Hip dysplasia in children is quite common. According to official statistics, this pathology is diagnosed in 3-4% of newborn babies. Either one or both hip joints may be affected. The prognosis and consequences of such a congenital disease depend on how early the problem was identified, as well as on the degree of underdevelopment of the components of the articulation and on compliance with all medical recommendations for treatment. Therefore, every parent should know about the existence of such an illness, since it is the mother or father who may be the first to notice that something is wrong with the child.

What it is?

Hip dysplasia in children is a congenital deficiency of the components of the hip joint, its underdevelopment, which can lead or has already led to congenital dislocation of the hip in a newborn.

The hip joint consists of 2 main components: the acetabulum of the pelvic bone and the femoral head. The acetabulum has the shape of a half-cup; along its contour there is a rim of cartilaginous tissue, which complements the shape and helps keep the femoral head inside. This cartilaginous lip also performs a protective function: it limits the range of unnecessary and damaging movements.

Scheme of the formation of congenital hip dislocation with hip dysplasia

The head of the femur is spherical in shape. It is connected to the rest of the thigh by a neck. The head is normally located inside the acetabulum and is securely fixed there. A ligament extends from the top of the head, which connects the head and the acetabulum; in addition, in its thickness there are blood vessels that nourish the bone tissue of the femoral head. The inner surface of the joint is covered with hyaline cartilage, its cavity is filled with fatty tissue. Externally, the joint is additionally strengthened by extra-articular ligaments and muscles.

When a child has dysplasia, one or more of the described structures turn out to be underdeveloped due to certain circumstances. This ensures that the head of the femur is not fixed inside the acetabulum, resulting in its displacement, subluxation or dislocation.

In most cases of dysplasia in infants, one of the following anatomical birth defects occurs:

• Pathological shape of the acetabulum (too flat), violation of its normal dimensions (too large or, conversely, small). Such circumstances do not make it possible to reliably hold the femoral head inside, which is why it is displaced.
• Underdevelopment of the cartilage cushion along the perimeter of the acetabulum, too long ligament of the femoral head, lack of fatty tissue inside the joint.
• Pathological angle between the neck and head of the femur.

Any of these defects, along with weakness of the muscles and intra-articular ligaments in infants, leads to dysplasia or congenital dislocation of the hip.

Breech presentation of the fetus is a risk factor for the development of hip dysplasia

Causes

Unfortunately, the true cause of the development of this pathology has not been established today. But experts have discovered a number of factors that contribute to an increased risk of hip dysplasia in newborns:

• incorrect position of the fetus inside the uterus during pregnancy, especially for breech presentations;
• the baby is too large at birth;
• the presence of the same disease in close relatives (genetic predisposition);
• pregnancy at a very young age;
• toxicosis in the mother during pregnancy;
• hormonal disruptions in the female body during pregnancy.

If at least one of the above risk factors is present, then such a child automatically falls into the risk group for hip dysplasia, even if there are no signs of the disorder at birth, and during the first months of life should be regularly examined by a pediatric orthopedic doctor.

How to suspect a problem?

Symptoms of dysplasia cannot always be detected on time, as they are often barely noticeable or completely absent. Among the signs that can be seen during an external examination of a child are:

1. Violation of the location of skin folds on the legs, the appearance of their asymmetry. You should carefully examine the folds under the buttocks, under the knees, and inguinal folds. If they are uneven (both in location and depth), childhood hip dysplasia can be suspected. But this is not a completely reliable sign, since up to 2-3 months the folds can be asymmetrical and normal due to the uneven development of subcutaneous fatty tissue in the baby.
2. Various leg lengths child. This is a more reliable symptom, but it occurs already at the stage of hip dislocation; with dysplasia it may be absent. To check the length of a baby's legs, you need to stretch them out and compare them by the location of the kneecaps. There is a second method: we bend the legs at the knees of the baby, who is lying on his back, and pull the heels towards the buttocks. Moreover, if the legs have different lengths, then one knee will be higher than the second. The leg is shortened on the side where the dislocation is located.
3. “Snap” symptom. To check it, the newborn needs to be laid on his back, legs bent at the knees and separated at the hip joints. In this case, a characteristic click occurs on the side of the dysplasia, which corresponds to the reduction of the femoral head. This sign is informative only until the baby is 2-3 weeks old.
4. Limitation of hip abduction. This sign is checked in the same way as the previous one. Informative after 2-3 weeks of life. Normally, the baby’s legs can be spread 80-90º or laid on the surface. If dysplasia occurs, this cannot be done.

It is important to know! In children under 3-4 months there is an increased muscle tone, which sometimes leads to difficulty in spreading the legs in the hip joints and creates a false-positive picture of the disease.

Unfortunately, no other symptoms exist until the child begins to walk. At an older age, attention is drawn to different leg lengths, gait disturbances, asymmetry of anatomical landmarks, and the development of a duck walk with bilateral dysplasia. Treatment at a later age is difficult and the situation can be corrected, but not always, it is only possible with the help of surgery. Therefore, it is important to identify pathology from the first months of a child’s life, when conservative therapy is effective.

This is how you need to check the symptom of a click and the amount of separation of the legs in the hip joints

Degrees of dysplasia

There are 4 degrees of this congenital disease:

1. Dysplasia itself– congenital underdevelopment of some joint structures, but there is no displacement of the femoral head. Previously, such a diagnosis did not exist, since it was impossible to diagnose it. Today, thanks modern techniques, dysplasia is often diagnosed and is an indication for conservative treatment in order to prevent possible congenital dislocation of the femur.
2. Pre-dislocation. It is diagnosed when the femoral head is slightly displaced, but does not extend beyond the acetabulum; when moving, it easily takes its normal position. If no measures are taken, the disease progresses and transforms into a dislocation.
3. Partial hip dislocation. It is installed when the femoral head is displaced, but does not completely protrude from the acetabulum. In this case, the ligament of the head is greatly stretched, which negatively affects its blood supply. When moving, it does not fall into place.
4. Congenital hip dislocation. This is an extreme degree of dysplasia, when the femoral head extends completely beyond the acetabulum. The joint capsule is tense, the ligament inside is very stretched.

