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Hip dysplasia in a newborn: what to do. Causes, symptoms of hip dysplasia in children, treatment methods

Dysplasia hip joints in infants - a fairly common phenomenon in children, which, unfortunately, is not diagnosed during gestation; it can only be determined after pregnancy and childbirth. But the diagnosis of “dysplasia” does not mean that the child has months ahead without movement. In this situation, it is necessary to help the joint develop.

Despite the fact that we can talk about hip dysplasia in a newborn only when the baby reaches three months of age (unless, of course, it is a congenital dislocation of the hip), this problem should be dealt with immediately after childbirth.

How to help your baby’s hip joint develop?

Where should you start? And you should start by spreading and bringing together the baby’s bent legs from the very first days of life. The movements should be performed carefully and gently so that they do not over-strain the muscles. The child should receive only pleasant sensations from such exercises.

Spread your legs as far apart as possible, without any effort or pressure. And soon you will notice that every day the opening angle will become larger and larger.

The most optimal amount of exercise is up to 300 per day. Be sure to place the baby on a hard surface (table or floor).

The sensations experienced by the child cause positive impulses in the cerebral cortex, which, in turn, develops him and encourages him to make active movements.

When the little one reaches the age of 3 months, be sure to visit an orthopedist and get an ultrasound. You should not trust a diagnosis that may be given to you in the absence of compelling evidence.

Water also plays a positive role in the fight against dysplasia. Water, of course, has a relaxing effect. But at the same time, chaotic movements of arms and legs are an excellent workout. At the same time, the baby overcomes, although insignificant, the resistance of the water, which has a very positive effect on all muscle groups.

If you want to enhance the effect, experts recommend adding sea salt to the water every other day.

Symptoms of hip dysplasia in a child

Of course, an experienced specialist can easily determine dysplasia in a child. But the baby doesn’t always end up in the doctor’s hands at the right time.

In order not to start the development of the disease and to start treatment in a timely manner, be very attentive to your child.

In the first month of life, problems with the hip joints are indicated by increased tone of the baby’s back muscles. In this case, the position of the baby’s torso is C-shaped, he tilts his head to one side, and quite often the fingers on one arm are constantly clenched into a fist.

You can also visually notice that one leg is shorter than the other. Such a baby has an additional fold on the buttock, asymmetry of the gluteal folds and buttocks. And the mother cannot completely spread the child’s legs to the sides with her knees bent.

At the age of 3-4 months, when bending the legs in the knee and hip joints, you can often hear a click. The heel is not in line with the shin. In this case, one leg is visually shorter than the other.

At the age of 6 months, the child begins to stand up and walk on his toes; when walking, the toes of one or both feet are noticeable, turned inward or outward. Sometimes a slight curvature of the spine and stooping catches the eye. This baby's gait is like that of a duck. One leg is shorter than the other due to the sloping pelvis.

If you notice deviations in the development of the child’s musculoskeletal system, then you should not put off visiting an orthopedist.

Treatment of hip dysplasia in infants

The complex of treatment procedures for detecting hip dysplasia usually includes the use of splints, wide swaddling, therapeutic massage and gymnastics.

If hip dysplasia is mild, then you should not resort to such harsh treatment methods as the use of splints.

If you start treatment of joint dysplasia in children in a timely manner, then massage and therapeutic exercises will help greatly in this matter.

Usually, several courses of massage performed by a specialist (in parallel with the constant use of some elements of massage and gymnastics by the child’s parents) are quite enough for the baby’s complete recovery. Unreasonable restriction of freedom of movement in early age may have a negative impact on the further development of the infant’s musculoskeletal system.

Exercises for hip dysplasia

If your child has been diagnosed with hip dysplasia, then in addition to a special massage, the doctor will recommend that you do a number of exercises with the baby:

1. Little Frog

Starting position - lying on your tummy on the table. Stroke the baby's back and legs, then bend each leg in turn and move it to the side. The hips should be pressed against a hard surface (hold them with your hand).

