home Adviсe Bilateral hip dysplasia in a child. Deviation from the norm and interpretation of results. Causes of hip dysplasia in children

Bilateral hip dysplasia in a child. Deviation from the norm and interpretation of results. Causes of hip dysplasia in children

After birth, hip dysplasia is common in newborns. Diagnosis of such diseases is quite difficult. Parents will be able to suspect the first signs in children under one year old. This disease is dangerous due to the development of adverse complications that can significantly worsen the baby’s quality of life.

What it is?

This pathology of the musculoskeletal system arises from the influence of numerous causes that lead to disruption of the intrauterine anlage of organs. These factors contribute to underdevelopment of the hip joints, as well as all the articular elements that form the hip joints.

With severe pathology, the articulation between the head of the femur and the acetabulum, which form the joint, is disrupted. Such violations lead to the appearance of unfavorable symptoms of the disease and even complications.

Congenital underdevelopment of the hip joints is quite common. Almost every third of a hundred children born is diagnosed with this disease. It is important to note that susceptibility to this disease is higher in girls, and boys get sick somewhat less frequently.

IN European countries dysplasia of large joints is more common than in African countries.

Pathology is usually found on the left side; right-sided processes are recorded much less frequently, as are cases of bilateral processes.

Causes

There are several dozen provoking factors that can lead to the development of physiological immaturity of large joints. Most of the impacts that lead to immaturity and disruption of the structure of large joints occur in the first 2 months of pregnancy from the moment the baby is conceived. It is at this time that the intrauterine structure of all elements of the child’s musculoskeletal system takes place.

The most common causes of the disease include:

Genetics. Typically, in families where cases of this disease have occurred, the likelihood of having a baby with pathologies of large joints increases by 40%. At the same time, girls have a higher risk of getting sick.
Exposure to toxic chemicals during pregnancy. This situation is most dangerous in the first trimester, when intrauterine development of the musculoskeletal system occurs.
Unfavorable environmental situation. Harmful environmental factors have negative action on the development of the unborn child. Insufficient amount of incoming oxygen and high concentration carbon dioxide can cause intrauterine fetal hypoxia and lead to disruption of the structure of joints.
Future mom over 35 years old.
The baby weighs more than 4 kilograms at birth.
The birth of a baby ahead of schedule.
Breech presentation.

Carrying a large fetus with an initially small uterus. In this case, the baby physically does not have enough space to active movements. This forced passivity during fetal development can lead to limited mobility or congenital dislocations after birth.
Infection with various infections of the expectant mother. During pregnancy, any viruses or bacteria easily pass through the placenta. Such infection on early stages development of the baby can lead to congenital defects in the structure of large joints and ligaments.
Poor quality nutrition, lack of vital essential vitamins , which are necessary for the full development of cartilage and ossification - the formation of bone tissue.
Excessive and very tight swaddling. Excessive pressing of the child's legs to the body can lead to the development of various types of dysplasia.

Kinds

Doctors classify various forms of the disease according to several main characteristics. For dysplasia, such criteria are combined into two large groups: according to the anatomical level of the lesion and according to the severity of the disease.

According to the anatomical level of the lesion:

Acetabular. There is a violation in the structure of the main large elements that make up the hip joint. Basically, with this option, damage to the limbus and marginal surface occurs. At the same time, the architecture and structure of the joint changes greatly. These injuries lead to disruption of movements that should be performed by the hip joint normally.
Epiphyseal. A pronounced impairment of mobility in the joint is characteristic. In this case, the norm of the angles that are measured to assess the work of large joints is noticeably distorted.
Rotary. With this variant of the disease, a violation may occur anatomical structure in the joints. This is manifested by the deviation of the main structures that form the hip joint from the median plane. Most often, this form is manifested by gait disturbance.

By severity:

Mild degree. Doctors also call this form preluxation. Severe disorders that arise with this option and lead to disability, as a rule, do not occur.
Medium heavy. It may also be called a subluxation. With this option, the head of the femur usually extends beyond the articulation during active movements. This form of the disease leads to the development of adverse symptoms and even long-term negative consequences of the disease, which require more active treatment.
Heavy current. Such a congenital dislocation can lead to adduction contracture. With this form, a pronounced violation and deformation of the hip joint occurs.

Symptoms

Identification of the first symptoms of anatomical defects of large joints is carried out already in the first months after the birth of the baby. The disease can already be suspected in an infant. When the first signs of illness appear, the baby should be shown to an orthopedic doctor. The doctor will conduct all additional examinations that will clarify the diagnosis.

To the most characteristic manifestations and signs of the disease include:

Asymmetry in the location of skin folds. They are usually quite well identified in newborns and infants. Every mother can evaluate this symptom. All skin folds should be approximately at the same level. Pronounced asymmetry should alert parents and suggest that the child has signs of dysplasia.
The appearance of a characteristic sound resembling a click, during adduction of the hip joints. This symptom can also be detected with any movements in the joint in which abduction or adduction occurs. This sound occurs due to active movements of the femoral head along the articular surfaces.
Shortening lower limbs. It can occur on one side or on both. With a bilateral process, the baby often experiences growth retardation. If the pathology occurs only on one side, then the child may develop lameness and gait disturbance. However, this symptom is detected somewhat less frequently when the baby tries to stand on his feet.
Pain in large joints. This sign intensifies when the child tries to stand on his feet. Increased pain occurs when performing various movements at a faster pace or with a wide amplitude.
Secondary signs of the disease: slight muscle atrophy in the lower extremities, as a compensatory reaction. When trying to determine the pulse in the femoral arteries, a slightly reduced impulse may be observed.

Consequences

Dysplasia is dangerous due to the development of unfavorable complications that can occur with a long course of the disease, as well as with insufficiently effective and high-quality treatment of the disease in initial stages.

With a long course of the disease, persistent gait disturbances may develop. In this case, surgical treatment is required. After such therapy, the baby may limp slightly. However, later this unfavorable symptom completely disappears.

Also, if signs of the disease have been observed for a long time, muscle atrophy may occur in the injured lower limb. On the contrary, the muscles on a healthy leg may be excessively hypertrophied.

Severe shortening also quite often leads to gait disturbances and severe lameness. In severe cases, this situation can even lead to the development of scoliosis and various posture disorders. This occurs due to a shift in the supporting function of damaged joints.

Large joint dysplasia can lead to various adverse consequences in adulthood. Quite often, such people have cases of osteochondrosis, flat feet or dysplastic coxarthrosis.