Degrees of hip dysplasia

Diagnostics

There are 2 methods that can confirm or refute the diagnosis of hip dysplasia:

• radiography,

X-ray examination is very informative, but is carried out only from 3 months of age. The reason is that in newborns, complete ossification of the structures of the hip joints has not yet been observed, which can cause false positive or false negative results. Up to 3 months, it is recommended to perform an ultrasound of the hip joints. This is an absolutely safe and highly informative research method that allows you to accurately diagnose dysplasia in infants.

X-ray allows you to accurately confirm the diagnosis of dysplasia in a child

Treatment

The main key to success in treating hip dysplasia is timely diagnosis. Therapy always begins with conservative methods, which are successful in most children. Surgical treatment may be necessary if diagnosis is late or if complications develop.

Conservative therapy

Includes several groups of therapeutic measures:

• physiotherapy;
• massage;
• wide swaddling;
• wearing special orthopedic structures;
• physiotherapeutic procedures;
• closed reduction of hip dislocation.

Exercise therapy is prescribed in each case of hip dysplasia not only as a therapeutic measure, but also as a preventive measure. This very simple method, which all parents can master, has absolutely no contraindications and is painless. A pediatrician or pediatric orthopedist should teach you how to perform leg exercises. You need to exercise 3-4 times daily for 5-6 months. Only in this case will physical therapy bring a positive result.

Some simple exercises to treat hip dysplasia:

Massage for dysplasia should be prescribed and performed only by a specialist. It allows you to achieve stabilization of the process, strengthen muscles and ligaments, reduce dislocations, and improve the general condition of the child. But there is also a general massage that parents can use. It should be done in the evening after bathing before bed.

Important to remember! For infants, not all massage techniques are used, but only stroking and light rubbing. Tapping and vibration are prohibited.

Wide swaddling is most likely a preventative rather than a curative measure. It is indicated in the case of the birth of a child from a risk group, in the presence of stage 1 pathology, and in cases of immaturity of the joint structures according to ultrasound data.

If it is not possible to correct the dislocation with the help of massage and exercise therapy, then they resort to the use of special orthopedic structures that make it possible to fix the legs in a position apart at the hip joints. Such designs are worn long time without taking it off. As the child grows, the structures of the joint mature and securely fix the femoral head inside, which does not jump out, thanks to various stirrups and splints.

The main orthopedic structures used to treat dysplasia:

• Pavlik stirrups,
• CITO bus,
• Volkov tire,
• Vilensky tire,
• Freika tire,
• Tyubanger tire.

All of these devices are worn and adjusted by an orthopedic surgeon. Parents are not allowed to remove or change parameters on their own. Modern stirrups and splints are made from natural, soft and hypoallergenic fabrics. They absolutely do not affect the child’s condition and the ability to care for him.

The complex of therapeutic and rehabilitation measures is always supplemented with physiotherapeutic procedures. Particularly effective: UV irradiation, warm baths, applications with ozokerite, electrophoresis.

If a dislocation has formed and there is no effect from conservative therapy, they can resort to closed bloodless reduction, which is carried out under anesthesia for a child from 1 to 5 years of age. The doctor returns the femoral head to the acetabulum, after which the child is given a coxite plaster cast for 6 months. Then rehabilitation continues. It is important to emphasize that the child does not tolerate such treatment well.

Surgery

Surgery is resorted to when the disease is diagnosed late, when all previous treatment measures are ineffective, as well as in the presence of complications. There are several options for surgical intervention, including palliative ones.

Forecast

As a rule, with timely diagnosis and adequate conservative therapy, the prognosis is favorable. By the age of 6-8 months, all components of the joint have matured, and dysplasia disappears. If the disease is not eliminated in time, then surgery and a long rehabilitation period may be necessary, and some children may develop a relapse after surgery. If the pathology has not been completely eliminated, then with age the following complications may arise: dysplastic coxarthrosis, impaired walking and gait, the formation of neoarthrosis, aseptic necrosis of the femoral head, etc.

Prevention of congenital hip dysplasia primarily involves avoiding the risk factors described above. If this cannot be done, then it is necessary to proceed to secondary measures, among which daily therapeutic exercises and massage are especially effective.

The birth of a child is a holiday for the family. The sadder the illness of a small newborn becomes. A common condition among children is known as hip dysplasia 2a.

The best weapon against disease is information. Let's consider the idea of ​​the disease, its symptoms, causes of occurrence and control measures.

IN Lately Hip dysplasia has become more common in newborns under the age of one year. The reasons have been established:

• Unfavorable atmosphere for fetal development (environmental);
• Disturbances during pregnancy (improper placement of the fetus, irresponsible attitude of the mother);
• Hereditary tendency to disorders of the musculoskeletal system.

The doctor will not be able to accurately name the cause of the disease.

What is hip dysplasia

Dysplasia is a disorder of the structure of the joints of the pelvis and hip. If the age of the hip joints has not reached maturity, the disease is classified as type 2a. More often, dysplasia manifests itself at birth, judging by the latest estimates, too often. Interestingly, dysplasia appears more often in little girls.

Type 2a – initial stage. At the first stage, the hip joint is in a relatively free, healthy position, but some shifts in the negative direction are already visible. At the mentioned stage, the ligaments and articular tissues do not adhere to the joint, do not hold it in place, because of this, the connection begins to “wobble” and become loose, like a flimsy bolt.

Select people believe that giving birth to a baby with a misaligned joint means a lifelong disability. The opinion is wrong. The truth is more complicated: it will continue to expand, turning into other types, leading to serious illnesses. Here are some examples:

• Pre-luxation (types 3a and 3b). At this stage, the head of the femur protrudes slightly from the acetabulum;
• Dislocation of the femoral head (type 4). The head comes out completely, the joint begins to deform. Mobility is impaired: the baby is able to limp or not step on his leg.

There are unilateral and bilateral hip dysplasia. The point is the involvement of the legs: either a single leg becomes a victim of dysplasia, or both at the same time. In newborns, unfortunately, bilateral dysplasia occurs more often.