After this, complicate the exercise - take a frog pose.

When your child can easily hold his spread legs, place your palm under his heels. Most likely, he will push off and try to crawl.

2. Bicycle

Lay the child on his back, clasp his legs with your hands. Slowly rotate your legs as if you were pedaling. First make a few movements forward, then back. Then straighten your legs, bend them and press them towards your tummy.

For massage you should use baby oil. Stroke the inner and outer surface of the thighs, lightly pinch the skin on the legs. If the child is uncomfortable, then the lesson should be stopped.

3. Butterfly wings

Spread your baby's legs apart. After prolonged training, your knees resemble butterfly wings. Wave them. If you hear a clicking sound, see an orthopedist immediately.

A slight asymmetry of the folds is not yet a sign of dysplasia. But this indicator is worth paying attention to. Although much more informative is the fact that one leg deviates to the side, while the other does not want to deviate.

4. Monkey

When the baby learns to hold its head well, wear it on your hip. The baby's legs should be spread wide apart.

A few workouts and you will get by with one hand, freeing the other for household chores. In addition, this fixed position is an excellent prevention of dysplasia.

If you are using a sling, remember the position on your side.

Violation of the formation and development of the hip joints is the main type of congenital anomalies of the musculoskeletal system in children under 1 year of age. The incidence of hip dysplasia in newborns is 25 cases per 1000. The incidence of the disease increases significantly in regions with poor environmental conditions.

Hip dysplasia, or DHS for short, is a disease in which, during embryogenesis, all the elements that participate in the formation of the joint remain underdeveloped, namely:

neural structures;

bone surfaces;

Another synonym for disease found in medical literature, is a congenital dislocation of the hip. The disease has three degrees of severity:

First degree (pre-dislocation) – there is underdevelopment of the osteochondral elements, while the musculo-ligamentous apparatus does not change and there is no deviation of the femoral head.

The second degree (subluxation) is a displacement of the head of the femur outward or upward, which develops against the background of characteristic signs of preluxation.

The third degree (dislocation) is a very severe form, in which there is no contact between the femoral head and the acetabulum, and the articular surfaces do not contact.

This figure shows the types of hip dysplasia

A – normal condition of the hip joint in a newborn; B – 1st degree of dysplasia (pre-luxation); C – 2nd degree of dysplasia (subluxation); D – 3rd degree of dysplasia (dislocation).

Historical background

The first signs of the disease in newborns were described by Hippocrates. To treat pathology, he used traction with heavy loads. Only at the beginning of the twentieth century did serious study of this disease begin, and work appeared on modern treatment and diagnosis of the disease. The term "dysplasia" was first introduced in 1925.

Causes of development of hip dysplasia in newborns

There are several theories that explain the reason for the development of congenital hip dysplasia in children.

Hormonal theory - the cause of the development of dysplasia is high level progesterone in the last trimester of pregnancy. This leads to a decrease in the tone of the muscular-ligamentous apparatus, which in turn leads to instability in the hip joint.

Hereditary theory - the disease occurs due to genetic predisposition.

Exogenous theory - pathology of the musculoskeletal system occurs due to disturbances in the process of bone tissue development caused by exposure to certain medicines and toxic substances.

Multifactorial theory - the occurrence of hip dysplasia in infants occurs from the cumulative effect of the facts described above.

Conditions contributing to the development of congenital third degree DTS (hip dislocation):

restriction of fetal mobility inside the uterus;

underdevelopment of the acetabulum;

lack of microelements and vitamins (vitamin E, iron, iodine, calcium, phosphorus);

breech presentation of the fetus.

Interesting fact

The dependence of the increased incidence of hip dysplasia on the nature of swaddling the child was established. Many countries in Asia and Africa have lower incidence rates due to the fact that newborns are carried on their backs, so they are not swaddled (they do not restrict the child’s movements). In the 70s of the twentieth century, Japanese doctors banned tightly swaddling children during DTS. As a result, the number of children with pathology decreased by approximately 10 times.