Diagnostics

Usually, this pathology It starts out pretty rough. Only a specialist can identify the first symptoms; it is quite difficult for parents to do this on their own at home.

The first step in establishing a diagnosis is a consultation with an orthopedic doctor. Already in the first year of a child’s life, the doctor determines the presence of predisposing factors, as well as primary symptoms of the disease. Usually, the first orthopedic signs of the disease can be recognized during the first six months of a child’s life. To accurately verify the diagnosis, various types of additional examinations are prescribed.

The safest and informative method, which can be used in infants is ultrasound. Interpretation of ultrasound allows you to establish various signs characteristic of the disease. This method also helps to establish the transient form of the disease and describe the specific changes that occur in the joint characteristic of this variant. Using ultrasound, you can accurately determine the timing of ossification of the nuclei of the hip joints.

Ultrasound diagnostics is also a highly informative method that clearly describes all anatomical defects observed in various types of dysplasia. This study is absolutely safe and is performed from the very first months after the birth of the baby. There is no significant radiation exposure to the joints during this examination.

X-ray diagnostics is used only in the most difficult cases diseases. X-rays should not be performed on children under one year of age. The study makes it possible to fairly accurately describe various anatomical defects that arose after birth. Such diagnostics are also used in complex clinical cases, in which the exclusion of concomitant diseases is required.

All surgical methods for examining large joints in newborns are not used. During arthroscopy, doctors use instrumental instruments to examine all the elements that make up the hip joint. During such studies the risk secondary infection increases several times.

Usually magnetic resonance and computed tomography large joints are carried out before planning various surgical interventions. In difficult cases, orthopedic doctors can prescribe examination data to exclude various diseases which may present with similar symptoms.

Treatment

Diseases of the musculoskeletal system need to be treated for a long time and with strict observance recommendations. Only such therapy makes it possible to eliminate as much as possible all the unfavorable symptoms that arise with this pathology. A complex of orthopedic therapy is prescribed by an orthopedic doctor after examining and examining the baby.

Among the most effective and commonly used treatment methods are the following:

Using wide swaddling. This option allows you to maintain the most comfortable position for the hip joints - they are in a slightly apart state. This type of swaddling can be used even for babies from the first days after birth. Becker's pants are one of the wide swaddling options.
Application of different technical means. The most commonly used are various tires and spacers. They can be of different rigidity and fixation. The selection of such technical means is carried out only on the recommendation of an orthopedic doctor.
Physical exercises and exercise therapy should be performed regularly. Typically, such exercises are recommended to be done daily. The complexes should be performed under the guidance medical personnel clinics, and subsequently – independently.
Massage. It is prescribed from the first days after the birth of the baby. Courses are conducted several times a year. With this massage, the specialist works well on the baby’s legs and back. This treatment method is well accepted by the child and correct implementation does not cause him any pain.
Gymnastics. A special set of exercises must be performed daily. Abduction and adduction of the legs in a certain sequence allows you to improve movement in the hip joints and reduce the manifestations of stiffness in the joints.
Physiotherapeutic methods of treatment. The baby can undergo ozokerite and electrophoresis. Also, various types are actively used for children. heat treatment and inductotherapy. Physiotherapeutic procedures for the treatment of dysplasia can be performed in a clinic or specialized children's hospitals.

Spa treatment. Helps effectively cope with adverse symptoms that arise from dysplasia. Staying in a sanatorium can significantly affect the course of the disease and even improve the baby’s well-being. For children with hip dysplasia, it is recommended to undergo sanatorium-resort treatment annually.
Adequate nutrition with the obligatory inclusion of all necessary vitamins and microelements. Children with musculoskeletal disorders must eat enough fermented milk products. The calcium they contain has a beneficial effect on the structure of bone tissue and improves the growth and physical development of the child.
Surgery In newborns, as a rule, it is not carried out. Such therapy is possible only in older children. Usually, before reaching 3-5 years of age, doctors try to carry out all the necessary treatment methods that do not require surgery.
The use of painkillers, non-steroidal anti-inflammatory drugs to eliminate pronounced pain syndrome. Such drugs are prescribed mainly for severe variants of the disease. An orthopedic doctor or pediatrician prescribes painkillers after examining the child and identifying contraindications to such medications.
Plaster application. It is used quite rarely. In this case, the affected leg is fixed quite tightly with a plaster cast. After some time, the cast is usually removed. The use of this method is quite limited and has a number of contraindications.

In order to reduce the risk of possible development of dysplasia, use the following tips:

Try to choose a looser or wider swaddle if the child has several risk factors for the development of dysplasia of large joints. This method of swaddling can reduce the risk of developing disorders in the hip joints.
Monitoring a healthy pregnancy. Try to limit the impact of various toxic substances on the body of the expectant mother. Severe stress And various infections can cause various intrauterine malformations. The expectant mother must ensure that she protects her body from contact with any sick or feverish acquaintances.
Using special car seats. In this case, the child's legs are in an anatomically correct position throughout the entire journey in the car.
Try to hold your baby correctly. Do not press the baby's legs tightly to the body. An anatomically more advantageous position is considered to be a more abducted position of the hip joints. Also remember this rule while breastfeeding.
Preventive complex gymnastic exercises . Such gymnastics can be performed from the first months after the birth of the child. The combination of exercises and massage significantly improves the prognosis of the disease.
Choose the right diapers. A smaller size can cause a forced adducted state of the child’s legs. Avoid overfilling the diaper and change them often enough.
Get regular check-ups with an orthopedic surgeon. Every child must attend such consultations before the age of six. one month old. The doctor will be able to identify the first signs of the disease and prescribe the appropriate treatment package.

With high-quality treatment, most negative manifestations of dysplasia can be eliminated almost completely. Medical supervision of a child diagnosed with dysplasia should be carried out over a long period of time. Such babies undergo regular examinations by a neurologist and orthopedist. Controlling the course of the disease helps prevent the development of dangerous and unfavorable complications.

To learn about what hip dysplasia is, how it is treated and at what age it is best to start treatment, watch the following video.

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 is a 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 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, a 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, moderate and severe degrees.

It is designated as preluxation, subluxation, dislocation of the hip:

Pre-luxation characterizes a mild form of the disease. 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

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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 receive less 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

The following types or forms of dysplasia exist:

Acetabular(cotabular dysplasia). It is characterized by pathology of the acetabulum of the pelvic bone, its flattening occurs, and disturbances occur in the cartilage of the limbus. 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). Characteristic appearance pain symptoms and leg deformities. 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 contact 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 refer you to 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), orthopedic treatment is indicated, 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.