It is difficult to distinguish pathology; the disease does not show its presence. The baby is not in pain, does not develop seizures, etc. clear symptoms violations. An attentive parent will notice the disease in telling manifestations:

• Different leg lengths;
• The buttocks are asymmetrical;
• A characteristic clicking sound is heard from the hip joint: the head of the femur pops out of the acetabulum.

If the child is one year old, the time has come for active walking, dysplasia 2a is manifested by the following signs:

• The baby loves to walk on his toes;
• "Duck" waddling gait.

If the doctor notices the symptom, so much the better. If the factor alerts parents, seek advice as soon as possible.

How is dysplasia diagnosed?

Independent diagnoses and prescription of treatment are prohibited for the benefit of the child. Diagnosis is pending; without clear evidence of the appearance of dysplasia, treatment will not begin. A common detection procedure is an ultrasound scan.

The procedure shows clear benefits. Firstly, it does not cause discomfort to children (and adults). Secondly, to do an ultrasound, you don’t need to pay a lot of money; the procedure is quite affordable.

An ultrasound is performed on infants starting at 4 months and ending at 6. The study will reveal the extent of the disease and confirm or deny the presence of the disease. Treatment will begin. Upon reaching the age of 6 months, you will have to go for an x-ray.

How is the treatment carried out?

The success of treatment of newborns with hip dysplasia (initial type) depends on the month when the disease is noticed. Statistics show: in 90% of cases, children remain healthy and continue to grow without insurmountable obstacles. More often, doctors achieve results by the age of one and a half years.

If the child is already six months old, immediate treatment will have to wait: sometimes up to five years or more. There is no guarantee that the result will be the best. More often it happens the other way around. Sometimes surgery is required.

If the baby walks with all his might and dysplasia of a subsequent degree is diagnosed, the result of treatment is unpredictable. To be honest, it is unlikely that treatment will bring complete recovery. Parents are required to follow the following rules:

1. Do not put the baby on his feet until the doctor writes the appropriate permission;
2. It is required to help the baby do special preventive exercises. For example, lie on your back, spread your legs and rotate your hip joint. Exercise helps bones become more flexible, stretches them;
3. Provide the child with a position where the hips are constantly apart. If you fix the correct position in the joint, the bones will get used to the accepted position and grow together correctly.

Fortunately, treatment is available and feasible with positive results. The main thing is to visit the doctor on time, without starting the disease.

How to help your child before diagnosis

If the baby is born healthy, hip dysplasia is not a problem.

For newborn children, a monthly examination by a pediatrician becomes mandatory. Three times a year, parents bring their child to an orthopedist. If doctors don't notice any warning signs, there's no need to worry.

There is an interesting preventive method known -. You cannot swaddle a child so that the legs of the wrapped baby remain straight, like those of a tin soldier. Recent studies show that there is a relationship between the two methods - swaddling with a “tin soldier” and pathology of the hip joint. Such swaddling was adopted in the times of great-grandmothers; do not allow representatives of the older generation to swaddle the baby in the wrong way.

It is better if the little one is wrapped up in the likeness of the children of ancient tribes: the baby simply “sits” in a diaper hung around his mother’s neck. The mother supports the child, and the baby's legs hang freely above the ground. If the baby is behind his back, the method is correct, the child clasps his mother’s back with his legs, the femurs are constantly in an apart, fixed state. The Japanese noticed that when the swaddling method became widely used in families with newborn children, the percentage of dysplasia decreased significantly!

Hip dysplasia, type 2a, most often appears in newborns. It is better for expectant mothers to closely monitor their health during pregnancy, without stopping caring for the baby after his birth.

Main symptoms:

• Violation of the depth of skin folds
• Violation of the position of skin folds
• Limited hip abduction
• Shortening one leg

Hip dysplasia is a congenital pathology of the formation of the joint, causing subsequent possible subluxation or dislocation of the femoral head. Hip dysplasia, the symptoms of which can manifest either in the form of underdevelopment of the joint, or in the form of excessive mobility in combination with insufficiency of the connective tissue, usually develops against the background of unfavorable heredity, pathology during pregnancy or gynecological diseases present in the mother.

general description

The danger of hip dysplasia lies in the fact that failure to detect it in a timely manner, along with the lack of the required treatment, can cause subsequent disruption of the functions performed by the affected lower limb, which is possible up to the development of pathology to such an extent that it determines the appropriate form of disability for the child. Taking this into account, the pathology relevant to hip dysplasia must be eliminated within the early period of its detection and, in fact, the life of the child.

The degree of underdevelopment of the joint against the background of dysplasia can vary significantly in each specific case, that is, these can be both severe forms of violations and excessive mobility, combined with a general weakness of the ligamentous apparatus.

Hip dysplasia is a fairly common pathology detected in newborns. On average, the detection rate is 2-3% per 1000 newborns. What is noteworthy is that this pathology revealed a dependence in terms of race. Thus, representatives of the African-American race encounter this pathology less often than Europeans, while American Indians, for example, encounter it more often than any other race. It was also revealed that hip dysplasia in girls is diagnosed many times more often than hip dysplasia in boys - on average, girls account for about 80% of cases of detection of this disease.

It would not be amiss to dwell on the anatomical features of the area that is affected by hip dysplasia, as well as what changes this area undergoes against the background of the current pathological process.

The hip joint is formed by the combination of the acetabulum and the femoral head. The acetabulum in the form of a cartilaginous plate is attached to the upper part of the cavity; due to it, the area of ​​contact between the articular surfaces increases, and the depth of the acetabulum also increases. The head of the femur contributes to the performance of two main functions, in particular, it is the depreciation of the loads that fall on the femur when running, jumping and walking in order to avoid injury, and it also ensures the passage of joints through it, which provides nutrition to the head of the femur.

Due to the special configuration of the hip joint, a variety of types of movement become possible: outward and inward rotation, abduction and adduction, flexion and extension. In the normal state, the listed movements are performed with a slight amplitude, which is achieved by limiting the femoral head ligament and the cartilaginous rim. In addition to this, the joint is surrounded by many muscles and ligaments, with the help of which mobility is also limited to a certain extent.