Symptoms of DTS

During the examination of the child, the doctor pays attention to the following signs:

volume of passive and active movements;

muscle tone;

symmetry or asymmetry of skin folds on the thighs;

size and position of the lower extremities.

The presence of hip dysplasia in a child has characteristic symptoms.

Clicking symptom (slipping symptom). The child is placed on his back, with his legs bent at the hip and knee joints at an angle of 90 0 (the doctor’s thumbs are located on the inner surface of the thighs, the remaining fingers are located on the outer surface). During hip abduction, the greater trochanter experiences pressure, causing the femoral head to be reduced. This process is accompanied by a click.

Relative shortening of the limb. This symptom is rare and is observed in cases of high dislocation.

Limitation of hip abduction. DTS in children causes restrictions on hip abduction of 80 0 or less. The greatest likelihood of symptoms is with unilateral lesions.

External rotation of the lower extremities – this sign is characterized by an outward rotation of the hip of the affected side. In some cases, it can also be observed in healthy children.

Asymmetrical position of the gluteal and femoral folds is detected during a visual examination.

Auxiliary (minor) signs of DTS in a newborn:

decreased pulsation of the femoral artery on the side of the pathologically changed joint;

muscle (soft tissue) atrophy on the affected side.

Sometimes there are asymptomatic cases of hip dysplasia.

Instrumental diagnostic methods

Many parents are interested in how one can absolutely determine whether a child has a DTS. To clarify the diagnosis, such diagnostic manipulations are performed.

X-ray examination. For a reliable result, before taking the picture it is necessary to: use protective pads, position the child symmetrically, carry out the procedure in the shortest possible time. To carry out the procedure, you will need the help of parents or another assistant to fix the child in the desired position. On x-ray, hip dysplasia has characteristic features:

displacement of the thigh from the vertical line outward;

discrepancy between the size of the head and the size of the glenoid cavity;

deviation of the femoral head from the central axis;

obliquity of the roof of the acetabulum.

Arthrography allows diagnosis of the capsule and ligaments that cannot be diagnosed using x-rays. This method makes it possible to establish the presence of DTS even in the first degree of the disease. An arthrogram allows one to determine the fusion of the acetabulum, fibrosis of the capsule, and the position and shape of the head. The procedure is performed under general anesthesia. Using a thin needle, the skin, subcutaneous fat and capsule are pierced, thus penetrating into the joint cavity, and a contrast agent is introduced: an inert gas or an iodine-containing substance. After this, an x-ray is performed.

Arthroscopy. An image of cartilage, ligaments, and bone surfaces is obtained by introducing a conductor with a camera into the joint cavity, which displays the image on the screen.

Ultrasound examination of the hip joint. The main advantage of the method is the absence of radiation exposure, due to which the method can be used repeatedly to monitor the treatment process. This method is completely safe for the child and is non-invasive. Ultrasonographic examination allows to detect the disease in the early stages. Ultrasound is performed when:

decreased muscle tone of the lower extremities;

severe course of childbirth and pregnancy;

presence of clinical signs of DTS.

Computed tomography (CT). Using CT, you can evaluate additional radiological indicators - the degree of atrophy of the soft tissues surrounding the joint. The main disadvantage of the method is the high radiation dose, including during a single examination.

Magnetic resonance imaging (MRI) – to determine indications for surgery.

Differential diagnosis of DTS in children

Symptoms of congenital hip dislocation may correspond to other diseases. Therefore, the doctor must conduct the maximum range of diagnostic studies to establish the correct diagnosis.

Hip dysplasia must be differentiated from the following diseases:

epiphyseal osteodysplasia;

rickets in infants;

arthrogryposis;

metaphyseal fractures;

paralytic dislocation;

pathological hip dislocation.

