Many fathers and mothers of children in the first year of life hear from doctors the diagnosis of “hip dysplasia” or “congenital dislocation of the hip,” which are essentially a single diagnosis. The pathology is congenital, meaning that in newborn children the hip joint is underformed or incorrectly formed. If the disease is not noticed in time or not treated, the sad consequences of dysplasia will remain with you for the rest of your life.
The causes of the disease are varied, but when answering the question of where dysplasia comes from in children, doctors do not come to a consensus. Possible causes of the disease include:
- heredity (passed through the female line);
- breech presentation of the fetus (the baby is not born head first, but vice versa);
- oligohydramnios;
- large fruit (there is not enough space for the baby to move fully, the volume motor activity the hip joint falls, which prevents full development);
- improper nutrition of the mother during pregnancy;
- violation hormonal levels in pregnant women;
- gynecological diseases of the mother, uterine fibroids or adhesions that contribute to the difficult movement of the baby in the womb;
- bad environment.
According to statistics, hip dysplasia occurs in newborn girls up to 7 times more often than in boys. Unfortunately, the disease is observed in a large number of infants - from 5 to 20%.
Consequences of dysplasia in childhood
The lack of an appropriate approach to treating children provokes the formation of complications.
Sick children begin to move independently much later than their peers; their gait is unstable, which becomes noticeable by the age of one and a half years. In children with dysplasia, the following is observed:
- Clubfoot.
- Flat feet.
- Lameness. In this case, the baby limps on the leg on the affected side, the body is tilted to the side, as a result, scoliosis develops - a curvature of the spine.
- Shifting from one leg to the other (with bilateral dysplasia).
Posture deteriorates, lumbar lordosis(the spine bends forward) or thoracic kyphosis (the spine bends backward). Possible development of osteochondrosis (damage to spinal tissues, intervertebral discs, associated apparatus of the spine), as an aggravating disease. There are cases when hip dysplasia develops from unilateral to bilateral. It is possible to become disabled from infancy.
The baby grows, becomes older, pathologies that are not eliminated in a timely manner appear - the body cannot withstand prolonged increased loads. Known medical cases, when hip dysplasia treated in infancy, in adolescence affects connection complications. It is observed in 2-3% of cases; unfortunately, medical science is not yet able to influence this fact.
Appropriate intervention will save you from expensive, hazardous treatment in the future. Trying to hip joint traditional methods just useless!
After getting rid of dysplasia in childhood, the child is healthy, but doctors do not recommend professional sports. The exception is skis and aquatic species sports, where the load on the lower limbs is otherwise distributed, during training the muscles are strengthened and stabilized. It is extremely important to monitor your weight and maintain it at normal levels; excess weight is harmful to your joints.
What are the dangers of untreated dysplasia in childhood?
Having started or not cured the disease in infancy, parents doom the child to health difficulties in adulthood.
Often, adult people with dysplasia are unusually plastic and flexible (become elastic, joints become mobile). An adult may not be aware of a diagnosis made by chance during an ultrasound scan. As a result of the disease in a person:
With dysplasia, the legs are not ready for long-term stress. A general “looseness” of the musculoskeletal system develops. If congenital dislocation in children is not corrected in time, the joint will gradually adapt to the abnormal motor function, take on a different shape and will not become fully functional. He will not adapt to providing support for the limb, to adequate abduction. The disease worsens a person’s quality of life and is fraught with potential danger – there may be difficulties with the nervous and vascular supply to the leg.
Orthopedic devices will no longer help an adult; the formation of the body has long been completed. Medicine will eliminate hip dysplasia even in an elderly person, exclusively through surgery or with the help of prosthetics.
Aggravating diseases
Neoarthrosis is considered an aggravating disease - in the pelvic bone tissue a new joint is formed. The body will adapt if the dislocation of the femur is not corrected. The pelvic bones and femur will change during growth: the acetabulum gradually heals, a new cavity will form. Such an adaptation of the body leads to shortening of the hip and difficulties with the functions of the muscles located nearby. Neoarthrosis is not an alternative to a full-fledged joint, but it can perform the functions of a healthy component of the body for decades.
Doctors consider coxarthrosis of the hip joint to be a difficult consequence of dysplasia - a disease that gradually destroys the hip joint. According to statistics, more than 86% of cases of this disease are the result of dysplasia. Typically, coxarthrosis appears at the age of 25-35 years against the background of decreased physical activity or pregnancy.
The onset of the disease is acute, the disease progresses quickly. The patient is worried about strong constant pain, osteochondrosis of the spine develops, motor activity decreases, gait changes, which develops into ankylosis - a pathology when the joint is set to a state of flexion. causes disability, inability to move without a cane. There are cases when the diseased leg becomes shorter, surgery to replace the joint is possible, otherwise the person loses his ability to work.
How to recognize dysplasia
Parents of newborns should immediately show their child to an orthopedic doctor if:
- the baby's legs are of different lengths;
- asymmetrical folds on the buttocks;
- there is an extra fold on the thigh;
- the legs are retracted asymmetrically;
- the baby’s knees do not touch the surface of the table when the legs are abducted, they cannot be fully abducted;
- the child’s hip joint moves easily, with a characteristic click (you can hear the head of the femur popping out of the acetabulum).
When the baby has already begun to walk independently, or is over a year old, parents should be alert to:
- “duck walk”, the little one sways in different directions when walking;
- the child's habit of walking on his toes.
How earlier illness revealed, the better for health. Medical practice shows that in 90% of newborns with initial type dysplasia, the disease goes away by six months of age, provided they undergo treatment and follow doctor’s instructions.
If the disease is diagnosed after six months, treatment in children takes a long period, the result will be worse (surgical intervention is possible). If a diagnosis of “dysplasia” is made to a child who has already learned to walk, unfortunately, one cannot count on a full recovery. Treatment of dysplasia diagnosed after 12 years of age can last for decades. The consequences are unpredictable, so newborn pathologies should be treated on time and visits to the clinic should not be missed.
Diagnosis, treatment and prevention
Newborns are examined in the maternity hospital. In older children, hip dysplasia is diagnosed using ultrasound. Ultrasound machines are available, the procedure is not harmful to health, and can be performed on children starting from 4 months of age. For children over 6 months of age, mandatory x-rays are prescribed. There are known cases of dysplasia in newborns that are not accompanied by well-known symptoms (18%), for this reason it is possible to accurately establish a diagnosis only with the help of ultrasound or x-ray examination.
The rate of recovery in children is directly related to the time of diagnosis. The younger the baby, the easier it is to treat. Properly selected treatment will help the hip joint mature in a child’s body.
Doctors choose methods to eliminate the disorder based on the degree of the disease. For treatment, soft devices (for newborns) and splints are widely used to help position the sick baby correctly, fixing the legs at a right angle. If there is a dislocation of the joint, a gentle correction will be carried out by an osteopath, who will need a number of sessions to bring it back to normal. Massage, physical therapy and physiotherapy are effective for treatment:
- ozokerite;
- amplipulse;
- electrophoresis;
- mud therapy.
- preventive massage once a quarter;
- the use of special devices for carrying newborns, allowing them to keep their legs wide apart (slings, ergo backpacks, car seats).
The health of children is a great happiness for parents. Unfortunately, this is not always the case. Newborn babies from 5 to 20 cases are diagnosed with hip dysplasia. Collocation "hip dysplasia" shocks all parents. However, there is no need to panic; it is important to correctly diagnose this disease and take immediate action.
What is hip dysplasia?
The baby has an unformed hip joint, this physiological phenomenon. As a result, it is mobile and can come out of the articular cavity. This affects the fact that it may develop incorrectly, and then a diagnosis of hip dysplasia is made.
In the international classification of this disease (ICD-10 code), it is assigned separate group and class Q 65.0 - 65.5. We are talking about congenital dislocation of the hip joints.
This pathology requires serious medical intervention. Rather painstaking and attentive attitude on the part of parents in order to avoid future complications in the form of inflammation, acute pain and lameness.
Structure of the hip joint
The hip joint differs from many joints in that it carries a large range of movements. It can move and rotate in different directions. The femur has a thin neck and head. IN in good condition there is a distance from the head to the cavity itself. The head should be in the center and clearly fixed by ligaments.
In utero, the fetus does not experience stress on the joints, and at birth the baby does not have any stress. These ligaments and muscles do not form. Sometimes at birth they discover that the head is not where it should be.
In the early stages it is necessary to put the head in place. It is important to do this before you start walking, while there is no load on the joint. Otherwise, hip dislocation is possible. It is called innate. Although practice shows that children are not born with such a pathology. You can foresee the development of some problems with the joint in the future.