In a newborn child, the hip joint, even in its normal state, differs from the anatomical features of the joint of an adult. Thus, in a child, the acetabulum has a flatter shape, its location is also different, in particular, it is not in an inclined position, like in an adult, but in an almost vertical position; in addition, in a child, the ligaments here are more elastic. The femoral head is retained in the socket by the rounded ligament, acetabular labrum and articular capsule.

There are three main forms of hip dysplasia: the acetabular form (the development of the acetabulum is subject to disruption), rotational dysplasia (characterized by a violation of the geometric features of the position of the bones along the horizontal plane) and dysplasia of the femur from the upper sections.

If the development of any of the departments in the hip joint is impaired, then the ligaments, articular capsule and acetabular labrum lose the ability to adequately hold the femoral head, that is, to keep it in the required place. This, in turn, leads to an upward and outward displacement of the femoral head. The acetabular labrum is also subject to displacement, and therefore its ability to provide fixation of the femoral head is finally lost. In the event that a partial exit occurs articular surface head beyond the location of the socket, the child develops a condition defined as subluxation.

Subsequently, if the pathological process progresses, the femoral head moves higher, causing it to completely lose any connection with the glenoid cavity. The position of the acetabular labrum in this case is concentrated below the head, with a twist inside the joint, which already indicates this pathological condition like a dislocation.

Ultimately, if, as this picture progresses, no treatment attempts are made, the acetabulum begins to fill with fatty and connective tissue, which, in turn, leads to serious difficulties in further attempts to reduce the dislocation.

Hip dysplasia: degrees and types

Hip dysplasia may be accompanied by the following anatomical disorders:

• abnormal development of the acetabulum – here the acetabulum is partially corrected in its own spherical shape, acquiring a more flattened shape, becoming smaller in size;
• weakness of the ligaments in the area of ​​the hip joint;
• underdevelopment of the cartilaginous rim surrounded by the acetabulum.

The degrees of hip dysplasia are determined on the basis of the pathological changes accompanying this condition; in a general discussion, we have identified them above, and we will add a little more detail to their features:

• Dysplasia. With dysplasia itself, we are talking about inferiority and abnormal development of the hip joint, but so far without accompanying changes in its configuration. It can be difficult to determine pathology only through visual examination, because here it is detected mainly through additional diagnostic procedures. Somewhat earlier, dysplasia during this period was not considered as a disease at all; it was not diagnosed and, accordingly, the necessary treatment was not prescribed. Now dysplasia is a full-fledged diagnosis; moreover, it also happens that doctors carry out so-called overdiagnosis, which is explained by the “detection” of this disease in completely healthy child, which, as is clear, is also not correct.
• Pre-dislocation. In this case we are talking about a condition that precedes subluxation and dislocation. The capsule of the hip joint here is in a stretched state, and the head of the femur, although slightly displaced, easily returns to its original, normal anatomical position. The gradual progression of pathological changes leads to the fact that pre-luxation, as already noted, is transformed into subluxation, and then into dislocation (if the necessary therapeutic measures are excluded).
• Subluxation of the hip. There is a partial displacement of the head of the hip joint relative to the socket. In particular, it bends the cartilaginous rim in the acetabulum while simultaneously shifting it upward. Because of this, the ligament in the head of the femur becomes stretched, it loses its characteristic tension.
• Hip dislocation. In this case, there is a complete displacement of the head of the femur in relation to the acetabulum, with which, as is clear, it is initially connected anatomically. That is, the head of the femur in this case is located outside the cavity, but outside, above it. The cartilaginous rim along its upper edge is in a position pressed by the head of the femur, which is why it bends deep into the joint. The femoral head ligament and articular capsule are in a tense and stretched state.

Let us also highlight the main types of dysplasia:

• Acetabular dysplasia. This type of pathology is caused by a violation of the development of the acetabulum alone, in which it has a reduced size, a flatter shape, and its cartilaginous rim is in an underdeveloped state.
• Femoral dysplasia. If we consider the normal anatomical position of the femoral neck, then here it articulates with the body of the femur, which occurs at the appropriate angle. If such an angle is violated, increasing or, conversely, decreasing, then this determines the main mechanism in the disease we are considering, that is, hip dysplasia.
• Rotational dysplasia. This form of dysplasia is caused by a violation of the configuration along the horizontal plane of anatomical formations. The axes surrounding the movement of each of the joints in the lower extremities do not coincide with each other in the normal anatomical position. If the axes do not coincide when they go beyond the limits normal values The head of the femur is positioned incorrectly relative to the acetabulum.

Hip dysplasia: causes

The reasons in this case can be identified as predisposing factors that contribute to the development of such a pathology in a newborn child:

• incorrect position of the fetus, in particular - breech presentation, in which in the womb the fetus is in a position with the pelvis towards the exit of the uterus, and not, as expected, with the head;
• large size of the fruit;
• heredity - that is, the presence of the pathology in question in the parents;
• toxicosis in a pregnant woman, which is especially important when it appears in a young expectant mother.

Some other factors play a separate role. One of the options is to identify the features ecological environment in the region where the child was born. It was revealed that dysplasia is diagnosed on average 6 times more often in those regions where such a situation is defined as unfavorable. Another factor is the peculiarities of swaddling children. Thus, in countries where the child is not swaddled, due to which the legs can be in a bent and abducted position for a significant period of time, the diagnosis of dysplasia occurs several times less frequently than in countries where tight swaddling is preferred.

If at least one of the predisposing factors is present, the child at birth is registered as at risk for the development of pathology, even if the child is in a normal, healthy condition, in the absence of anatomical abnormalities inherent in dysplasia.

