Some Mechanical Factors in the Causation of Congenital Dislocation of the Hip

The seeds of osteoarthritis of the hip in later life are often sown at about the time of birth. From a short time before birth and for an unknown time subsequently, the capsule of the joint may be under the influence of parental hormones, making it abnormally liable to stretching and permanent laxity. The mechanism of the hip is such that this stretching may well result from any forcible extension of the joint; once the damage has been done it may be difficult to undo, and all the changes that subsequently develop in the subluxated or dislocated hip are secondary to this. At birth a child's hip should be handled with the greatest care, and at no time should it be extended. If extension was prevented from developing too quickly by means of some appliance, such as a Frejka pillow, the typical form of congenital dislocation of the hip might well disappear and osteoarthritis in later life be greatly reduced.