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. It is recommended to wear it continuously until the baby is 1 year old.

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?

A dislocation of the hip joint will occur, and the person may limp for the rest of his life if not treated promptly. early period. An inflammatory process appears, which means acute pain 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 in adolescence, problems with the hip joint may occur. At an older age, something that was not cured at a younger age, before starting to walk, manifests itself. Early correction allows us to resolve 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.

You should not ignore such pathology as “Hip Dysplasia”. If treatment is not started before the child’s bones become stronger, then most likely he will remain disabled with a “duck gait.”

From this article you will learn about what kind of disease this is, what can cause this disease, how to recognize dysplasia and, most importantly, get acquainted with methods of treating a disease that can cost a child happy childhood, adaptation in society and many happy moments.

This article will be useful primarily to parents who are planning or who have very young children. In most cases, dysplasia affects girls and can be caused by both heredity and injuries at such a fragile age.

Hip dysplasia in children - description of the disease

Hip dysplasia in children

When a pediatrician diagnoses “hip dysplasia,” it is understood that the baby has a congenital pathology in the development of elements of the hip joint.

Subsequently, if not applied adequate treatment, this can lead to gait disturbances, constant pain in the back and joints, curvature of the spine, pelvic displacement and, ultimately, to a wheelchair. Hip dysplasia in newborns indicates underdevelopment of all elements of the joint, as well as their incorrect alignment.

Dysplasia is a congenital defect of the hip joint associated with improper development of its constituent structures: the musculo-ligamentous apparatus, the articular surfaces of the pelvis and the head of the femur. Due to impaired growth of joint structures, the femoral head is displaced relative to the articular surface of the pelvis (subluxation, dislocation).

Surgeons and orthopedists use the term “hip dysplasia” to combine several diseases:

congenital preluxation - a violation of the formation of the joint without displacement of the femoral head;
congenital subluxation – partial displacement of the femoral head;
congenital dislocation is extreme dysplasia, when the femoral head does not come into contact with the articular surface of the acetabulum of the pelvic bone;
X-ray immaturity of the hip joint – borderline state, characterized by a lag in the development of bone structures of the joint.

In newborns and children in the first months of life, preluxation is most often observed - a clinically and radiologically determined disorder in the development of the hip joint without displacement of the femoral head. Without proper treatment, as the child grows, it can transform into subluxation and dislocation of the hip.

Due to a violation of the ratio of articular surfaces, cartilage is destroyed, inflammatory and destructive processes occur, which leads to the occurrence of a severe disabling disease - dysplastic coxarthrosis.

Unilateral dysplasia occurs 7 times more often than bilateral, and left-sided - 1.5-2 times more often than right-sided. In girls, disorders of the formation of the hip joints occur 5 times more often than in boys.

Pathogenesis - the course of the disease

There are several theories for the occurrence of hip dysplasia, but the most substantiated are genetic (25-30% have female inheritance) and hormonal (the effect of sex hormones on the ligaments before childbirth).

The hormonal theory is confirmed by the fact that dysplasia is much more common in girls than in boys. During pregnancy, progesterone prepares the birth canal for childbirth by softening the ligaments and cartilage of the woman's pelvis.

Once in the fetal blood, this hormone finds the same application points in girls, causing relaxation of the ligaments that stabilize the hip joint. In most cases, if the process is not interfered with by tight swaddling, restoration of the ligament structure occurs within 2-3 weeks after birth.

It has also been noted that the occurrence of dysplasia is facilitated by limited mobility of the hip joints of the fetus during intrauterine development. In this connection, left-sided dysplasia is more common, since it is the left joint that is usually pressed against the wall of the uterus.

In the last months of pregnancy, the mobility of the hip joint can be significantly limited with the threat of miscarriage, more often in first-time mothers, in the case of breech presentation, oligohydramnios and a large fetus.

Today, the following risk factors for hip dysplasia are identified:

presence of hip dysplasia in parents
abnormalities of the uterus
unfavorable course of pregnancy (threat of miscarriage, infectious diseases, taking medications)
breech presentation of the fetus
transverse position of the fetus,
multiple pregnancy
oligohydramnios
natural childbirth with breech presentation of the fetus
pathological course of childbirth,
first birth
female
large fruit.

The presence of these risk factors should be a reason for observation by an orthopedist and preventive measures(wide swaddling, massage and gymnastics).

Classification of hip dysplasia

preluxation;
subluxation;
hip dislocation.

Preluxation and subluxation occurs in every 2-3rd child, it can be unilateral or bilateral, it occurs almost painlessly in childhood, the child can walk, run and even jump freely, parents do not notice almost any abnormalities, with the exception of clubfoot, valgus stop, scoliotic posture. In case of preluxation, the head of the femur can be freely moved within the joint, while the ligaments surrounding the joint are weakened, resulting in instability.
Subluxation - the head of the femur can pop out and return to its place in the joint; as a rule, a dull click is heard.
Dislocation is an extremely rare occurrence; per 1000 children born, one has such a pathology. In a dislocation, the head of the femur lies outside the joint.

It is into these three types that in modern medicine it is customary to divide hip dysplasia.

Causes of dysplasia in newborns

Here the opinions of doctors differ: some specialists insist on a genetic factor, while gynecologists and obstetricians talk about malformations of the child’s joints even at the age of early stages mother's pregnancy, which, according to doctors, contributes to bad habits, poor ecology, poor nutrition, and infectious diseases.

In this case, terminology is indispensable. Let us describe one of the mechanisms of the origin of dysplasia in children. When there is functional blocking in the cervical spine (which occurs during childbirth and after), the upper lobe of the trapezius muscle is tensed, and at the same time tension occurs in the lower lobe; in the thoracic spine, blocking subsequently occurs in the lumbosacral and iliosacral joints.

As a result of this, the iliac crest rises higher on one side, and a pelvic distortion occurs (a twisted pelvis). What kind of stirrups can we talk about in this case if on one side the leg looks shorter than the other? Accordingly, the femoral head, in relation to the other, is located asymmetrically.

Any dynamic loads in this case are painful. And no massage, and no orthopedic devices will correct this situation. Lost every hour, every day, not to mention weeks and months.