Hip dislocation
Dysplasia exists in mild degree, medium and heavy.
It is designated as preluxation, subluxation, dislocation of the hip:
- Pre-luxation characterizes light form diseases. It belongs to the first degree. Indicates incomplete dynamics of joint development. In this situation, the head does not move relative to the socket.
- Subluxation characterizes the second degree of dysplasia. With this disease, there is an incomplete displacement of the head in relation to the glenoid cavity.
- Hip dislocation– this is the third degree of the disease and is characterized by 100% displacement of the head in relation to the glenoid cavity.
Degrees of joint dysplasia
Stories from our readers!
I want to tell my story about how I cured osteochondrosis and hernia. Finally, I was able to overcome this unbearable pain in my lower back. I'm leading active image life, I live and enjoy every moment! A few months ago I got twisted at the dacha, sharp pain in the lower back prevented me from moving, I couldn’t even walk. The doctor at the hospital diagnosed osteochondrosis of the lumbar spine, herniated discs L3-L4. He prescribed some medications, but they did not help, the pain was unbearable. They called an ambulance, they put a blockade and hinted at an operation, I kept thinking about this, that I would turn out to be a burden for the family... Everything changed when my daughter gave me an article to read on the Internet. You can’t imagine how grateful I am to her for this. This article literally pulled me out of my wheelchair. In recent months I have started to move more; in the spring and summer I go to the dacha every day. Who wants to live a long and energetic life without osteochondrosis,
Causes of the disease
Some time before childbirth and during the process itself, the woman in labor produces a special hormone, relaxin, which makes the ligaments more elastic. It is produced so that the mother can give birth. It makes the mother's hip joint mobile.
Relaxin acts simultaneously on mother and fetus. And if the fetus is a girl, then her ligaments are more susceptible to the influence of this hormone than boys. Therefore, dysplasia occurs more often in girls than in boys. According to the most conservative estimates, for every 1 boy with dysplasia there are 5 girls. More often this ratio is 1:9.
In primiparous women, the concentration of this hormone is maximum. Therefore, when a woman gives birth to a girl as her first child, such a child is closely monitored.
Other reasons are: 
- Heredity.
- Often it is a large fruit. The baby may not have enough space in utero, and the leg is often crushed, so the joint does not develop normally.
- If the mother in labor is malnourished, the child may not receive enough nutrients for full development.
- Infection of a child due to mother's illness.
- Taking toxic drugs that affect bone and destroy it.
- Tight swaddling of the baby in the first days.
Forms of development of dysplasia
There are following types or forms of dysplasia: 
- Acetabular(cotabular dysplasia). Characterized by pathology of the cocetabulum pelvic bone, its flattening occurs, and disturbances occur in the limbus cartilages. The joint, along with the head and muscles, do not develop normally.
- Rotary appears when a child’s joints are delayed in development. Two important joints do not function well with each other - the hip and knee. Manifests itself in the form of childhood clubfoot.
- Epiphyseal(dysplasia of the proximal femur). The appearance of pain symptoms and deformities of the legs is typical. Movement in the hip joint is impaired. The head of the joint ossifies and it becomes fragile. Therefore, changes occur in the position of the femoral neck.
- Transient dysplasia- This is a change in the shape of the femoral head. This stage is considered the most dangerous. It happens more often to girls. In this case, a violation of the anatomy of the joints occurs. The condition of the ligaments is disturbed. Sometimes the head extends beyond the socket.
The disease can be unilateral or bilateral, depending on the involvement of one or both joints.
Methods for determining dysplasia at home
There are 3 important indicators so that a mother can recognize the first signs: 
- Folds. Their symmetry. Gluteal and thigh. If they are not the same, but are located at different depths and at different levels, this is a signal! It is urgent to show the baby to a specialist.
- Same knee height. The child is placed on his back, and his legs are bent at the hip joint and knee joint. The height of the knees should be the same. If not, this is a reason to contact a specialist.
- Uniformity of leg spread. The child's legs should be spread evenly in both directions. This is the norm. If one leg is more spread apart than the left one, this is a reason to consult a specialist. More often this happens with the left leg.
If the baby has the same folds, knees at the same level, and legs spread equally, this does not mean that you should ignore a visit to a specialist. Because there is bilateral dysplasia, when both legs are crooked. In such a situation, everything will be symmetrical, but the situation will be bad.
Therefore, you need to regularly attend preventive examinations of specialists to identify and detect signs at an early stage!
Signs of dysplasia
Diagnosis of dysplasia
In some infants, in a certain position, when the legs are spread apart, a click is heard. This indicates that the femoral head is in an unstable position. A visit to an orthopedist is also indicated.
As the child ages, the data changes. From the age of 4 months, if there is a possibility of a disorder of the hip joint, the baby is recommended for X-ray diagnosis in order to exclude it or confirm it.
Diagnostics means:
- Thorough examination by a pediatrician. If a pathology is suspected, the doctor sends for examination:
- And .
- If dysplasia is suspected, the doctor may order an x-ray examination. X-ray diagnostics will show the whole picture of the condition of the joints.
Defining Angles
Hip angles
After an ultrasound, the doctor draws three lines on the result of the image that form the alpha and beta angles:
- Emphasizes the formation of ossification nuclei.
- The data is compared with the Graph table, where the alpha angle shows the correct development of the acetabulum in the child.
- When a doctor examines the beta angle, he has information about the degree of development of the cartilaginous zone.
- In infants under 3 months, the alpha angle is more than 60 degrees, the beta angle is less than 55. This is considered normal.
Hip angles
Deviation from the norm and interpretation of results
In the case when the alpha angle is 43 and its limits do not go beyond 49 degrees, and the beta is more than 77, the child, based on the results of the x-ray examination, is given a verdict of subluxation; if the alpha angle is less than 43 degrees, the child is given a dislocation.
The transcript of the results looks like this.
| 1 type | Norm | A – the hip joint is formed correctly, B – the cartilaginous plate is expanded and has a limited length |
| 2nd view | Delay | A – delayed formation (up to 3 months), B – delayed formation (after 3 months), shown orthopedic treatment, C – pre-dislocation. |
| 3rd view | Subluxation | A – the head of the femur is displaced, the cartilaginous structure is normal. Presence of structural changes |
| 4 view | Dislocation | The hip joint has a pathology; the cartilaginous protrusion does not cover the head of the femur. |
Read also
Dysplasia in children older than 6 months
Orthopedists realign the femoral head. At the same time, the leg is pulled out and fixed with a plaster cast. Works efficiently. After this procedure, which is performed without anesthesia, the legs are fixed for 4 months or more.
After removing the plaster, a spacer splint is installed on the baby’s legs. Its width varies. Over time, the distances between the struts decrease. It is removed when the joint is completely restored.
If residual dysplasia remains, then it is necessary to engage in physical therapy with specialists.
In children under 1 year of age and one-year-olds, manifestations of dysplasia are observed:
- Inability to abduct the hips evenly.
- Asymmetry of skin folds.
- The presence of a click when moving the joints apart.
- Different leg lengths.
- The affected limb is turned outward. Observed during sleep.
Treatment
Fixing orthopedic devices
When the diagnosis is confirmed, doctors recommend using it to keep the child’s joints in an extended position. They use Pavlik stirrups, tires, Freik pillows, special pants and others. Recommend constant wearing up to 1 year of the baby's life.
They are important for the baby both in the present time and as a manifestation of the child’s future. To prevent diseases in adulthood, such as scoliosis and osteochondrosis.
Pavlik stirrups Fixed with plaster
Wide swaddling is required:
- It is strictly forbidden to carry or lay down the baby when his legs are hanging down or pressed tightly against him.
- With this method, the baby’s arms are tightly fixed to the body line, and the legs can be in free “flight”.
- Orthopedic devices fix the child’s hip joint. The legs are bent and spread apart.
Gymnastics and physical therapy
Why is hip dysplasia dangerous?
Hip dislocation will occur and the person may limp for life if not treated early. An inflammatory process appears, and this sharp pains and limited mobility.
If you do not treat prematurely with conservative methods - massage, special orthopedic stirrups, plaster casting, splints - then surgical interventions are possible in the future to eliminate this problem.
IMPORTANT! The specificity of dysplasia is that timely intervention eliminates major consequences that may arise in the future. At 1.5-2 years of age, dysplasia threatens with lameness if it is not diagnosed and treated.