Hip dysplasia: symptoms

The symptoms, which will be discussed below, are revealed during the examination, therefore this point can also be attributed to the diagnosis of dysplasia; these symptoms consist of the following features:

• Violation of the location of folds on the skin, violation of their depth. During the examination, the doctor pays attention to the location of the folds under the left and right buttocks, inguinal and popliteal folds. They should normally be located at the same level. Accordingly, with a deeper position of the folds on one side when compared with the other, we can assume the relevance of the disease we are considering. Meanwhile, this sign cannot be called a reliable indicator of the disease, because in most newborn children there are certain differences in the position of the folds when such a comparison is made. As a rule, the folds are leveled out when the child reaches the age of 2-3 months. In addition, we note that if a diagnosis such as bilateral dysplasia is relevant, then asymmetries in the position of the folds will most likely not be detected.
• Shortening of one of the legs compared to the other. This sign can be considered the most reliable, but it can only be detected in the case of a severe form of the disease, with an already formed hip dislocation. The head of the femur is displaced backward, which contributes to the shortening of the limb. To check for this symptom, during the examination, the doctor stretches both of the baby’s legs, comparing the level at which the kneecaps are located.
• Slipping symptom (“click symptom” or Marx-Ortolani sign). No less reliable and, at the same time, reliable method for identifying the disease we are considering. Here the child must be placed on his back, after which the doctor grasps his legs so that the thumbs grip from the inside, and the remaining fingers, accordingly, grip from the outside. Next, attempts are made to separate them to the sides. In the absence of disturbances in the configuration of the joints, that is, normally, the baby’s hips can practically be laid on the surface on which he is laid (on the table), that is, it is possible to separate them to 80-90 degrees. If there is dysplasia, then the hip on the affected side can be abducted only to a certain position, and then with the doctor’s hand, during such manipulations, a characteristic click is felt, indicating the reduction of the femoral head. In the future, if the leg is released, it will again be in its original position, then, in a certain period of time, with a sharp movement, it will dislocate again. Detection of dysplasia by a doctor on the basis of this symptom is allowed only when the child is about 2-3 weeks old; in other cases, the diagnostic method is not informative.
• Limited hip abduction. This symptom can be detected in a child aged 3 weeks. It is defined in the same way as the previous “clicking” symptom. On the healthy side, the child’s leg can lower to the table surface almost to the very end, while with the affected leg it will not be possible to achieve the same result.

It should be taken into account that the persistence of dysplasia in congenital hip dislocation subsequently becomes the cause of gait disturbances in older age. The adoption of a vertical position by the child subsequently determines the asymmetry of the position of the folds (popliteal, inguinal and gluteal).

As additional methods for diagnosing hip dysplasia, an X-ray examination (allowed for the baby from 3 months of age) or ultrasound (without age restrictions) is mandatory. Diagnostics can also be supplemented by MRI or ultrasonography of the joint.

Hip dysplasia: consequences

As is clear from the specifics of the pathology, in the absence of an appropriate approach to the disease, its further course causes the development of complications. Thus, children with dysplasia begin to walk later than their peers; their gait is characterized by instability, clubfoot, swaying from foot to foot, and lameness. In frequent cases, increased lordosis from the lumbar side is detected with compensatory development of kyphosis from the thoracic segment.

Disability due to hip dysplasia can occur literally with early age baby. Lack of treatment also leads to a number of diseases in adulthood, which is caused by the progression of this pathology, combined with osteochondrosis.

An important feature that is relevant for the lower extremities with dysplasia is that they are simply not capable of withstanding prolonged loads.

Due to hip hypermobility, a general “looseness” of the musculoskeletal system develops. Without timely elimination of congenital dislocation, the joint, gradually adapting to the distorted motor function, will receive slightly different outlines, both from the side of the head of the femur and from the side of the location of the acetabulum. A joint corrected in this way will not be full-fledged, because it is simply not adapted to provide the limbs with support or adequate abduction. In this case, we are talking about such a pathology as neoarthrosis.

The most unfavorable complication of the disease we are considering is the development of dysplastic coxarthrosis. This disease develops by the age of 25-35; if, when it appears, surgical intervention with joint replacement is not performed, the person loses his ability to work.

Treatment

As already noted, treatment for hip dysplasia should be started as early as possible. It uses a variety of means, due to the influence of which the baby’s legs are fixed in the desired position, in particular, these are various splints and devices, special pillows, panties, stirrups, etc. Treatment of babies in the first months of their life is carried out only with the use of elastic and soft structures, the impact of which will not interfere with normal movement of the limbs.

Pavlik stirrups have proven to be one of the most effective options in the treatment of dysplasia. This product is in the form of a chest bandage, the basis of which is soft tissue; special pins are attached to this bandage, thanks to which the appropriate impact is provided on the child’s legs so that they take the desired position. With this fixation, not only the necessary impact on the legs is ensured, but also sufficient freedom for movement.

A congenital pathology in which the hip joint stops developing correctly is called dysplasia. In the future, it can lead to dislocation or subluxation of the femoral head. With dysplasia, either immaturity of the joint or an increase in its motor function in combination with inferior connective tissue is revealed. Pathology can develop due to: unfavorable heredity, gynecological diseases of the mother or disorders of intrauterine development of the fetus.

If the disease is not detected in time and treated, then hip dysplasia in a newborn can provoke dysfunction of the lower extremities, and even threaten disability. Therefore, this anomaly should be detected in infants as early as possible. The sooner the pathology is detected and treatment is carried out, the more effective it will be.

Hip dysplasia

This congenital abnormality can cause subluxation or dislocation of the hip. The stages of dysplasia vary from severe disorders to excessive mobility combined with weak ligaments. To prevent the adverse consequences of hip dysplasia for the baby’s health, it is necessary to identify and begin to treat this disease as early as possible, preferably in the first months of life.

This pathology, among congenital and acquired diseases, is diagnosed quite often: per 1000 newborns there are 20-30 children with dysplasia. It has also been noted that this anomaly occurs among American Indians more often than among other races, and African Americans are less susceptible to it than Caucasians. It is also noted that this pathology occurs less frequently in boys than in girls: the ratio is approximately 20% to 80%.

According to ICD 10, hip dysplasia is classified as a separate class and group (code M24.8).

Anatomical structure of the hip joint and its disorders

This joint consists of the femoral head, which connects to the acetabulum. The acetabulum is attached to the upper part of the acetabulum - this is a plate of cartilage tissue that increases the contact area of ​​the joint surface and the depth of the acetabulum. In children in the first month of life, this joint even normally differs from the structure of the hip joint of an adult: the flatter acetabulum is located almost vertically and the ligamentous apparatus is more elastic. The femoral head is fixed in the socket by the rounded ligament, articular capsule and acetabular labrum.