And if we also remind you about the displacement in the cervical spine, which leads to a violation cerebral circulation and remembering the hypothalamus, which regulates the production of hormones by other glands, including the production of hormones responsible for normal growth and full development, it becomes scary.

As you can see, treatment should be comprehensive, thanks to the use of manual diagnostic methods and therapy, many problems can be successfully corrected without expecting the process to worsen.

The generally accepted causes of dysplasia include:

Difficult labor and breech presentation of the baby in the womb (occurs 10 times more often than in the normal course birth process and the position of the baby). In 80% of cases it occurs in girls.
Tight swaddling. Pediatricians almost unanimously argue that young parents should abandon tight swaddling, which restricts the child’s movements. The fact is that the fragile joints of the baby will constantly be in an immobilized position, which can lead to their deformation - displacement of the joint from the acetabulum. Even statistics speak of the need to abandon “cocoonization”: in southern countries, where mothers do not swaddle their babies, hip dysplasia is 80% less common than in northern countries. After tight swaddling was banned in Japan, the percentage of dysplasia dropped from 3 to 0.2.
Hormonal disorders. In the third trimester of pregnancy, the mother’s body begins to produce in excess the hormone progesterone, which is necessary to relax the ligaments of the articular apparatus - a kind of preparation for the birth of a child. While having a positive effect on the mother, high levels of the hormone can harm the baby, causing underdevelopment of the joints. A high level of oxytocin, which increases the tone of the fetal muscles, also has a very negative effect, which leads to joint dislocation. Experts insist on a hormonal factor in the development of dysplasia, because it is more common in girls, who are physiologically very sensitive to changes in the mother’s hormonal levels.

Other causes of dysplasia include: insufficient consumption by the pregnant woman of foods containing phosphorus, calcium, iodine and iron, as well as vitamins E and B; oligohydramnios, increased uterine tone and large fetus size.

Symptoms of the disease

What should alert parents? Up to 1 month. Increased tone back muscles, visually one leg is shorter than the other, an additional fold on the buttock, asymmetry of the gluteal folds and buttocks, incomplete spread of the legs, with bent knees. The position of the child’s body is C-shaped, the head is held on one side, and the child often holds a clenched fist on one hand.

3 - 4 months. When bending the legs at the knee and hip joints, a click is often heard, and the foot is flatvalgus (the heel is not in line with the shin). One leg is visually shorter than the other.
6 months and older.

The habit of standing up and walking on your toes, when gait, the toes of one or two feet are turned inward or outward, clubfoot. Excessive curvature of the spine in lumbar region- horizontal pelvis, gait, “like a duck’s.” Visual slight curvature of the spine, stoop. One leg is shorter than the other due to the sloping pelvis.

There are five classic signs, which help to suspect hip dysplasia in infants. Any mother can notice the presence of these symptoms, but only a doctor can interpret them and draw conclusions about the presence or absence of dysplasia.

However, these signs, determined “by eye”, do not prove dysplasia 100%, and are so-called - probable signs, which can also occur normally.
Absolute proof of normality or pathology can only be objective methods research - x-ray and ultrasound diagnostics.

Diagnosis of pathology

The first to examine the child for the presence of dysplasia is a neonatologist in the maternity hospital and, if symptoms indicating a violation of the formation of the hip joint are detected, he refers him for consultation to a pediatric orthopedist. An examination by a pediatric orthopedist or surgeon is recommended at 1, 3, and 6 months of age.

The most difficult thing is to diagnose preluxation. Upon examination, in this case, asymmetry of the folds and a clicking symptom may be detected. Sometimes there are no external symptoms.
With subluxations, asymmetry of the folds, a clicking symptom and limitation of hip abduction are detected.

In some cases there is slight shortening of the limb. Dislocation has a more pronounced clinical picture, and even parents can notice the symptoms of the pathology. To confirm the diagnosis, additional examination methods are performed - ultrasound and radiography of the hip joints.

Ultrasound examination of the hip joint is the main method for diagnosing dysplasia up to 3 months. The method is most informative at the age of 4 to 6 weeks. Ultrasound is safe method examinations, therefore, can be prescribed as screening at the slightest suspicion of dysplasia.

Indications for undergoing an ultrasound of the hip joints before 4 months of age are the identification of one or more symptoms of dysplasia (clicking, limited hip abduction, asymmetry of the folds), a family history, and breech birth (even in the absence of clinical manifestations).

X-ray of the hip joints is an accessible and relatively cheap diagnostic method, however, today it is used limitedly due to the danger of radiation and the inability to image the cartilaginous head of the femur. During the first 3 months of life, when the heads of the femurs consist of cartilage, x-rays are not an accurate enough diagnostic method.

From 4 to 6 months of age, when ossification nuclei appear in the head of the femur, radiographs become a more reliable way to detect dysplasia. X-rays are used to assess the condition of the joints in children with a clinical diagnosis of hip dysplasia, to monitor the development of the joint after treatment, and to evaluate its long-term results.

Refuse to undergo this examination for fear of harmful effects X-ray exposure, it’s not worth it, since undiagnosed dysplasia has much more serious consequences than an x-ray.

Difficulty in detecting the disease in infants early stages lies in the lack of expression of key symptoms, which is why at the birth of the baby he is carefully examined by a pediatrician to identify any pathologies. If there is a suspicion of hip joint pathology, a referral for ultrasound diagnostics is issued. According to the plan, such diagnostics are carried out at 1, 3, 6 and 12 months.

In addition, you can determine the presence of pathology in a child yourself:

Place the baby on his back, bend his legs at a right angle at the knees and hip joints and carefully spread them apart. If there is some discomfort and restriction in movement, if the legs touch the surface asymmetrically, you should urgently show the child to an orthopedist.
Asymmetry of folds on the baby’s butt and hips. To check, place your baby on his tummy and straighten his legs. Also included in this symptom is the unequal length of the legs.
Clicking when turning the hip. The “symptom of slipping” is defined as follows: place the child on his back, bend his legs at a right angle at the knees and hip joints, thumb Place your hands on the inner surface of the thigh, the index and middle ones on the outer surface: carefully move the thigh away; if you hear a click, it means that the femoral head is in an unstable position.

At an older age, another symptom of dysplasia appears - lameness when walking, as well as the so-called. duck walk.

