Newport JR Hip Orthoses: Early Intervention Aids Joint Alignment
April 2004 Issue
|Dulcey Lima, CO, OTR/L|
The Newport JR Hip Orthosis was designed to restore and maintain joint alignment to produce improved mechanics and effective alignment of the hip structures. Early intervention is most effective when the child is actively growing to better direct the soft tissue development and bony alignment.
Adult alignment will be compromised if the skeletal system fails to achieve mechanically effective alignment during periods of active growth. Spastic muscles around the joint continue to impact joint integrity and also interfere with the attainment of functional activities. The residual abnormal bony alignment and deformity continue to have a profound impact on function. Ideally, providing more normal joint positioning will encourage more effective modeling and provide the child with an opportunity for improved structural stability.
Early Hip Development
The development of normal hip skeletal alignment, shape, and function is directly affected by a baby's development in the first months and years of life. At birth, the hip is held in flexion and lateral rotation. The acetabulum is shallow and lax, allowing maximum range of motion to facilitate the baby's descent into and out of the birth canal.
|Deanna Fish, MS, CPO|
As the baby begins to creep, crawl, and stand, the angle between the neck and shaft of the femur decreases from 140 to 125 degrees by six years of age, creating greater acetabular coverage and structural stability for walking, running, and other gross motor skills. As hip flexion tightness and medial rotation become more balanced with the emergence of hip extensors and lateral rotators, the femur "untwists" and becomes more aligned with the femoral condyles.
The hips of children with orthopedic problems often lack proper alignment and stability because spastic muscles exert abnormal forces on the bones. The lack of normal developmental activities reduces the opportunity for normal weight-bearing forces to stimulate bone and joint congruity. Use of a hip orthosis facilitates more stable positioning and provides an opportunity for more normalized structures to develop.
Clinical Indications of the Newport JR
Functional standing and sitting are important developmental skills that are often delayed in physically challenged children. For functional purposes, potential uses of the Newport JR include:
1. Orthosis to widen the base of support in sitting to promote increased stability and hands-free sitting.
2. Orthosis to provide more neutral alignment for children who have painful hips and multiple orthopedic problems.
3. Night positioning orthosis to stretch tight hip adductor, abductor, flexor, and/or extensor muscle groups.
4. Orthosis to promote a more abducted and stable independent standing position.
5. Orthosis to stabilize the hips within a standing frame for supported standing.
6. Orthosis to position the hips, knees, and feet for improved independent walking.
Many surgeons use a bilateral hip spica cast to stabilize the hips for six-eight weeks after soft tissue or bony procedures. These casts provide stabilization, but are also heavy, awkward, and non-removable. Spica casts often create hygiene issues and do not allow observation of the incision site. The Newport JR can be used in place of the hip spica and set at the exact range needed for postoperative stabilization.
Advantages to using the Newport JR in place of a hip spica cast include:
1. Ability to set flexion, extension, abduction, adduction, and change settings over time.
2. Ability to make the orthosis non-removable by riveting the straps shut or applying a layer of fiberglass over the straps for easy removal in the physician's office.
3. Ability to remove the orthosis to perform hygiene tasks and replace the soiled liners with the extra set of liners provided.
4. Curved proximal offset of the PJ Virtual Joint allows clearance over the incision site and allows hips to be fully abducted in the orthosis without impingement.
5. Thigh cuffs encompass the thigh and distribute contact over a broad area.
The Newport JR is available in five sizes.
For more information, contact Orthomerica Products Inc., 800.446.6770.
Dulcey Lima and Deanna Fish are clinical education managers for Orthomerica Products Inc. They lecture regularly at national and international meetings, assist with new product and marketing efforts, and provide seminars and consultation to the orthotic and prosthetic community.