There are the following forms of hip dysplasia: acetabular, which is characterized by a violation of the formation of the acetabulum, upper dysplasia hip bones and rotational dysplasia, in which the bones are displaced relative to the horizontal.

If there is an anomaly in the formation of any part of the hip joint, this means that the femoral head is not held by the acetabular labrum, as well as the articular capsule and ligamentous apparatus in the proper place. As a result, it moves outward and upward. At the same time, the acetabular labrum also shifts, which will no longer be able to fix the femoral head. When the femoral head partially extends beyond the acetabulum, hip subluxation occurs.

At further development pathology, the head of the femur shifts even higher, and it completely loses contact with the acetabulum. Thus, the head turns out to be higher than the acetabular labrum, which is wrapped inside the joint - a hip dislocation is formed. If treatment is not started, the acetabulum fills with connective and fatty tissue. It is almost impossible to restore a neglected state.

Causes of development of hip dysplasia

The appearance of dysplasia can be caused by many reasons.

• Firstly, heredity: the percentage of occurrence of this developmental anomaly in a child increases if the father or mother was also diagnosed with dysplasia at birth.
• Secondly, breech presentation of the fetus and other factors that disrupt the normal intrauterine development of the child.
• Third, unfavorable environmental conditions (in areas where the level of air pollution exceeds the permissible level, this pathology occurs 5-6 times more often than in places where the environment is more favorable).

Experts have found that the practice of tight swaddling also predisposes the baby to develop hip dysplasia. The child must be given the opportunity to move his legs freely.

Diagnosis of hip dysplasia

If the doctor suspects that the baby has hip dysplasia, it is necessary to visit a pediatric orthopedic doctor within 21 days after discharge from the hospital. The specialist will examine the child and prescribe appropriate treatment. For timely detection of this disease, children are examined by a specialist at the following age intervals - at 1 month, at 3 months, at 6 months and a year.

A child's susceptibility to the occurrence of this anomaly increases in the presence of the following factors: maternal toxicosis during pregnancy, high birth weight, breech presentation and diagnosis of dysplasia in the mother or father. Newborns at risk are examined with special care.

The baby is examined when he is calm and well-fed. The room where the inspection is taking place must be warm and quiet. The doctor checks for the following signs indicating pathology: asymmetry of skin folds on the legs, shortening of the hip, limited hip abduction, and the Marx-Ortolani sign.

The asymmetry of skin folds in the groin, under the knees, and also on the buttocks becomes more noticeable in a child at 2-3 months. When examining a newborn, the doctor carefully looks at the level of folds on both legs, as well as their shape and depth. However, the presence or absence of this symptom is not a sufficient basis for an accurate diagnosis. Symmetrical skin folds are observed in a child with bilateral dysplasia, as well as in half of newborns with developmental disorders of one hip joint. Asymmetry of skin folds in the groin in infants under 2 months also does not give rise to the detection of hip dysplasia, since it is sometimes present in a healthy child.

A more accurate diagnosis can be made by identifying such a sign as thigh shortening. The child should be placed on his back and his legs should be bent at the knees and hip joint. If in this position of the legs it is clear that one knee is located higher than the other, this indicates that the child has the most serious form of this pathology, namely, congenital dislocation of the hip.

But the main confirmation of congenital hip dislocation is Marx-Ortolani sign. The baby should be placed on his back. The doctor should bend the child's legs and clasp his thighs with his palms so that the thumbs are placed on the inside and the remaining fingers on the outside of the thigh. Taking the child's legs, the doctor carefully and evenly begins to move the hips to the sides. A symptom indicating the presence of pathology is a click that is felt when the head of the femur is reduced into the acetabulum. It must be borne in mind that this symptom is not informative enough in newborns in the first weeks of life. Appearing in 40% of recently born children, it subsequently disappears without a trace.

Limited movement in the hip joint also indicates a disorder in its development. A healthy child’s legs can be abducted to 80° or 90° and placed on the table surface without any effort. If the legs are not abducted more than 50° or 60°, this suggests a developmental anomaly. At 7-8 months healthy children The legs can be abducted by 60° or 70°, and in children with congenital dislocation only by 40° or 50°.

If the doctor doubts the diagnosis, he can confirm or refute it using X-ray and Ultrasound. However, to diagnose pathology in a child who is not yet 3 months old, X-rays are not taken. At this age, most of the joint is formed by cartilage, which is not visible on an x-ray photo. Later, special charts are used to read infant X-rays. Based on how the joint looks in the picture, the doctor determines the severity of dysplasia.

In the first months of life, ultrasonography is used to examine infants. This method successfully replaces x-rays - at this age it is not dangerous and provides a lot of information.

The diagnosis of “dysplasia” is made only in the presence of symptoms of pathology and abnormalities in the development of the joint, revealed by x-ray or ultrasound. If a developmental disorder is not detected in time, then bilateral dysplasia of the right and left joints can result in very serious consequences for the child’s health, including disability.

How to treat hip dysplasia

It is necessary to treat and take measures to prevent dysplasia immediately, starting with early dates. To do this, a variety of means are used to help keep the baby’s legs in a bent and abducted position: special pillows, splints, devices, panties, stirrups. For the treatment of newborns in the first months of life, the use of soft and elastic devices is provided, the wearing of which does not interfere with the child’s movement of his legs. If it is not possible to fully treat the child, you need to start swaddling him widely. The same method is also suitable for infants who are at risk, as well as children whose ultrasound examination revealed symptoms of an immature joint.

A good effect in the treatment of hip dysplasia in children under one year of age is achieved by using Pavlik stirrups. This soft fabric design is a chest band with a system of special straps attached to it that hold the baby's legs in a flexed and abducted position. Pavlik stirrups serve to fix the child’s legs in the desired position, but at the same time give him the opportunity to move freely.

To fully restore movement and enhance the effect of treatment, it is necessary to do exercises to strengthen the muscles. At each stage: when spreading the legs, to keep the joints in the desired position, as well as for rehabilitation, different exercises are performed.