Prevention
The main goal for this disease is to fix the head of the hip bone in the articular cavity. It is necessary to give it the opportunity to acquire ligaments so that it does not move in the future. If the child’s legs are fixed in the correct position (bent and apart), the head of the femur rises to its desired state and is strengthened by this position.
Today, a device for carrying infants called a sling has become fashionable. It is comfortable for mother and baby, and in addition helps to avoid problems with dysplasia in the future, since in the sling the baby’s legs are widely spread and pressed against the mother.
The sling will help prevent dysplasia
Tips for preventing dysplasia by Dr. Komarovsky
Doctor Komarovsky's advice will always help your child: 
- If your child is diagnosed with dysplasia, do not panic, and take good care of the baby.
- Wide swaddling shown and a diaper one size larger. Do not encourage standing and the desire to walk; let the child crawl longer.
- Use butt massage, do gymnastics.
- Take targeted actions aimed at preventing dysplasia.
- Mandatory visit to an orthopedic doctor every 3 months. In 2-3% of people during adolescence, problems with the hip joint may develop. At an older age, something that was not cured at a younger age, before starting to walk, manifests itself. Early correction allows you to solve this issue once and for all.
- Follow your doctor's recommendations which he will give based on the child’s condition
- There should be a dialogue between parents and doctor. Both are responsible.
- If parents like to dress their baby in overalls, Instead of regular diapers and blankets, it is important to know that there should be enough space at the bottom of the onesies so that the baby can move his legs freely.
Hip dysplasia is a congenital disorder of the joint formation process, which can cause dislocation or subluxation of the femoral head. There is either underdevelopment of the joint or its increased mobility in combination with insufficiency connective tissue. IN early age manifested by asymmetry of skin folds, shortening and limitation of hip abduction. Subsequently, pain, lameness, and increased fatigue of the limb are possible. Pathology is diagnosed based on characteristic signs, ultrasound data and x-ray examination. Treatment is carried out using special means of fixation and exercises for muscle development.
ICD-10
Q65.6 Q65.8
General information
Hip dysplasia (from the Greek dys - disorder, plaseo - form) is a congenital pathology that can cause subluxation or dislocation of the hip. The degree of joint underdevelopment can vary greatly - from gross violations to increased mobility combined with weakness ligamentous apparatus. To prevent possible negative consequences Hip dysplasia must be identified and treated early - in the first months and years of the baby’s life.
Hip dysplasia is one of the most common congenital pathologies. According to experts in the field of traumatology and orthopedics, the average frequency is 2-3% per thousand newborns. There is a dependence on race: in African Americans it is observed less frequently than in Europeans, and in American Indians it is observed more often than in other races. Girls get sick more often than boys (about 80% of all cases).
Reasons
The occurrence of dysplasia is due to a number of factors. There is a clear hereditary predisposition - this pathology 10 times more often observed in patients whose parents suffered from a congenital disorder of the development of the hip joint. The likelihood of developing dysplasia increases 10 times with a breech presentation of the fetus. In addition, the likelihood of this pathology occurring increases with toxicosis. medicinal correction pregnancy, large fetus, oligohydramnios and some gynecological diseases in the mother.
Researchers also note a connection between the incidence rate and unfavorable environmental conditions. In environmentally disadvantaged regions, dysplasia is observed 5-6 times more often. The development of dysplasia is also influenced by national traditions of swaddling babies. In countries where newborns are not swaddled and the baby's legs are in a position of abduction and flexion most of the time, dysplasia is less common than in countries with traditions of tight swaddling.
Pathogenesis
The hip joint is formed by the head of the femur and the acetabulum. In the upper part, a cartilaginous plate is attached to the acetabulum - the acetabular lip, which increases the area of contact of the articular surfaces and the depth of the acetabulum. The hip joint of a newborn baby, even normally, differs from the joint of an adult: the acetabulum is flatter, located not obliquely, but almost vertically; ligaments are much more elastic. The femoral head is held in the socket by the round ligament, articular capsule, and acetabular labrum.
There are three forms of hip dysplasia: acetabular (impaired development of the acetabulum), dysplasia of the upper femur and rotational dysplasia, in which the geometry of the bones in the horizontal plane is disrupted.
If the development of any part of the hip joint is disrupted, the acetabulum, articular capsule and ligaments cannot hold the femoral head in its proper place. As a result, it moves outward and upward. In this case, the acetabular labrum also shifts, finally losing its ability to fix the head of the femur. If the articular surface of the head partially extends beyond the socket, a condition occurs, called subluxation in traumatology.
If the process continues, the femoral head moves even higher and completely loses contact with the glenoid cavity. The acetabular labrum appears below the head and wraps inside the joint. Dislocation occurs. If left untreated, the acetabulum gradually fills with connective and fatty tissue, making reduction difficult.
Symptoms of dysplasia
Hip dysplasia is suspected when there is shortening of the hip, skin fold asymmetry, limited hip abduction, and the Marx-Ortolani slip sign. Asymmetry of the inguinal, popliteal and gluteal skin folds is usually better identified in children older than 2-3 months. During the examination, pay attention to the difference in the level of location, shape and depth of the folds.
It should be taken into account that the presence or absence of this characteristic not enough to make a diagnosis. With bilateral dysplasia, the folds can be symmetrical. In addition, the symptom is absent in half of children with unilateral pathology. Asymmetry of inguinal folds in children from birth to 2 months is not very informative, since it sometimes occurs even in healthy infants.
The symptom of shortening of the femur is more reliable in diagnostic terms. The child is placed on his back with his legs bent at the hip and knee joints. The location of one knee lower than the other indicates the most severe form of dysplasia - congenital hip dislocation.
But the most important sign indicating congenital dislocation of the hip is the “click” or Marx-Ortolani symptom. The baby is lying on his back. The doctor bends his legs and clasps his thighs with his palms so that the II-V fingers are located on the outer surface, and thumbs– on the inside. Then the doctor evenly and gradually moves the hips to the sides. With dysplasia, a characteristic push is felt on the affected side - the moment when the head of the femur is reduced into the acetabulum from a dislocated position. It should be borne in mind that the Marx-Ortolani symptom is not informative in children in the first weeks of life. It is observed in 40% of newborns, and subsequently often disappears without a trace.
Another symptom indicating joint pathology is limited movement. In healthy newborns, the legs are abducted to a position of 80-90° and laid freely on a horizontal table surface. If abduction is limited to 50-60°, there is reason to suspect a congenital pathology. In a healthy child of 7-8 months, each leg is abducted by 60-70°, in a baby with congenital dislocation - by 40-50°.
Complications
With minor changes and no treatment, there may be no painful symptoms at a young age. Subsequently, at the age of 25-55 years, the development of dysplastic coxarthrosis (arthrosis of the hip joint) is possible. As a rule, the first symptoms of the disease appear against the background of a decrease in physical activity or hormonal changes during pregnancy.
Characteristic features of dysplastic coxarthrosis are acute onset and rapid progression. The disease is manifested by unpleasant sensations, pain and limitation of movements in the joint. In the later stages, a vicious position of the hip is formed (the leg is turned outward, bent and adducted). Movements in the joint are sharply limited. In the initial period of the disease greatest effect is ensured through properly selected physical activity. With pronounced pain syndrome and vicious installation of the hip, endoprosthetics is performed.
With unreduced congenital dislocation of the hip, over time, a new defective joint is formed, combined with shortening of the limb and impaired muscle function. Currently, this pathology is rare.
Diagnostics
A preliminary diagnosis of hip dysplasia can be made in the maternity hospital. In this case, you need to contact a pediatric orthopedist within 3 weeks, who will conduct the necessary examination and draw up a treatment regimen. In addition, to exclude this pathology, all children are examined at the ages of 1, 3, 6 and 12 months.
Particular attention is paid to children who are at risk. This group includes all patients with a history of maternal toxicosis during pregnancy, a large fetus, breech presentation, as well as those whose parents also suffer from dysplasia. If signs of pathology are detected, the child is referred for additional studies.
A clinical examination of the baby is carried out after feeding, in a warm room, in a calm, quiet environment. To clarify the diagnosis, techniques such as radiography and ultrasonography are used. In young children, a significant part of the joint is formed by cartilage, which is not displayed on x-rays, so this method is not used until 2-3 months of age, and then special diagrams are used when reading images. Ultrasound diagnostics is a good alternative to x-ray examination in children in the first months of life. This technique is practically safe and quite informative.
It should be borne in mind that the results of additional studies alone are not enough to make a diagnosis of hip dysplasia. The diagnosis is made only when it is identified as clinical signs, as well as characteristic changes on radiographs and/or ultrasonography.