Treatment

Today, the main principles of conservative treatment of hip dysplasia are:

Early start of treatment;
Giving the limb a position conducive to reduction (flexion and abduction of the hip);
Maintaining the possibility of active movements;
Long-term and continuous treatment;
Application additional methods— therapeutic exercises, massage, physiotherapy.

The effectiveness of conservative treatment is assessed using ultrasound and radiography of the hip joints. Standard scheme treatment of hip dysplasia includes: wide swaddling, massage and exercise therapy for up to three months, Pavlik stirrups (Gnevkovsky apparatus) for up to 6 months, and subsequently - abduction splints in the presence of residual defects. When diagnosing a dislocation after 6 months, sometimes they first resort to adhesive traction, followed by fixation of the joint in an abduction splint.

The duration of treatment and the choice of orthopedic devices depend on the severity of dysplasia (preluxation, subluxation, dislocation) and the age of the patient.

When prescribing Pavlik stirrups or other devices, it is important to adhere to the recommendations of the attending physician and observe the regime of wearing them. As a rule, stirrups must be worn constantly in the first two weeks, removing them only for evening swimming.

Exercise therapy for hip dysplasia is used from the first days of life. It strengthens the muscles of the affected joint and promotes the full physical development of the child. Massage begins at the age of 7-10 days, it prevents muscle dystrophy and improves blood supply to the affected joint, thus helping to speed up recovery.

Physiotherapeutic treatment includes electrophoresis with calcium chloride, cocarboxylase and vitamin C, paraffin applications on the hip joint area, ultraviolet irradiation and vitamin D preparations.

It should be borne in mind that massage, exercise therapy and physiotherapeutic procedures at each stage of treatment have their own characteristics. Therefore, they should only be used under the supervision of a physician.
Surgical treatment is used after the child reaches the age of 1 year.

Indications for surgery are true congenital dislocation of the hip in the absence of the possibility of conservative reduction, repeated dislocation after closed reduction and late diagnosis (after 2 years).

A child with congenital hip dislocation should be followed up by an orthopedist until the age of 16. It is important to understand that hip dysplasia in infancy can be corrected in a few months, but if it is not cured in time, correction of disorders in older age will take much more time and effort.

To prevent the serious consequences of dysplasia, you just need to follow your doctor’s recommendations. Some of the most effective ways treatment - fixing the legs in a spread position. As a preventive measure, the use of wide swaddling can be used, when the baby’s legs are bent at a right angle at the knees and hip joints, widely spread to the sides. At this method A multilayer diaper is placed between the legs.

This allows you to fix the limbs in the required position. As therapeutic exercises You can carry out extension and bending of the legs to and from the stomach with abduction of the hips one hundred and eighty degrees, as well as rotational movements along the femoral axis with the legs. Gymnastics should be continued for up to four months.

Dysplasia of the hip joints can be treated with physiotherapy and massage. It makes sense to use soft devices, for example, a Vilensky splint or Pavlik stirrups, this will help fix the joints in the correct position up to the age of 3 months. If a child at the age of two is diagnosed with dysplasia of the hip joints, then surgical intervention cannot be avoided.

The disadvantage of the operation is expressed in a long and difficult recovery period. If your baby is diagnosed with joint dysplasia, do not despair. The earlier a problem is discovered, the easier it can be dealt with.

Treatment of dysplasia corresponds to the severity. If a child has mild hip dysplasia, then you can follow simple rules to normalize the development of joints.

Children are prescribed massage, then gymnastics. In more complex cases, the child is given abduction splints to fix the legs. Splints are prescribed by an orthopedist who carefully examines the type of dysplasia using ultrasound, x-rays and orthopedic methods. If you achieve results using conservative techniques If it doesn’t work out, they resort to surgical treatment.

Parents can independently perform a massage with rotation of the leg along the femoral axis with pressure on the limb, but the child may experience pain. At an older age, cycling, physical exercise in warm water, and therapeutic exercises are recommended. Most importantly, do not forget about preventive examination of children, because timely diagnosis and treatment can avoid many problems.

Modern treatment of dysplasia in children using manual medicine methods

In order to go to see a doctor, you need to take with you photocopies of an extract from the maternity hospital, the orthopedist’s reports and conclusions, an x-ray or ultrasound and a photocopy of their description. If we approach the problem of dysplasia in infants in a new way, we must admit: traditional treatment often only torments babies. In order to establish the root cause, be it dislocation, subluxation or preluxation.

At the very early stage, you should not torture your baby with orthopedic devices. Every day a child must learn about the world, experience dynamic loads on the hip joints, during which blood circulation improves, all functions are restored, and normal physiological development of the hip joints and tissues surrounding it occurs.

They approach this problem one-sidedly only from the side of orthopedics, considering only disorders in the hip joints, forgetting about the integrity of the whole organism as a single functional system it is forbidden. Most specialists are very critical of treatment innovations - the use of manual medicine, I believe that if the technique works, then it must be used.

I was pleasantly surprised when I attended the International Conference on Manual Therapy in 2002 that I was not the only one opposed to outdated methods of treating dysplasia. There are already orthopedists who are learning manual therapy techniques, but in Ukraine this is still a matter of the future.

Manual therapy in the hands of a “non-specialist” can cause irreparable harm patient's health. There is a choice - massage and “orthopedic devices”. For example, various stirrups, insoles for flat feet, devices - corsets for scoliosis, a “chance” collar, corset belts for radiculitis, crutches, a wheelchair. Or manual medicine, but at the same time they must remember that every day lost in childhood is irreplaceable.

At each stage of a child’s development, the formation of both organs and tissues constantly occurs. Don't let your body adapt to problems - look for ways to solve them. “A tablet under the tongue is the easiest thing.” Movement is life. And if something is wrong in biomechanics, then it must be eliminated, and not anesthetized and delayed. The body will tell you at the first stage with acute pain, which the baby cannot tell you about, but you can determine this by tonic muscle tension.

Look for the reason why this pain comes from, and do not suppress this pain. In severe cases - true hip dislocation - I am in favor of comprehensive treatment, using manual therapy and orthopedics together, and in extreme cases, surgery.

Everyone chooses a path to solve a problem, i.e. treatment, myself And what was laid down in childhood will grow. In this particular case, we are talking about children, the parents choose, since no one takes into account the opinion of the baby. He can scream for some time, have sleepless nights, making it clear that he does not agree with this, but he cannot change anything - the parents decide.