In addition, for more effective treatment The baby is given a muscle massage on the buttocks.

Severe pathology is treated with closed, one-stage reduction of the dislocation, followed by application of a plaster bandage to immobilize it. This method is used to treat children from 2 to 4 years of age, less often at 5 or 6 years of age. A child over 6 years old and a teenager cannot have a dislocation corrected. Sometimes, to treat dislocations, children aged 1 year 6 months to 8 years are given skeletal traction.

If conventional therapy does not bring results, corrective surgery is performed: the dislocation is reduced, and surgery is also performed on the upper part of the femur and acetabulum.

Malformations of the skeleton and connective tissues, if not treated in time, can cause many serious problems and cause significant discomfort to its owner. Congenital hip dislocation or hip dysplasia is a common diagnosis. Find out why this disease is dangerous, how to treat congenital pathologies of the pelvic bones and what to do during the rehabilitation period.

What is hip dysplasia

The femur bed consists of the ilium, which is lined with cartilage tissue and is called the acetabulum. The cavity of the bed contains the head of the femur, and ligaments form around it. This is a kind of capsule that helps the head of the femur to be held inside the bed with a standard tilt of the acetabulum. Any violation of biomechanics - joint hypermobility, insufficient ossification of the heads, violation of the femoral axis - is considered dysplasia.

In newborns

Hip dislocation in infants is manifested by a disturbance during the development of one or more of its immature joints. In this case, the elasticity of the cartilage is lost, the acetabulum is leveled, and the femoral head becomes soft. Over time, bones become shorter or begin to grow in the wrong direction. Depending on the displacement of the structures, this pathology is characterized as dislocation or subluxation.

Hip dysplasia in newborns is much more common than a similar problem in adults. At the same time, late ossification appears more often in girls. In almost half of the cases, the left side of the body suffers from underdevelopment of the hip organs, and bilateral disease accounts for only 20%. Scientists believe that the disease is provoked by pregnancy pathologies, pelvic position of the fetus, heredity, and poor fetal mobility.

In children after one year

It is easy to identify the disease in a one-year-old baby, because by this time children begin to sit, walk and crawl on their own. In this case, a limp may appear on the leg on the side of which the pelvic pathology is located. If the hip dislocation is bilateral, the child walks with a duck gait. In addition, in sick children the gluteal muscle decreases in size, and when pressure is applied to the heel in a lying position, mobility of the leg axis from the foot to the thigh is observed.

In adults

The geometry of the joint in adults can be disrupted due to injury or be a continuation of a childhood illness. This occurs due to intrauterine disorders, as a consequence of complications during difficult childbirth, or with pathologies of the body’s endocrine system. Treatment for adults is longer and more complex. Very often standard methods of therapy are not enough, then doctors recommend joint replacement.

Reasons

Doctors believe that congenital hip dislocation can occur for various reasons. For example, scientists have recently found that unfavorable natural conditions, hereditary factors, frequent stress can contribute to the development of this pathology and aggravate treatment. The main reasons are:

• breech presentation of the fetus;
• the newborn is too heavy;
• maternal infectious diseases;
• tight swaddling;
• joint injuries;
• deviations in the development of the spine;
• foot deformity;
• spinal cord pathologies;
• hormonal disorders;
• restriction of intrauterine movements of the fetus;
• The age of the woman giving birth is over 35 years.

Species

Hip dislocations can be unilateral or bilateral, the latter being very rare. In addition, doctors divide pathology into three main types:

• Acetabular dysplasia. Symptoms: the acetabulum is of non-standard size, usually reduced in diameter, has a flat base and an underdeveloped cartilaginous dome.
• Dislocation of the femur. Normally, the femoral neck connects to the body at an angle of 40 degrees in adults and 60 degrees in newborns. Violation of the angle leads to dislocation.
• Rotational dysplasia. Described as a violation of the anatomical structure and placement of bones. It manifests itself in children in the form of clubfoot, shortening of the limb.

Degrees of dysplasia in children

Doctors distinguish several stages of development of disorders of the geometry of the hip joint, depending on the severity. These include:

• Initial stage. When structural changes have already begun, but have not yet developed to such a point that the doctor can make a diagnosis after a visual examination.
• Pre-dislocation. It is characterized by stretching of the capsule and a slight displacement of the femoral head.
• Subluxation of the hip. The head of the joint is noticeably displaced in relation to the trochanteric cavity. It moves the rim slightly, causing the hip ligaments to become stretched.
• Dislocation. The head is located outside the acetabulum, up and out. The edge of the cartilaginous rim is pressed and bent inward. The supporting elastic ligaments have lost their flexibility.

Why is hip dysplasia dangerous in children?

An undiagnosed dislocation can cause serious disturbances in the structure of the hip organ and many unpleasant symptoms. With unilateral dislocation, children experience gait disturbance, limited mobility, pelvic distortion, pain in the knees and hip, and mild muscle atrophy. If bilateral dysplasia has been diagnosed in a child, you may notice a duck gait, deterioration in functions internal organs pelvis, the appearance of pain in the lumbar region.

For adults, the consequences of dysplasia are fraught with arthrosis of the hip joint and dysplastic coxarthrosis. The latter pathology of the musculoskeletal system is characterized by a decrease in physical activity, deterioration of muscle condition, pain in the back, legs, and hips. Sometimes, at the place where the femur comes into contact with the pelvic bone, a growth of a false joint is observed - neoarthrosis. Clinical symptoms manifest themselves in the form of acute pain, lameness, and shortening of one leg. Neoarthrosis is often observed in other connective tissues and can lead to disability.

Signs in infants

It is advisable to carry out visual diagnostics up to seven days after birth. At this stage, the baby's muscle ligaments are relaxed, more mobile and elastic. Doctors may suspect hip dislocation in children at risk: girls, breech babies, newborns from mothers with severe toxicosis, or when the child was born with a large weight. Wherein external signs Hip dysplasia may be absent in infants. The diagnosis is usually made according to three main criteria.