Treatment of hip dysplasia
Treatment should begin as early as possible. Are used various means to hold the child’s legs in the position of flexion and abduction: devices, splints, stirrups, panties and special pillows. When treating children in the first months of life, only soft elastic structures are used that do not interfere with the movements of the limbs. Wide swaddling is used when it is impossible to carry out full treatment, as well as during the treatment of babies at risk and patients with signs of an immature joint identified during ultrasonography.
One of the most effective ways treatment of children younger age are Pavlik stirrups - a product made from soft fabric, which is a chest bandage to which a system of special straps is attached that holds the child’s legs abducted to the sides and bent at the knee and hip joints. This soft design fixes the baby's legs in the desired position and, at the same time, provides the child with sufficient freedom of movement.
Play a major role in restoring range of motion and stabilizing the hip joint. special exercises to strengthen muscles. At the same time, for each stage (spreading the legs, keeping the joints in the correct position and rehabilitation), a separate set of exercises is compiled. In addition, during treatment, the child is prescribed a massage of the gluteal muscles.
In severe cases, a one-stage closed reduction of the dislocation is performed, followed by immobilization with a plaster cast. This manipulation is performed in children from 2 to 5-6 years old. Once the child reaches the age of 5-6 years, reduction becomes impossible. In some cases, with high dislocations in patients aged 1.5-8 years, skeletal traction is used. If ineffective conservative therapy Corrective operations are performed: open reduction of the dislocation, surgical interventions on the acetabulum and the upper part of the femur.
Prognosis and prevention
With early initiation of treatment and timely elimination pathological changes the prognosis is favorable. In the absence of treatment or if therapy is insufficiently effective, the outcome depends on the degree of hip dysplasia; there is a high probability of early development of severe deforming arthrosis. Prevention includes examinations of all young children, timely treatment identified pathology.
is a violation of the development of all components of the joint, which occurs in the fetus, and then during a person’s life. Dysplasia leads to a violation of the configuration of the joint, which causes a violation of the correspondence of the femoral head and the glenoid cavity on the pelvic bones - a congenital dislocation of the hip joint is formed.
On average, the prevalence of pathology is 2 - 4%, it differs in different countries. Thus, in Northern Europe, hip dysplasia occurs in 4% of children, in Central Europe - in 2%. In the USA - 1%, and among the white population the disease is more common than among African Americans. In Russia, 2–4% of children suffer from hip dysplasia, and up to 12% in environmentally unfavorable areas.
Anatomy of the hip joint
The hip joint is formed by the acetabulum of the pelvis and the head of the femur.The acetabulum has the appearance of a semicircular bowl. Along its edge there is cartilage in the form of a rim, which complements it and limits movement in the joint. So the joint is 2/3 of the ball. The cartilaginous rim, which complements the acetabulum, is covered from the inside with articular cartilage. The bone cavity itself is filled with fatty tissue.
The head of the femur is also covered with articular cartilage. It has a spherical shape and is connected to the body of the bone using the femoral neck, which has a small thickness.
The joint capsule is attached along the edge of the acetabulum, and on the femur it covers the head and neck.
There is a ligament inside the joint. It starts from the very top of the femoral head and joins the edge of the glenoid cavity.
It is called the femoral head ligament and has two functions:
- depreciation of loads on the femur during walking, running, jumping injuries;
- it contains vessels that supply the head of the femur.
- flexion and extension;
- adduction and abduction;
- turns in and out.
Signs of hip dysplasia in a child
Risk factors for hip dysplasia in newborns:- breech presentation of the fetus(the fetus is in the womb not with the head towards the exit of the uterus, but with the pelvis);
- fetus large sizes;
- the presence of hip dysplasia in the child’s parents;
- toxicosis of pregnancy in the expectant mother, especially if pregnancy occurs at a very young age.
To identify hip dysplasia, the child should be examined by an orthopedist. Visits to this specialist at the clinic in the first year of a child’s life are mandatory. certain deadlines.
The room where the examination will be carried out must be warm. The child is completely undressed and placed on a table.
The main symptoms of hip dysplasia, which are revealed during examination:
If hip dysplasia and congenital hip dislocation persist in older age, gait disturbance is observed. When the child is in an upright position, asymmetry of the gluteal, inguinal, and popliteal folds is noticeable.
Types and degrees of dysplasia
In a newborn, the muscles and ligaments that surround the hip joint are poorly developed. The femoral head is held in place mainly by ligaments and a cartilaginous rim located around the acetabulum.Anatomical disorders that occur with hip dysplasia:
- abnormal development of the acetabulum, it partially loses its spherical shape and becomes flatter and smaller in size;
- underdevelopment of the cartilaginous rim, which surrounds the acetabulum;
- weakness of the hip ligaments.
- Degrees of hip dysplasia
- Dysplasia itself. There is abnormal development and inferiority of the hip joint. But its configuration has not yet been changed. In this case, it is difficult to identify pathology during examination of the child; this can only be done with the help of additional methods diagnostics Previously, this degree of dysplasia was not considered a disease; it was not diagnosed or prescribed treatment. Today such a diagnosis exists. Overdiagnosis occurs relatively often when doctors “identify” dysplasia in a healthy child.
- Pre-luxation. The hip joint capsule is stretched. The head of the femur is slightly displaced, but it easily “falls” back into place. Subsequently, preluxation transforms into subluxation and dislocation.
- Hip subluxation. The head of the hip joint is partially displaced relative to the socket. It bends the cartilaginous rim of the acetabulum and moves it upward. The femoral head ligament (see above) becomes tight and stretched
- Hip dislocation. In this case, the head of the femur is completely displaced relative to the acetabulum. It is located outside the cavity, above and outward. The upper edge of the cartilaginous rim of the acetabulum is pressed by the head of the femur and bent into the joint. The joint capsule and ligament of the femoral head are stretched and tense.
Types of hip dysplasia
- Acetabular dysplasia. A pathology that is associated with impaired development of only the acetabulum. It is flatter and reduced in size. The cartilaginous rim is underdeveloped.
- Femoral dysplasia. Normally, the femoral neck articulates with the body at a certain angle. Violation of this angle (decrease - coxa vara or increase - coxa valga) is a mechanism for the development of hip dysplasia.
- Rotational dysplasia. Associated with a violation of the configuration of anatomical formations in the horizontal plane. Normally, the axes around which all joints of the lower limb move do not coincide. If the mismatch of the axes goes beyond the normal value, then the position of the femoral head in relation to the acetabulum is disrupted.
X-ray diagnosis of hip dysplasia
In young children, ossification of some parts of the femur and pelvic bones has not yet occurred. In their place are cartilages that are not visible on x-rays. Therefore, in order to evaluate the correctness of the configuration anatomical structures hip joint, special schemes are used. Photographs are taken in direct projection (full face), on which conditional auxiliary lines are drawn.
Additional lines that help in diagnosing hip dysplasia from radiographs:
- midline- a vertical line that runs through the middle of the sacrum;
- Hilgenreiner line- a horizontal line that is drawn through the lowest points of the iliac bones;
- Perkin line- a vertical line that passes through the upper outer edge of the acetabulum on the right and left;
- Shenton line- this is a line that mentally continues the edge of the obturator foramen of the pelvic bone and the neck of the femur.
Normal indicators of the acetabular angle in children of different ages:
- in newborns - 25 - 29°;
- 1 year of life - 18.5° (in boys) - 20° (in girls);
- 5 years - 15° in both sexes.
The h value is another important indicator that characterizes the vertical displacement of the femoral head in relation to the pelvic bones. It is equal to the distance from the Hilgenreiner line to the middle of the femoral head. Normally, in young children, the h value is 9 - 12 mm. The presence of dysplasia is indicated by enlargement or asymmetry.
Magnituded.
This is an indicator that characterizes the displacement of the femoral head outward from the glenoid cavity. It is equal to the distance from the bottom of the glenoid cavity to the vertical line h.
Ultrasound diagnosis of hip dysplasia
Ultrasonography ( ultrasound diagnostics) hip dysplasia is the treatment of choice in children under 1 year of age.
The main advantage of ultrasound is diagnostic method is that it is quite accurate, does not cause harm to the child’s body and has practically no contraindications.
Indications for ultrasonography in young children:
- the presence of factors in the child that allow him to be classified as at risk for hip dysplasia;
- identifying signs characteristic of the disease during a child’s examination by a doctor.