The principle of treatment of joint dysplasia:

Use manual methods to eliminate subluxation/dislocation.
Relax tense muscles of the pelvis and spine to prevent displacement of the joints.
Prescribe therapeutic exercises to strengthen the ligaments.
Give time for the joints to form without restricting the baby’s movements.

If you are told that a child with dysplasia will not walk or will limp, then this is not so. The likelihood of lameness is only in the extreme form of dysplasia - with a true dislocation of the hip. The rest of the children walk normally and outwardly practically do not differ from their peers until a certain age.

But these children are guaranteed an equally terrible disease - scoliosis, osteochondrosis with all associated diseases. Unfortunately, scoliosis also awaits those children who were tortured by dressing them in stirrups and various devices in childhood, receiving massages, ultraphoresis, swimming, and not receiving truly correct treatment, i.e. They didn’t initially eliminate the reason why this all happened.

Alternative treatment for hip dysplasia

Even among orthopedic doctors, traumatologists, and surgeons there is no consensus and mutual understanding about dysplasia. Dysplasia manifests itself differently in all children and is not always detected immediately after birth. The joints may be normal at birth and in the first few months of development, but later be diagnosed as abnormal by 6-12 months.

During the initial examination immediately after birth, even a very experienced orthopedist cannot give an accurate diagnosis, although a redisposition to hip dysplasia can be predicted from the first day. If you pay attention to torticollis, in which the child constantly holds his head in one direction.

Each child is individual and develops according to genetic characteristics parents. Parents are not afraid of the fact that a child at 7-8 months does not yet have teeth and, for example, a large fontanel has not “closed” in time. Parents are confident that the teeth will grow and the fontanel will harden, although these two conditions can be compared to “oral dysplasia” and “skull dysplasia.”

But the signs of hip dysplasia must be constantly monitored, because in essence, dysplasia in children is weak, incomplete development of the joint, in most cases it is a natural feature of the body of a small child, and much less often a sign of a disease - a true dislocation.

Over the past 30-40 years, nothing has changed in the treatment of hip dysplasia, with the exception of various orthopedic devices and testing them on children. Pavlik stirrups, Freik splint, CITO, Rosen, Volkov, Schneiderov, Gnevkovsky apparatus, etc. - these orthopedic devices are needed only for true hip dislocation.

And they are prescribed to almost every child from one month to one year constant wearing except for swimming. Often, in this case, the child’s psyche is disturbed - at first he is whiny, restless, and then depressed, oppressed, withdrawn, indifferent to everything.

Children at the age of 2.5 years were repeatedly brought to me in devices; they differ sharply in physical and mental development. Although there were those who adapted and jumped and ran in the apparatus, racing with their peers.

Dangerous consequences of the disease

Why is dysplasia dangerous? The answer is simple: lameness. It turns out that the hip joint, due to neglect, begins to form in its own way, and the muscular-ligamentous apparatus is fixed in this position. The child will walk, but will have a “duck” gait.

Further, due to a violation of the axis and fulcrum, problems with the spine begin: lordosis, kyphosis, osteochondrosis, and so on. And with age the process will only get worse. A new false joint is formed, but it will not be able to perform its function. Here you will only need surgical treatment, although it all depends on how advanced the process is.

If treated during infancy, it will take an average of six months, and if later, the result may only be seen several years later. In order not to miss pathology, it is enough to visit the pediatrician every month.

If he has any suspicions, he will refer you to an orthopedist. And then it will be determined whether parents should worry or not. The result of untreated dysplasia primarily depends on the degree of underdevelopment of the joint (how sloping the roof of the hip joint is, how underdeveloped the femoral head is), as well as on accompanying conditions that inhibit further development (hypertonicity, dysbiosis, rickets, etc.).

If hip dysplasia is minimally expressed, and there are no aggravating factors, in 50% it can be eliminated spontaneously. Think! 50% is every second child, because it is unknown which of them will be yours.

With severe dysplasia of the hip joints, subluxation and dislocation of the hips, spontaneous normalization does not occur. With untreated dysplasia, if its complications do not occur and, due to the sloping roof of the hip joint, subluxation or dislocation of the hip does not occur, your child will complain of rapid fatigue, pain in the legs at the end of the day and after physical activity, and a gentle lameness will appear.

In case of dislocation of the hips, which can be complicated by untreated hip dysplasia, in addition to the above complaints, a diving-type lameness, the so-called “duck gait,” will be striking.

Sources: www.sbornet.ru, miralady.com, doctorignatyev.com, orthoped.in.ua, deti.health-ua.org, mama.ua, medicalexclusive.com.ua, tvoymalysh.com, www.ivetta.ua, www.moideti.com

megan92 () 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I am fighting the effect, not the cause...

Daria () 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. So it goes

megan92 () 13 days ago

Daria () 12 days ago

megan92, that’s what I wrote in my first comment) I’ll duplicate it just in case - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

julek26 (Tver) 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now they sell everything on the Internet - from clothes to TVs and furniture.

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is actually not sold through pharmacy chain to avoid overpricing. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then everything is fine if payment is made upon receipt. Thank you!!

Margo (Ulyanovsk) 8 days ago

Has anyone tried it? traditional methods joint treatment? Grandma doesn’t trust pills, the poor thing is in pain...

Andrey A week ago

Which ones folk remedies I haven't tried it, nothing helped...

Ekaterina A week ago

I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods...

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and backs, and the state fully finances the treatment for each patient.

Hip dysplasia is congenital disease, which can arise for many reasons. Pregnancy rarely goes perfectly. Dirty air, unhealthy food, unfavorable heredity - all this can affect the development of the fetus.

It is best to identify this disease in newborns in order to create the necessary conditions for correction. Otherwise, there is a high risk of complications.

Symptoms

It is commonly called underdevelopment of the acetabulum, ligaments with muscles, cartilage tissue or the joint itself. This disease is not so dangerous if it is diagnosed in a timely manner in children.

Girls suffer from hip dysplasia more often than boys, so they need to be examined more carefully. Even an experienced pediatrician can miss warning signs due to fatigue or inattention. Parents can independently recognize dysplasia in newborns and infants by the following signs:

One of the baby's legs is noticeably shorter than the other.
The gluteal folds are asymmetrical.
There is an unusual fold on the thigh
Bent knees are at different heights.

Quite often, with this pathology, the hip joint moves too freely, making a loud click when moving to the extreme position. This sound indicates that the femur is popping out of the acetabulum. The pelvis develops unevenly, the structure of the hip is unstable. If your child shows these signs, take him to the doctor as soon as possible.