Asymmetry of skin folds

The skin folds under the knee, in the groin, on the back and front of the thigh should be a mirror image of each other: they should be the same size and depth. If, when lying on your stomach, the depressions are located higher than each other, there is a high probability that the symptom indicates instability of the joints. Do not forget that slight asymmetry can occur even in healthy children. The criterion for diagnosing gluteal folds is not objective for bilateral disorders.

Clicking symptom

This sign is considered the most reliable only when the disease is diagnosed no later than 3 weeks after birth. If the head of the femur moves when the hip is abducted or the rotation of the leg is accompanied by a click, this indicates that the head has slipped from the joint capsule. To identify dysplasia in older children, it is advisable to use more informative examination methods.

Hip abduction angle

Another symptom of congenital dislocation is the inability to spread the child’s legs when lying on his back at an angle of 90 degrees. An unhealthy hip of grade 2 or 3 is characterized by an angle of inclination of no more than 60 degrees. This symptom can be found between 3 and 6 weeks of age. When muscle tone is increased, achieving the desired result will be problematic.

How to identify hip dysplasia in newborns

If clinical diagnostic methods do not give a definite answer, the orthopedic doctor will prescribe additional examinations: radiography or ultrasound. Both methods help to detect underdevelopment of the acetabulum, deviations in the structure of the neck, head or bone. In cases where this does not produce results, they resort to magnetic resonance imaging or CT.

X-ray diagnostics

X-ray exposure of the bone skeleton, although it creates a serious radiation load on the child’s body, also helps to obtain a picture of the structure of the acetabulum and head. In newborns and children younger age Most of the hip joints consist of cartilage, so the study is carried out in a special way. The image is drawn with horizontal and vertical lines to form a cetabular angle. Its size is the basis for making a diagnosis.

Ultrasound diagnostics

The method is considered as safe as possible. Doctors conduct an initial examination up to 7 days after birth for children who are predisposed to developing pathology. Subsequently, using an ultrasound machine of the hip joints, the condition of the bone part, the cartilaginous protrusion is monitored, the position of the femoral head at rest and during movement is studied, and the angle of inclination of the acetabulum is calculated. To interpret the data obtained, fixed norm tables are used.

Treatment of dysplasia in children

Therapy for congenital joint dislocation will be more successful the earlier it is started. Treatment is always carried out comprehensively using therapeutic exercises, physiotherapeutic procedures, special spacers, orthopedic splints and massage. Complete restoration of the anatomical structure of the hip joints will take a long time. On average, doctors give prognoses from two months to a year, but sometimes the treatment regimen is extended.

Wide swaddling of baby

One of the effective treatment methods in the first days of a baby’s life is the fixed swaddling technique. To do this, place a soft diaper, folded several times, on the perineum and secure it with another cloth. Due to this, the baby’s legs remain constantly in the spread position of extension/flexion at the desired angle. If dysplasia in children was detected at a late stage, the legs are additionally secured with a plaster cast.

Pavlik stirrups

The principle of this method is based on fixing the bend of the legs at the knees using stirrups. The Pavlik device is produced ready for use - it is a chest bandage made of soft tissue, with shoulder and popliteal straps for fixing the limbs. You need to wear the bandage for about a month. If the results of the control examination are unsatisfactory, the dislocation is reduced under anesthesia, and stirrups continue to be worn for another 5-6 months. The Pavlik design cannot be used for:

• pronounced displacement of the femoral head;
• infringement of the capsule;
• significant disturbances in the structure of the acetabulum.

Massage

Therapeutic massage helps speed up blood circulation, strengthen the hip muscle groups, and improve the trophism of the ligamentous apparatus. The technique involves the use of gentle stroking, tapping or rubbing movements. Massage is done daily. First, knead the chest, upper and lower parts of the body, and stomach. Then they smoothly move on to massage the inner thighs, bend and move their legs to the sides, and move their limbs in a circle.

Physiotherapy

To improve metabolic processes in tissues and normalize blood circulation in the damaged area, physiotherapy is used. Various techniques help eliminate pain and muscle spasms. For children, as a rule, choose:

• warm baths;
• ultraviolet irradiation;
• paraffin or ozokerite compresses;
• electrophoresis with calcium, phosphorus or iodine.

Reduction of congenital hip dislocation

When conservative treatment of dysplasia does not help, the doctor may suggest a joint correction procedure - closed reduction of the dislocation. As a rule, this method will give the desired effect when treating children under two years of age. Afterwards, bloodless reduction will be technically difficult to perform, so for children over 3 years of age, head reduction is done using skeletal traction. After the procedure, plaster casts will be placed on the legs for rigid fixation, which must be worn for up to 6 months.

Surgery

The operation is indicated for children for whom all of the above methods have not helped. Its essence is to arrange all the components of the hip part in the right direction. There are a lot of surgical treatment methods: open reduction of a dislocation, corrective surgery, derotational osteotomy, joint replacement surgery, etc. Choice best method depends on the degree of deformation of the pelvic cavity and the elasticity of the ligaments.

Treatment of dysplasia in adults

To relieve chronic pain and reduce inflammation, drugs from the NSAID group are used, for example, Ketoprofen, Naproxen, Ibuprofen or Diclofenac. To prevent complications or treat osteoarthritis, neoarthrosis, and to prevent the development of coxarthrosis, chondoprotectors are prescribed: Rumalon, Arteparon and other intramuscular injections. Exercise therapy exercises eliminate defects and prevent dysplasia.

Exercises

The goal of gymnastics is to strengthen muscles and improve motor activity. Exercise therapy is used at all stages of treatment, except for surgery (immediately before and after). It is recommended to do the exercises 2-3 times daily; during rest breaks you can stretch your limbs with a massage. An approximate set of exercises:

• Take a “lying on your back” position. Bend your knees. On the count of three, begin to imitate riding a bicycle by moving your legs back and forth. You need to repeat the gymnastics 10-15 times.
• From the same body position, try to bring your feet as close to each other as possible.
• Do alternate flexion and extension of your legs, equally distributing the load on both limbs.

Video

Found an error in the text?
Select it, press Ctrl + Enter and we will fix everything!