Indicators that are assessed during ultrasound diagnosis of hip dysplasia:
- alpha angle - an indicator that helps to assess the degree of development and the angle of inclination of the bony part of the acetabulum;
- beta angle is an indicator that helps assess the degree of development and angle of inclination of the cartilaginous part of the acetabulum.
For young children, the preferred type of examination for suspected hip dysplasia and congenital hip dislocation is ultrasound diagnostics due to its high informativeness and safety. Despite this, in most cases, radiography is used in clinics, since it is a simpler and faster diagnostic method.
Types of hip joints, which are distinguished depending on the picture obtained during an ultrasound examination:
| Joint type | Norm | Hip dysplasia | Subluxation | Dislocation |
|||||||
| Classification within type | A | B | A | B | C | A | B | ||||
| The shape of the edge of the acetabulum, which is located above the femoral head | Rectangular | In the form of a semicircle | Beveled | Beveled |
|||||||
| The position of the edge of the acetabulum, which is located above the femoral head | Located horizontally. | Positioned horizontally but shortened | Slightly bent inside the joint cavity. | Strongly bent inside the joint cavity. |
|||||||
| Cartilage covering the head of the femur | | Normally encloses the head of the femur | Shortened, its shape changed | Shortened, deformed. Does not completely cover the head of the femur. Tucked inside the hip joint. |
|||||||
| Structural changes No. | There are structural changes. |
||||||||||
| alpha angle | > 60° | 50-59° | 43-49° | > 43° | 43° |
||||||
| beta angle | < 55° | > 55° | 70-77° | > 77° | > 770 |
||||||
| Femoral head position: at rest; while driving. | Is in normal position; | Is in normal position; | Deflected outward; Deflected outward. | Deflected outward; Deflected outward. |
|||||||
| It is in normal position. | Slightly deviated outward. | ||||||||||
Treatment of hip dysplasia
Wide swaddling of baby
Wide swaddling can rather be attributed not to therapeutic, but preventive measures with hip dysplasia.Indications for wide swaddling:
- the child is at risk for hip dysplasia;
- During an ultrasound scan, immaturity of the hip joint was revealed in a newborn child;
- there is hip dysplasia, while other treatment methods are impossible for one reason or another.
- the child is placed on his back;
- two diapers are placed between the legs, which will limit the bringing of the legs together;
- These two diapers are fixed on the child’s belt with the third one.
Wearing orthopedic structures
Pavlik stirrups- an orthopedic design developed by Czech doctor Arnold Pavlik in 1946. Previously, rigid structures were mainly used, which were poorly tolerated by small children and led to complications in the form of aseptic necrosis of the femoral head. Pavlik stirrups are a soft design. It allows the child to move more freely in the hip joints.
The structure of Pavlik's stirrups:
- chest bandage, which is attached using straps thrown over the child’s shoulders;
- shin guards;
- straps, connecting bandages on the chest and legs: the two rear ones spread the legs to the sides, and the two front ones bend the legs at the knee joints.
Frejk bandage (Frejk splint, Frejk abduction panties)
Freyk's panties work on the principle of wide swaddling. They are made of dense material and ensure constant separation of the child’s legs by 90° or more.
Indications for wearing a Freika splint:
- hip dysplasia without dislocation;
- hip subluxation.
Vilensky tire
is an orthopedic design that consists of two leather straps with lacing and a metal spacer between them. The first application of the Vilensky Splint on a child is carried out at an appointment with an orthopedic doctor.
Correct placement of a Vilensky splint on a child:
- place the child on his back;
- spread your legs apart as shown by the doctor at the appointment;
- insert one foot into the leather strap on the appropriate side of the tire and lace it securely;
- put your other leg into the other belt and lace it up.
Basic rules for wearing a Vilensky splint:
- Careful lacing. If the straps are laced correctly and tightly enough, they should not slip.
- Constant wearing. Typically, Vilensky splints are prescribed for 4 to 6 months. They cannot be removed during this entire period. This is only allowed while the child is bathing.
- Precisely adjusted spacer length. The adjustment is made by the doctor using a special wheel. During play, the child can move it. In order to prevent this, you need to secure the wheel with electrical tape.
- The splint must not be removed even while changing the child's clothes.. For convenience, you need to wear special clothes with buttons.
We can say that this tire is a modification of the Vilensky tire. It also consists of two cuffs that are fixed on the shins, and a spacer located between them.
Tübinger splint (orthosis)
Can be considered a combination of the Wilensky splint and Pavlik stirrups.
Tübinger bus device:
- two saddle-shaped leg struts connected to each other by a metal rod;
- shoulder pads;
- the “strings of pearls” that connect the spacers to the shoulder pads at the front and back are adjustable in length and allow you to change the degree of flexion in the hip joints;
- special Velcro, which is used to fix the orthosis.
- for age 1 month. with spacer length 95-130 mm;
- for ages 2 - 6 months. with spacer length 95-130 mm;
- for ages 6 - 12 months. with spacer length 110-160 mm.
The Volkov splint is an orthopedic design that is currently practically not used. It is made of polyethylene and consists of four parts:
- a crib that fits under the child’s back;
- the upper part, which is located on the tummy;
- side parts that accommodate the shins and thighs.
The Volkov splint can be used in children under 3 years of age. Available in 4 sizes.
Disadvantages of the Volkov tire:
- it is very difficult to choose the size for a specific child;
- the hips are fixed in only one position: it cannot be changed depending on changes in the configuration of the hip joint on radiographs;
- the design quite severely limits the child’s movements;
- high cost.
Massage for hip dysplasia
Massage for hip dysplasia is carried out only as prescribed by an orthopedic doctor, who is guided by the results of the examination and X-ray and ultrasound data. Massage can be performed in the presence of orthopedic structures (splints, see above), without removing them.
- The child must be placed on a hard, flat surface. A changing table is best.
- During the massage, an oilcloth is placed under the child, since stroking the tummy and other actions of the massage therapist can provoke urination.
- A massage course usually consists of 10 - 15 sessions.
- The massage is carried out once a day.
- For the session, you need to choose a time when the child has slept and is not hungry. It is optimal to carry out procedures in the first half of the day.
- In order for the effect to become noticeable, you need to conduct at least 2 - 3 courses of therapeutic massage.
- The break between courses is 1 - 1.5 months. This is a mandatory condition, since massage represents a fairly high load for children in the first year of life.
Approximate massage scheme for a child with hip dysplasia
| Starting position | Manipulation |
| Lying on your back. | General massage: stroking and light rubbing of the tummy, chest, arms, legs (hips, legs, feet, soles). |
| Lying on your stomach with your legs apart and bent at the knees. |
|
| Lying on your back with your legs apart. |
|
Massage for children under one year of age also includes elements of gymnastics, which are also shown in the table.
Therapeutic exercises for hip dysplasia
Therapeutic gymnastics is always used in the conservative treatment of hip dysplasia. It continues during rehabilitation. Exercise therapy is indicated after reduction of hip dislocation, including surgical reduction.Goals of therapeutic exercises for hip dysplasia:
- promote the normal formation of the hip joint, restore its correct configuration;
- strengthen the thigh muscles that will support the head of the femur in the correct position relative to the acetabulum;
- ensure normal physical activity of the child;
- promote normality physical development a child suffering from hip dysplasia;
- ensure normal blood supply and nutrition to the hip joint, prevent complications, for example, aseptic necrosis of the femoral head.
Physical activity necessary for normal development of the hip joint in children under 3 years of age:
- hip flexion in an extended position while lying on your back;
- independent transitions from a lying position to a sitting position;
- crawl;
- transition from a sitting position to a standing position;
- walking;
- formation of throwing skill;
- a set of exercises for the leg muscles;
- a set of exercises for the abdominal muscles;
- a set of breathing exercises.
Physiotherapy for hip dysplasia
| Procedure | Description | Application |
Electrophoresis:
| The drug is injected directly through the skin into the joint using a weak direct electric current. Calcium and phosphorus help strengthen, correct formation joint |
|
| Applications with ozokerite | Ozokerite is a mixture of paraffins, resins, hydrogen sulfide, carbon dioxide, and mineral oils. When heated (approximately 50°C), it has the ability to improve blood circulation and tissue nutrition, and accelerate recovery. | For hip dysplasia, ozokerite is used, heated to 40 - 45°C. Applications are made: a piece of cloth soaked in ozokerite is applied to the skin, then covered with cellophane and a layer of cotton wool or something warm. |
| Fresh warm baths | Warm water acts almost the same as ozokerite: it improves blood circulation, tissue nutrition and accelerates recovery processes. | The child takes warm baths for 8 - 10 minutes at a temperature of 37°C. |
| UV therapy | Ultraviolet rays penetrate the skin to a depth of 1 mm, stimulating protective forces, regenerative processes, improving blood circulation. | UV therapy is carried out according to a scheme that is selected individually for each child, depending on age, general condition, concomitant diseases and other factors. |
Reduction of congenital hip dislocation
The first closed bloodless reduction of congenital hip dislocation was performed in 1896 by the doctor Adolf Lorenz.