It also happens that dysplasia is not noticed in children older than one year. This is possible if the child missed examinations by an orthopedist. The following signs should alert parents:

The child does not walk normally unless corrected. Prefers to walk on tiptoes.
Doesn't keep balance. When walking, his body sways from side to side.
Does not allow legs to spread, bent at the knees, screams or cries in pain.
Legs easily twist into an unnatural position.

The pathology will not develop until the baby gets back on his feet. Nine out of ten children completely get rid of all symptoms of the disease after undergoing a year of treatment.

Treatment

Like other pathologies, it is necessary to treat this disease, especially if it was diagnosed too late. After all, the child can still be restored to the ability to walk normally. True, the chances of a full recovery are getting smaller every week after the baby starts.

If you are not sure whether your baby is suffering from a deformed hip joint, but do not have the opportunity to consult with a specialist, try not to aggravate the course of the disease. For this:

Do not swaddle newborns tightly: such fixation forces the joint to constantly remain in an inverted position.
It is better to use a wide swaddling: spread the baby’s legs so that they look in different directions, and place two folded diapers between them. This way the bone will be in the right place, and the development of the hip joint will proceed normally.

Orthopedic products. The most famous today are Pavlik's stirrups.
Exercise therapy, swimming on the tummy. There are different exercises for each age.
Physiotherapy: ozokerite application, electrophoresis with calcium and chlorine, mud therapy.

In rare cases it is required surgery. It is mainly given to older children.

It is much more difficult to cure hip dysplasia if the deformity is discovered after six months. In this case, the recovery period can last five years or more.

Consequences

Congenital subluxation of the hip leads to pathological changes in the development of the entire hip system. Newborns have virtually no discomfort from dysplasia. But the older the child gets, the more pain and the disease will cause him suffering.

In newborns

In the absence of experience, it is difficult to determine whether the strange position of the leg is a sign of dysplasia. The thigh may look unusual due to the absence muscle tone. But the consequences of the disease are specific and cannot be confused with other ailments.

What complications are typical for dysplasia:

Gradual loss of function of the hip joint. Subluxation gets worse over time because the joint does not have the opportunity to develop normally. Abduction of the leg bent at the knees causes pain.
Shortening of the injured limb. Asymmetry increases with each week of the baby's life, especially if swaddling is incorrect.
Deformation of the glenoid cavity. Over time, the bone will no longer fall into place even when brought into the correct position.
Development of pelvic asymmetry. Lack of nutrition of the bones leads to their atrophy; on the side of the deformity, the pelvis decreases in size.
Increased neck-shaft angle. The legs are positioned even more asymmetrically.

Rare complications are also possible. Displacement of the head of the bone in newborns can provoke the formation of a new acetabulum. This leads to the development of a new joint, which subsequently becomes the cause of deforming arthrosis.

All these negative consequences can be avoided if you start correcting the position of the bone from the first months.

If you start treatment before three months, by the age of one and a half years the child will completely get rid of the subluxation. In this case, the disease will not affect his gait or the development of his hip joints.

Children from one to two years old

The consequences of dysplasia in children examined after six months are more severe than in infants. The older the baby gets, the stronger his bones are, which means it is more difficult to carry out corrections. If it is enough to fix the baby in the correct position to correct the position of the hip joint, then older children need a whole range of procedures to cure all the deformities that have occurred.

With dysplasia, the head of the femur does not have support and constantly suffers from overload. As a result, the entire femur bone cannot grow normally. This leads to the following complications:

Decreased neck-shaft angle.
Stretching, atrophy of the femoral ligament, up to its complete disappearance by the age of four.
Shortening of the muscles of the injured hip and the entire limb.

These deformities cause a lot of discomfort to the child and interfere with normal crawling and walking. Children suffering from dysplasia often prefer to sit in bizarre, strange positions. They try to avoid pain caused by involuntary prolapse of the femur.

Older children

Over time, many small changes lead to serious consequences. Cases of late diagnosis of hip dysplasia are extremely rare, so doctors have not yet had time to study all the deformities caused by the disease. Here are the main problems that develop as a result of delayed treatment or its absence:

The pelvis tilts forward, shifting to the painful side. Constant uneven load on the spinal column leads to scoliosis.
The child experiences pain when walking and limps on an underdeveloped leg. Over the years, the limp gets worse.
Pathological dislocation of the hip develops in both directions.
Movement of the knee joint becomes painful due to the atrophy process.
The child cannot keep the pelvis in balance and rolls over when walking from one foot to the other. A “duck walk” is formed, which is practically impossible to correct when the pathology develops.
Chronic pain occurs in the lower back, which is forced to cope with colossal overloads. Hyperlordosis develops in the lumbar region.
The pelvic organs are subject to constant unnatural mechanical stress. This leads to pain, chronic diseases, damage to the pelvic organs and a general deterioration in their functioning.

It is also possible to completely block the movement of the damaged hip in older age due to further overload of the weakened joint and hormonal changes. This is the most unpleasant option possible, occurring only in advanced cases. In adulthood, this can lead to the development of dysplastic coxarthrosis. This disease requires joint replacement surgery. Otherwise, the person loses his ability to work.

Other consequences

Children with dysplasia always stand on their feet later than their healthy peers. Even the most favorable progression of the disease hopelessly disfigures the gait of children, depriving it of stability. In the absence of timely treatment, the child may list sideways, clubfoot, limp, and awkwardly roll from side to side at the same time.

It is impossible to correct your gait while the bone is popping out of the joint. You can start instilling new habits only when healing procedures will begin to bear fruit.

Often children can walk normally only after surgery.

Lack of timely treatment, constant load on the deformed hip can lead to healthy child little disabled person. What you can expect:

From the thoracic segment, curvature of the upper spinal column (kyphosis) almost inevitably develops, “balancing” the forward bend of the spine in the lumbar region. Over the years, kyphosis in children progresses, compensating for the increasing lordosis.
Children with dysplasia cannot bear prolonged stress because their bodies are constantly forced to cope with the difficult task of maintaining balance.
The musculoskeletal system is in constant motion due to hip hypermobility.

Occasionally children's body may try to correct the situation on his own by changing the outline of the joint, and the bone will begin to fall into place. The result can be considered self-healing, but such a joint will not allow the deformed limb to move as freely as a healthy one.

