older.
Signs in Older Babies
As babies grow, the signs of hip problems change. In babies older than 2 months, doctors look for:
- Uneven leg lengths.
- Asymmetrical skin folds on the thighs.
- Limited hip movement, especially spreading legs wide.
- One leg turning outward more than the other.
- Delayed walking or unusual walking pattern
Why Tests Change for Older Babies
The Barlow and Ortolani tests become less useful after 2 to 3 months. This happens because:
Muscles get stronger and can hide the instability.
If hip stay dislocated, soft tissues tighten and make the “clunk” harder to feel.
Alternative Tests for Older Infants
For babies older than 3 months, doctors may use:
Limited Abduction Test: Checking if the baby’s legs can spread wide apart
Galeazzi Sign: Looking for uneven knee heights when the baby’s hips and knees are bent
Imaging Tests: Ultrasound for babies under 6 months or X-rays for older babies
Congenital Hip Dislocation Treatment
Treatment Based on Age and Severity
Treatment depends on how old your baby is and how serious the hip problem is:
- For Newborns to 6 Months
Pavlik Harness: Most common treatment for young babies
- Soft fabric straps that hold the hips in the correct position
- Usually worn for 6 to 12 weeks
- Allows some movement while keeping hips stable
- Success rate is very high when started early
- Observation: For very mild cases, your doctor might just want to check regularly
Instruction to patient :
- Check for skin irritation.
- Do not remove the harness unless instructed.
- Dress the baby in loose clothing over the harness.
- Adjust diapering techniques.
- For Older Babies (6-18 Months)
Closed Reduction:
- If the Pavlik harness doesn’t work or for older babies,
- The procedure is done under anaesthesia.
- The doctor manually puts the hip back into place.
- The baby wears a spica cast afterwards to keep the hip stable.
Spica Cast:
A hard cast that covers the lower body
It keeps the hip in the right position for 2 to 4 months.
Requires special care is required for diapering and bathing
- For Children Over 18 Months
Open Reduction Surgery:
- For older children or difficult cases,
- A surgical procedure is performed to place the hip correctly.
Followed by spica casting.
The procedure may include reshaping the socket or other corrections.
Instruction to parents For babies in a spica cast:
- Keep the cast clean and dry.
- Check the skin around the edges for irritation.
- Use special diapering techniques.
- Position the baby carefully for sleep and play.
Key Takeaways
- Early Detection Is Crucial
Early detection of hip problems enables simpler treatment that yields better results. Regular check-ups are essential.
- Treatment Works Well
Early intervention for hip problems leads to normal hip development along with no physical restrictions in children. The effectiveness of treating hip issues during infancy exceeds 90 percent.
- Follow Treatment Plans Carefully
- Follow all instructions exactly.
- Keep all follow-up appointments.
- Ask questions if you are unsure about anything.
- Remember that temporary inconvenience prevents long-term problems.
- Trust the Process
Your baby will likely adjust easily to treatment procedures that might feel uncomfortable, although they seem difficult for you. Your baby will experience brief discomfort to avoid developing long-lasting complications.
Conclusion
Early detection of hip problems using Barlow and Ortolani tests will help your baby develop normal hips. Brief examinations performed during routine check-ups require only few minutes to identify problems that protect children from future pain and disabilities. The majority of babies with hip problems can achieve complete recovery through appropriate medical treatment.
Trishla Ortho offers expert paediatric orthopaedic care and treatment services for congenital hip dislocation alongside other paediatric orthopaedic conditions through their team of experienced specialists. The team delivers support to parents while understanding their worries throughout their child’s treatment process. The correct medical approach at the proper times enables your baby to develop normal, healthy hips, which lead to an active lifestyle.