Indications for reduction of congenital hip dislocation:
- The presence of a mature hip dislocation, which is determined by radiography and/or ultrasound.
- The child is over 1 year old. Before this, the dislocation can be reduced relatively easily with the help of functional techniques(splints and orthoses, see above). But there is no single unambiguous algorithm. Sometimes a dislocation after 3 months of age cannot be corrected by any means other than surgery.
- The child's age is no more than 5 years. At an older age, it is usually necessary to resort to surgery.
- severe displacement of the femoral head, inversion of the articular capsule into the joint cavity;
- pronounced underdevelopment of the acetabulum.
Closed reduction for congenital hip dislocation is performed under anesthesia. The doctor, guided by X-ray and ultrasound data, performs a reduction - returning the femoral head to the correct position. Then, for 6 months, a coxite (on the pelvis and lower limbs) plaster cast is applied, which fixes the child’s legs in an extended position. After removing the bandage, massage, therapeutic exercises, and physiotherapy are performed.
Forecast
Some children develop a relapse after closed reduction of congenital hip dislocation. How older child, the more likely it is that you will eventually have to resort to surgery.
Surgical treatment of congenital hip dislocation
Types of surgical interventions for congenital hip dislocation:
- Open reduction of dislocation. During the operation, the doctor cuts through the tissue, reaches the hip joint, dissects the joint capsule and sets the head of the femur to its usual place. Sometimes the acetabulum is first deepened using a milling cutter. After surgery, apply plaster cast for 2 - 3 weeks.
- Surgeries on the femur. An osteotomy is performed - a section of the bone in order to give the proximal (closest to the pelvis) end of the femur the correct configuration.
- Operations on the pelvic bones. There are several options for this surgical interventions. Their main idea is to create a support above the femoral head that will prevent it from moving upward.
- Palliative operations. They are used in cases where correction of the configuration of the hip joint is impossible. Aimed at improving the general condition of the patient and restoring his performance.
Indications for surgery for congenital hip dislocation:
- The child was first diagnosed with dislocation at the age of 2 years.
- Anatomical defects that make closed reduction of a dislocation impossible: entrapment of the articular capsule inside the cavity of the hip joint, underdevelopment of the femur and pelvic bones, etc.
- Pinching of articular cartilage in the joint cavity.
- Severe displacement of the femoral head that cannot be reduced using a closed method.
- state of shock as a result of loss of large amounts of blood;
- osteomyelitis ( purulent inflammation) femur and pelvic bones;
- suppuration in the surgical area;
- aseptic necrosis (death) of the head of the femur is a fairly common lesion due to the fact that the head of the femur has some peculiarities of blood supply (the only vessel passes through the ligament of the femoral head and is easily damaged);
- nerve damage, development of paresis (limitation of movements) and paralysis (loss of movement);
- injuries during surgery: fracture of the femoral neck, pushing through the bottom of the acetabulum and penetration of the femoral head into the pelvic cavity.
Summary: problems in the treatment of hip dysplasia
Modern methods of diagnosing and treating hip dysplasia are still far from perfect. In outpatient settings (clinics), cases of underdiagnosis (the diagnosis is not made in time for existing pathology) and overdiagnosis (the diagnosis is made in healthy children) are still common.Many orthopedic structures and surgical treatment options have been proposed. But none of them can be called completely perfect. There is always a certain risk of relapses and complications.
They practice in different clinics different approaches to the diagnosis and treatment of pathology. Currently, research continues to be actively conducted.
Sometimes hip dysplasia and congenital hip dislocation are detected in adulthood. Most types of operations can be used up to 30 years, until signs of arthrosis begin to develop.
Forecast
If hip dysplasia was identified at an early age, then with proper treatment the disease can be completely eliminated.Many people live with hip dysplasia their entire lives without experiencing any problems. If this condition was discovered accidentally during an x-ray, the patient should be constantly monitored by an orthopedist and come for examinations at least once a year.
Complications of hip dysplasia
Disorders of the spinal column and lower extremities
With hip dysplasia, the motor skills of the spinal column, pelvic girdle, and legs are impaired. Over time, this leads to the development of poor posture, scoliosis, osteochondrosis, and flat feet.Dysplastic coxarthrosis
Dysplastic coxarthrosis is a degenerative, rapidly progressive disease of the hip joint, which usually develops between the ages of 25 and 55 in people with dysplasia.Factors that provoke the development of dysplastic coxarthrosis:
- hormonal changes in the body (for example, during menopause);
- stopping playing sports;
- overweight bodies;
- low physical activity;
- pregnancy and childbirth;
- injuries.
- feeling of discomfort and discomfort in the area of the hip joint;
- difficulty turning the hip and abducting it to the side;
- pain in the hip joint;
- difficulty in mobility in the hip joint, up to its total loss;
- eventually the hip flexes, adducts, and externally rotates, locking itself into that position.
If dysplastic coxarthrosis is accompanied by severe pain and significant impairment of mobility, then endoprosthetics (replacement with an artificial structure) of the hip joint is performed. Neoarthrosis
A condition that is now relatively rare. If a hip dislocation persists for a long time, then the joint undergoes restructuring with age. The femoral head becomes flatter.The acetabulum decreases in size. Where the head of the femur rests on the femur, a new articular surface forms and a new joint is formed. It is quite capable of providing various movements, and to some extent this condition can be considered as self-healing.
The femur on the affected side is shortened. But this disorder can be compensated, the patient is able to walk and maintain working capacity.
Aseptic necrosis of the femoral head
Aseptic necrosis of the femoral head develops due to damage blood vessels, which pass in the ligament of the femoral head (see above). Most often, this pathology is a complication of surgical interventions for hip dysplasia.As a result of poor circulation, the femoral head is destroyed, and movement in the joint becomes impossible. The older the patient, the more severe the disease, the more difficult it is to treat.
Treatment of aseptic necrosis of the femoral head is surgical endoprosthetics.
Why does hip dysplasia develop?
The causes of hip dysplasia remain unclear. Orthopedists cannot explain why, under equal conditions, some children develop this pathology and others do not. Modern medicine puts forward several versions.1. Effect of the hormone relaxin. It is released in a woman's body immediately before childbirth. Its function is to make the ligaments more elastic so that at the time of birth the baby can leave the pelvis. This hormone penetrates the fetal blood, affecting the hip joint and its ligaments, which stretch and cannot reliably fix the head of the hip bone. Due to the fact that female body more susceptible to the effects of relaxin; in girls, dysplasia is observed 7 times more often. 
2. Breech presentation of the fetus. When a child remains in this position for a long time later pregnancy, his hip joint experiences a lot of pressure. The uterus resembles an inverted triangle and there is less space in its lower part than under the diaphragm, so the baby's movements are limited. This impairs blood circulation and the maturation of the components of the hip joint, so in such children the risk of hip joint pathologies is 10 times higher. Childbirth in this position of the fetus is considered pathological due to high risk damage to the hip joint.
3. Low water. If in the third trimester the amount of amniotic fluid is less than 1 liter, then this complicates the movements of the fetus and threatens pathologies of the development of the musculoskeletal system.
4. Toxicosis. Its development is associated with the formation of a pregnancy center in the brain. Changes in hormonal, digestive and nervous system complicates pregnancy and affects the formation of the fetus.
5. Large fruit over 4 kg- in this case, the fetus experiences significant pressure from the internal organs during pregnancy, and it is more difficult for it to pass through the birth canal.
6. First birth before 18 years of age. Primiparous women have the highest levels of the hormone relaxin.
7. Mother's age is over 35 years. At this age, women often have chronic diseases, suffer from circulatory disorders in the pelvis and are more susceptible to toxicosis,
8. Infectious diseases, transferred during pregnancy, increase the risk of fetal development pathologies.
9. Pathologies of the thyroid gland negatively affect the formation of joints in the fetus.
10. Heredity- hip dysplasia in relatives increases the risk of developing dysplasia in a child by 10-12 times.
11. External influences- radiation, x-ray radiation, taking medications and alcohol have a negative impact on the formation of joints during the prenatal period and their maturation after childbirth.
How to prevent hip dysplasia?