Over the years, even children who have not received treatment get used to their situation and learn to live with a disability. But the growing body creates everything heavy load to the underdeveloped half. This leads to the development of new diseases in children, including osteochondrosis, and further progression of the pathology. Therefore, it is important to devote all efforts to healing children as quickly as possible, regardless of at what stage the subluxation of the hip joint was discovered.

As children age, the number of available, pain-free treatment options decreases as children's bones grow and become stronger. But there is no age threshold after which dysplasia stops causing pain and deforming the skeleton. Surgical intervention helps even in advanced cases, returning the opportunity to live a full life.

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.

Due to the fact that the hip joint has a cup-shaped configuration, all types of movements are possible in it:

flexion and extension;
adduction and abduction;
turns in and out.

Normally, these movements are possible with a small amplitude, since they are limited by the cartilaginous rim and ligament of the femoral head. There are also a large number of ligaments and strong muscles around the joint, which also limit mobility.

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);
large fruit;
the presence of hip dysplasia in the child’s parents;
toxicosis of pregnancy in the expectant mother, especially if pregnancy occurred at a very young age.

If a child has at least one of these factors, then he is taken under observation and included in the risk group for this pathology, even though he may be completely healthy.
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 within a certain time frame.
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 vertical 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 diagnostic methods. 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 children younger age 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 assess the correct configuration of the anatomical structures of the 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.

An important indicator of the condition of the hip joint in young children, which is determined on radiographs, is the acetabular angle. This is the angle formed by the Hilgenreiner line and a tangent line drawn through the edge of the acetabulum.

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.

Magnitudeh.

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.

During ultrasound diagnostics, you can take a picture in the form of a slice, which resembles an x-ray in an anteroposterior projection.

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.
									There are no structural changes.	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 to preventive measures for 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.

Wide swaddling technique:

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.

Loose swaddling allows you to keep your baby's legs apart at approximately 60 - 80°.

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 such as aseptic necrosis head of the femur.
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.

All parts of modern Pavlik stirrups are made of soft fabric.

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.

In order to determine the size of a Freud splint for a child, you need to separate his legs and measure the distance between the popliteal fossae.

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 corresponding side of the tire and lace it securely;
put your other leg into the other belt and lace it up.

Vilensky tire sizes:

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 use special clothes with buttons.

CITO bus

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 braces 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.

Tübinger tire dimensions:

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.

Tire Volkov

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 price.

Listed above are only the most common orthopedic structures that are used to treat hip dysplasia. In fact, there are many more of them. New ones appear regularly. Different clinics prefer different designs. It's difficult to say which one is the best. Rather, such a wide variety indicates that there is no best option. Each has its own advantages and disadvantages. It is better for the child’s parents to focus on the prescriptions given by the orthopedic doctor.

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.

To carry out a massage for children with hip dysplasia, you need to use the services of a massage therapist who has experience and specializes in diseases of young children. Parents can independently give their child a general relaxing massage every day before bed.

Approximate massage scheme for a child with hip dysplasia

Initial 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.	Foot massage: stroking, rubbing, alternately moving to the sides (as if a child is crawling). Back and lower back massage: stroking and rubbing. Buttock massage: stroking, rubbing, pinching, light tapping with fingers and patting. Massage of the hip joint and outer thighs: stroking, rubbing. Removing the legs to the sides - “crawling”. “Hovering” - the massage therapist takes the baby under the chest and under the pelvic area, lifts it above the changing table.
Lying on your back with your legs apart.	Massage of the front and inner surfaces of the legs: stroking and rubbing. Bending and spreading the legs to the sides. The massage therapist must act carefully and avoid sudden movements. Circular movements of the legs in the hip joints inward. Soles massage: stroking, rubbing, kneading.

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 the normal physical development of 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.

In children under one year of age, therapeutic exercises are performed passively. It is part of the therapeutic massage complex (see above).

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.

A set of exercises after reduction of a dislocation or surgical intervention is developed individually for each patient.

Physiotherapy for hip dysplasia

Procedure	Description	Application
Electrophoresis: with calcium and phosphorus; with iodine.	The drug is injected directly through the skin into the joint using a weak constant electric current. Calcium and phosphorus contribute to the strengthening and proper formation of the joint.	the procedure involves applying two electrodes moistened with a solution to the joint area medicinal substances; electrophoresis can be performed in a hospital setting, on an outpatient basis (in a clinic) or at home; The course usually includes 10 - 15 procedures.
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, and 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 a 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 is relatively easily reduced using 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.

Contraindications to closed reduction of congenital hip dislocation:

severe displacement of the femoral head, inversion of the articular capsule into the joint cavity;
pronounced underdevelopment of the acetabulum.

The essence of the method

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. The older the child, the more likely it is that surgery will eventually be necessary.

Surgical treatment of congenital hip dislocation

Kinds surgical interventions with 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, a plaster cast is applied for 2 to 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 such 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.

Complications after surgical treatment of congenital hip dislocation:

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 Diagnosis and treatment of 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.

Different clinics practice 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 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;
excess body weight;
low physical activity;
pregnancy and childbirth;
injuries.

Symptoms of dysplastic coxarthrosis:

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 complete 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 femoral head abuts the femur, a new articular surface forms and forms new joint. 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 the female body is more susceptible to the effects of relaxin, dysplasia is observed 7 times more often in girls.
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 the high risk of 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 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-rays, 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, as early detection pathology and timely treatment ensure complete 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: 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.

A newborn examination is mandatory. after feeding in a warm room, when the child is relaxed. When screaming or crying, the baby's muscles are tense and tense; in this situation, the newborn tightens his legs and does not allow his hips to spread.

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).

If during the examination the doctor has doubts about the health of the joint, then within 3 weeks it is necessary to show the child to a qualified pediatric orthopedist. Considering the difficulties of diagnosing dysplasia, in doubtful cases, parents are advised to consult 3 independent specialists.

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.

Every month these changes become more pronounced and more difficult to treat. If soft stirrups and spacer splints are used for children under 6 months, then in the second half of the year they already need semi-rigid splints (Volkov splint, Polonsky splint). Moreover, than younger child, the easier he tolerates the treatment and the faster he gets used to it.

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 spasm, 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.

Practitioners consider these methods more likely as prevention of the development of complications in the early stages of dysplasia, and not as treatment in advanced stages. Therefore, if a child is diagnosed with a subluxation or dislocation, then stirrups cannot be avoided.

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 the joint is straightened using manual therapy, 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.
Physiotherapy 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.
Surgery 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.