The maturation and formation of the hip joint occurs over several months after birth. Based on this, the American Academy of Pediatrics has developed recommendations to help prevent hip dysplasia.
How to recognize hip dysplasia in newborns?
Congenital subluxation or dislocation are severe stages of dysplasia that require urgent treatment. They are usually diagnosed in the maternity hospital during an examination by a pediatric orthopedic surgeon. Parents should also know how to recognize hip dysplasia in newborns, since early detection of pathology and timely treatment ensure full recovery within 3-6 months. Signs of dysplasia in newborns
- Clicking symptom- one of the most reliable signs of dysplasia. It is detected during the first week and can persist for up to 3 months. The essence of the method: the child lies on his back, legs bent at the hip and knee joints at a right angle. The specialist’s hands lie on the knee joints: the thumbs cover inner surface joint, the rest lie on the outer surface of the thigh. The knees are brought to the midline. The doctor slowly moves them apart, and a click is felt and sometimes heard on the sore side - this is the femoral head taking its place. The next stage: the doctor brings the child’s hips together, at this stage a click is felt again - this is the femoral head leaving the acetabulum. The click is explained by the slipping of the lumbosacral muscle from the anterior surface of the femoral head if there is a dislocation and the head does not fit into the acetabulum.
- Shortening one leg. The child lies on his back, his legs are bent at the knees and placed on his feet. If one knee is higher than the other, then there is a high probability of congenital hip dislocation.
- Asymmetrical arrangement of skin folds, their increased number. The child's folds are checked with the legs straightened in front and behind.
- Limitation of hip abduction. However, in some children this symptom does not develop until the 3rd or 4th week. In healthy children, the knees can be placed on the table surface without effort until the age of 4 months.
Indirect symptoms, which indicate pathology of the musculoskeletal system and often accompany dysplasia. Their detection in itself does not indicate problems with the hip joint, but should be a reason for a thorough examination of the child.
- Softness of the skull bones (craniotabes);
- Polydactyly - more than normal number of fingers;
- Flat feet and displacement of the axis of the foot;
- Violation of reflexes characteristic of newborns (searching, sucking, cervical).
When a diagnosis of subluxation or dislocation is made, treatment begins without delay. If you hope that the child will “outgrow” and leave him without treatment, then without close contact of the articular surfaces, deformation of the joint occurs:
- The acetabulum becomes flatter and is unable to support the head of the femur;
- The roof is behind in development;
- Stretching of the joint capsule.
Is it possible to treat dysplasia without stirrups?
Treatment of dysplasia without stirrups is permissible at an early stage of the disease, when the structure of the joint is not disturbed, but only its maturation is slow and there is a delay in ossification of the heads of the pelvic bones. For treatment, a variety of techniques are used that improve blood circulation, relieve muscle spasms, and saturate with minerals, which accelerates the ossification of the nuclei and the growth of the roof of the joint. - Wide swaddling- its goal is to spread the child’s hips as far apart as possible, using diapers or diapers 1-2 sizes larger. A multi-layer starched diaper is placed between the baby's legs. It should be so wide that with the legs apart, its edges would be in the popliteal hollows.
- Massage and physical therapy- strengthen the muscles and ligaments that fix the joint, promote rapid maturation of the joint. It is advisable to have the massage done by a specialist. Since its inept implementation can harm the child and slow down the development of the joint. The butterfly exercise is recommended: legs bent at the hips and knees are spread apart 100-300 times a day.
- Physiotherapy: warm baths, paraffin applications improve blood supply to the joint, eliminate muscle spasm. Electrophoresis with calcium and phosphorus helps saturate the joint with minerals that are necessary for its formation.
- Homeopathic remedies (Height is normal together with vitamin D, Osteogenon). Preparations containing calcium and phosphorus are prescribed to accelerate the maturation of the ossification nuclei of the pelvic bones.
- Fitball, toys or swing on which the child sits with his legs spread wide apart.
- Swimming or water aerobics 3 times a week. Swimming on your stomach. For older children, it is recommended to swim with fins without bending their knees.
- Limiting vertical load on joints. Do not allow your child to stand or walk for as long as possible. Actively encourage tummy time and crawling.
- Carrying in a sling in a hip position. In this position, the head fits tightly into the articular cavity, occupying the correct physiological position.
Dynamic gymnastics, which some authors include in the treatment complex, is contraindicated for any stages of hip dysplasia.
Attention! A large number of chiropractors and traditional healers promise to get rid of dysplasia without stirrups. Most of their patients then end up in orthopedic departments and are forced to spend 6 to 12 months in rigid stirrups or the Gnevkovsky apparatus. If your child is diagnosed with a subluxation or dislocation, this means that weak muscles and ligaments are unable to hold the head of the pelvic bone in the acetabulum. Therefore, when using manual therapy If the joint is straightened, the head will not be fixed and the dislocation will occur again after a few hours. It takes a long time to reduce the ligamentous apparatus, so in case of preluxation, subluxation and dislocation, stirrups are indispensable.
How does hip dysplasia manifest in adults?
Adults suffer from problems with the hip joint if in childhood they were incorrectly treated for dysplasia at the stage of dislocation or subluxation. In this case, the discrepancy between the surfaces of the femoral head and the acetabulum leads to rapid wear of the joint and inflammation of the cartilage - develops dysplastic coxarthrosis. Usually adult hip dysplasia appears during pregnancy, hormonal disorders, and a sharp decrease in physical activity. As a rule, the onset of the disease is acute and the condition of patients quickly deteriorates.Manifestations of hip dysplasia in adults
Treatment of the consequences of hip dysplasia in adults
- Chondroprotectors (Vitreous, Rumalon, Osteochondrin, Arteparon) are injected directly into the joint or in the form intramuscular injections courses 2 times a year.
- Nonsteroidal anti-inflammatory drugs(Diclofenac, Ketoprofen) relieve pain and reduce inflammation.
- Therapeutic exercise aimed at strengthening the muscles in the hip joint: abdominal muscles, gluteal muscles, quadriceps femoris, back extensor muscles. Swimming, skiing, yoga are suitable.
- Eliminate stress on the joint: weight lifting, running, jumping, parachuting.
- Surgical treatment necessary in severe cases. Hip arthroplasty is the replacement of the head and neck of the femur, and in some cases the acetabulum, with metal prostheses.
Hip dysplasia is a common pathology, diagnosed in 3 out of 1000 children in infancy. Most often, the disease is detected immediately after birth and is characterized by underdevelopment of the joint or weakness of the muscle ligaments. Measures to correct pathology should be applied immediately to avoid serious problems with the child's future health.
When the disease is diagnosed early in newborns and infants up to 6 months, dysplasia responds well to treatment and completely disappears by the time the baby takes his first steps. However, in advanced stages or interrupted treatment, problems with the child’s gait may occur. Limping will be accompanied by painful inflammation of the joints.
Causes of dysplasia in children
There are many reasons for the immaturity of the hip joints. Statistics show that girls are more susceptible to the disease (80% of cases), and about 60% of cases suffer from dysplasia of the left hip joint. Most often it develops during pregnancy. During this period, the appearance of anomalies is influenced by the following factors:
- Genetic predisposition. If parents had immature joints in childhood, there is a high probability of developing the disease in children.
- Hormonal imbalances. Increased content progesterone in the body of the expectant mother in the last stages can weaken the baby’s muscle ligaments.
- Improper and inadequate nutrition of a pregnant woman, as a result of which developing fetus There is a lack of microelements and vitamins involved in the structure of the child’s body.
- Increased muscle tone of the uterus, which affects the formation of the baby’s skeleton and organs throughout pregnancy.
- A large fetus with an abnormal location in the womb may be subject to anatomical displacement of the bones.
- The birth of a premature baby can cause deviations from the norm in the further development of its organs, muscles and musculoskeletal system.
- Bad habits and intake medicines also negatively affect the development of the fetus.
- Some diseases of mother and child can cause underdevelopment of joints.
Types of hip dysplasia
Dear reader!
This article talks about typical ways to solve your issues, but each case is unique! If you want to know how to solve your particular problem, ask your question. It's fast and free!
The listed factors have different effects on the developing body of the baby, therefore, anomalies of immature joints will be individual. Congenital dysplasia Hip joints in children, depending on the types of anatomical disorders, are divided into three types:
- Acetabular. Congenital pathology associated with immaturity of the joint. Basically, this deviation is classified as type 2a according to Graf (ultrasound classification that determines the maturity of the joints). The disease is characterized by deviations in the structure of the acetabulum. At the same time, the femoral head puts pressure on the limbus cartilage located along its edges, causing its deformation. As a result, the capsule is overstretched and the femoral head is displaced.
- Epiphyseal dysplasia. This disease is characterized by stiffness of the joints, which leads to deformation of the limbs with painful sensations. The difference in diffuse angles can change either upward or downward. This is clearly visible on the X-ray image.
- Rotary. This type of disease is characterized by improper placement of bones, which leads to clubfoot in the child.
The disease can occur in mild and severe forms. Depending on this, dysplasia is determined by severity:
- I degree – pre-dislocation. This deviation from the norm develops when the head of the femur enters the beveled socket of the joint, while the muscles and ligaments do not change.
- II – subluxation. Part of the upwardly displaced femoral head enters the articulation cavity. In addition, the ligaments lose their tone and stretch.
- III – dislocation. The head of the femur moves upward and completely emerges from the socket. The strained ligaments are stretched, causing the limbus cartilage to move inside the joint.
Symptoms of the disease
Depending on the type of THD, the disease will manifest itself differently in children at different periods of life. Severe symptoms Deviations from normal development may be noticed by attentive parents or a pediatrician during the next examination. If a diagnosis is suspected or made, the doctor prescribes a consultation with an orthopedist, who will subsequently see the child.
In newborns
Congenital hip dysplasia can be detected in newborns while still in the maternity hospital. This disease is difficult to visually recognize in grades 1 and 2, because a baby under 2 months does not feel any abnormalities, but if the problem is not corrected in time, a feeling of discomfort and pain will begin to be felt as bones grow and cartilaginous tissue thickens.
With early dysplasia in newborns, parents may be alarmed by the following symptoms:
- asymmetry of skin folds in the area of the popliteal cavities and buttocks;
- the child reacts by crying when his legs try to separate;
- it is difficult to separate your legs bent at the knees.
Asymmetrical skin folds on the buttocks and hips of a child with dysplasia
However, grade 3 dysplasia in newborns is more pronounced, so it is difficult to miss. In this case, the following symptoms are observed:
- Click syndrome. Occurs when the legs are spread and brought together. Always present during dislocation.
- Shortening one leg. This symptom is determined in case of severe dislocation of the limb. To do this, the child is placed on his back, and his legs are bent at the knees, placing his feet on the table. If asymmetry is noticeable at the knee level, then dysplasia is clearly present.
- Hip abduction is limited. Indicates muscle dystrophy with disruption of bone formations.
- Visible abnormal placement of the hip.
In infants up to one year old
Hip dysplasia in infants under one year of age will be determined by the local pediatrician during examination. In children, there is problematic hip abduction, and in grades 2 and 3, shortening of the leg.
These symptoms are accompanied by additional signs:
- asymmetry of skin folds on the legs (but in infants younger than 2 months this symptom- variant of the norm);
- click syndrome;
- muscle atrophy;
- weak pulsation of the femoral artery;
- disturbance of the sucking reflex.
In babies after one year
Undiagnosed and untreated hip dysplasia will cause many problems for the baby and his parents. As soon as the child begins to walk, he will feel pain and discomfort. Clear signs manifestations of the disease will be:
- limping;
- pain when walking followed by inflammation of the joints;
- duck gait, which occurs with bilateral dislocation.
Consequences of the disease for the child
Untreated hip dysplasia is dangerous. It leads to severe undesirable consequences, which are not always treatable. Subsequently painful inflammatory processes lead to the death of the muscles of the diseased limb, dysfunction of the musculoskeletal system and disability.
The consequences of late detection of hip dysplasia are fraught with disability
Children who have begun to walk experience pelvic distortion, pain and muscle atrophy. Such a child begins to walk late, while limping and being capricious. With age, dysplastic coxoarthrosis develops, which by the age of 30, during hormonal changes, intensifies inflammatory processes in the joint, ending in its immobility. The diseased joint is replaced with an artificial one.
How is dysplasia diagnosed?
If underdeveloped joints are detected in infants, the orthopedist prescribes a full diagnosis of the disease. Besides visual methods use ultrasound. Infants from 3 months of age may additionally be prescribed x-ray diagnostics. X-rays are always used if there is a suspicion of dislocation and bilateral immaturity of the joints. All these methods help the doctor determine the severity of the disease.
After studying the results of the ultrasound and photos of the patient’s X-ray, the orthopedist will make a diagnosis and prescribe treatment (we recommend reading:). The child will be registered and the effectiveness of the prescribed treatment will be monitored over time. In general, infants up to six months of age recover quickly; it is more difficult to treat children after one year.
Features of treatment
Based on these examinations, the doctor prescribes orthopedic devices, physiotherapy and massage. They help strengthen and develop muscles, improve blood flow and rapid tissue regeneration.
However, when these methods are ineffective or the disease is diagnosed at a later stage, surgical intervention is used.
Conservative methods
For the treatment of stage 1 THD in newborns, the doctor prescribes wide swaddling (we recommend reading:). The baby is placed on his back, his legs are spread apart and cushions of 2-3 diapers are placed between them. All this is fixed with another diaper on the baby’s belt. This method is used for both treatment and prevention hip dysplasia joints. For grades 2 and 3, orthopedic devices are prescribed:
- Pavlik stirrups. The baby's legs are fixed in a bent and spread position using straps and a bandage that is attached to the chest.
- Vilensky tire. It is put on the child once by an orthopedist and is not removed until complete recovery. Consists of straps and a spacer, the length of which is adjustable.
- Tübinger cut. It is a design of shoulder pads and 2 saddle-shaped spacers, which are connected by a metal rod.
- Tire Volkova. Prescribed for children from 1 month to 3 years. The child's torso is secured in the crib structure, and the legs are secured in its side parts.
- Freika's tire. Prescribed for grade 1 and 2 dysplasia without dislocation. The splint fixes the child's legs at an angle of more than 90°.
Pavlik stirrups
When the dislocation is formed, and conservative treatment did not produce results, closed reduction of the joint is used. This operation is performed on children aged 1 to 5 years. After this, a plaster cast is applied to the affected hip for up to 6 months. Typically, such treatment is difficult for children to tolerate.
Physiotherapy
Depending on the severity of the disease, the doctor may prescribe physical therapy as an additional treatment. In combination with the main one, it will help the child cope with the disease faster. These methods include:
- Ural Federal District. Prescribed individually, accelerates tissue regeneration and stimulates the immune system.
- Electrophoresis with phosphorus and calcium to strengthen bones and joints (see also:).
- Applications with ozokerite. They are applied to the diseased joint and promote tissue restoration.
- Warm bath with sea salt. Activates protective functions, improves blood circulation and promotes rapid tissue regeneration.
Therapeutic massage and gymnastics
Exercise therapy and massage are prescribed individually. These methods are used in complex therapy or to prevent dysplasia. The massage is carried out in courses of 10 days exclusively by a specialist as prescribed by a doctor, after which it is repeated every other month. After physical therapy sessions, parents are usually instructed to continue exercising at home.
Dysplasia detected in time can be eradicated with massages and exercise therapy alone.
The purpose of these methods is:
- muscle strengthening;
- improved blood circulation;
- maintaining joint mobility and development physical activity child;
- preventing the occurrence of complications.
Surgical intervention
With severe underdevelopment of the head of the joint, late diagnosis, ineffective treatment and severe dislocation with displacement there is an urgent need for surgical intervention. The surgical method is used to restore joint mobility and blood circulation. However, there is a high risk of complications after surgery:
- inflammatory processes;
- severe blood loss;
- suppuration of the joint;
- tissue necrosis.
Preventive measures
Many parents are faced with a situation where it is quite difficult to recognize hip dysplasia and the diagnosis is made when the disease is already in an advanced state.
There are cases when the disease develops gradually. Prevention is recommended to prevent the occurrence of THD. Preventive methods include:
- Wide swaddling (we recommend reading:). It promotes proper development child's joints.
- Special devices according to age. These include portable slings and kangaroos, which allow the baby to hug the mother’s body while using them (more details in the article:). The child’s hips are in the desired position.
- Gymnastics and massage (see also:). Light massage movements relax the muscles, and a small physical activity strengthens them.
We recommend reading
Fusel oils in moonshine and other alcoholic beverages: influence, benefits, harm and purification
Functional projections of zodiac signs What can be said about vector projection signs
Degas E. “Blue Dancers. Essay based on the painting by Edgar Degas “Blue Dancers Dancers in Blue”
We reflect in the RSV reimbursement of social insurance expenses for the last year Appendix 2 line 090 of the calculation of insurance premiums