Congenital hip dislocation in numbers

A positive treatment result is achieved in 97% of cases if treatment is started within 3 months.

Starting treatment in the second half of the year has positive result only in 30% of cases.

Up to 6 months, pathology can be detected only in 40% of cases.

The duration of treatment, provided it begins before 3 months of age, is 2 months; treatment started after the child reaches one year old lasts more than 20 years.

Main types of treatment for DTS in newborns

There is a large number scientific works, the information of which contains a prescription for the treatment of hip dysplasia. At the same time, most authors are guided by the following principles:

the combination of severe pregnancy and asymmetry of the buttock folds is a pretext for starting medical therapy;

treatment is prescribed even if there are no clinical signs of the disease, but x-ray studies confirm the presence of congenital hip dislocation;

Treatment is prescribed if clinical signs of the disease are detected during examination.

Conservative treatment involves:

Wide swaddling: the lower limbs are not subject to restriction of joint mobility, which contributes to the correct formation of the acetabulum and spontaneous reduction of the dislocation. This swaddling is carried out for 1-2 months.

Spacers allow free access to the body by retracting the legs when bending. The most used splint for DTS is Pavlik stirrups.

Use of functional plaster casts improved by a distraction system.

Physiotherapeutic techniques reduce pain, prevent the appearance of contractures, and improve metabolic processes in tissues, reduce the activity of inflammatory processes. The following types of physiotherapy are used:

acupuncture;
hyperbaric oxygen therapy;

magnetic laser therapy;

mud therapy;

ultrasound;

amplipulse therapy;

electrophoresis - allows for DTS to inject drugs into the area of the hip joint.

If conservative methods are ineffective, the patient is advised to surgical treatment hip dysplasia. The following types of operations are used:

endoscopic treatment of dysplasia;

open reduction of hip dysplasia.

Memo for parents

After treatment for congenital hip dislocation, children must adhere to a special regimen.

Use orthopedic boots that support the ankle joints.

Do not use devices that force walking (walkers, etc.).

Early learning to walk is prohibited.

Rehabilitation measures for newborns with DTS

Rehabilitation is aimed at:

adaptation of the joint to new conditions of statics and dynamics;

activation of restoration (reparative) processes;

strengthening the muscles that serve the hip joint.

To achieve these goals, medications, physiotherapeutic treatment, and physical therapy are used.

Prevention of development of hip dysplasia in newborns

To prevent the development of DTS in a child, it is necessary:

avoid tight swaddling;

regularly visit an orthopedist and neurologist;

engage in physical therapy;

perform ultrasound of joints.

From the practice of an orthopedic doctor

Patient Yulia V., age 8 months. A diagnosis was made: “second degree hip dysplasia.” The patient underwent regular courses of outpatient treatment, but the lack of positive dynamics became the basis for the patient’s hospitalization in the trauma department of the regional children’s hospital.

During the examination upon admission to the hospital, the doctor revealed:

asymmetry of the femoral and gluteal folds;

limitation on abduction in the hip joints of up to 70 degrees;

shortening of the lower right limb by 1 cm.

An X-ray examination revealed hypoplasia of the leading elements of the left hip joint and the absence of femoral heads.

The following therapy was carried out:

The adductor muscles of the thigh were lengthened surgically (under general anesthesia);

3-week adhesive traction followed by reduction of the left femoral head and application of a plaster cast;

after three months the plaster cast was removed;

a Vilevsky splint was applied;

A control radiograph showed that the dislocation of the left femoral head was in a reduced position.

From the age of 6 months Yulia is allowed to crawl.

Rehabilitation treatment (frequency 1 time per 3 months), including:

physiotherapeutic treatment (mud therapy, massage of the lower extremities, electrophoresis, amplipulse therapy);

gymnastic development of the left hip joint with the help of exercises;

therapy with drugs to restore cartilage structure;

diet therapy;

B vitamins;

hyperbaric oxygenation.

At the age of 13 months, the Vilevsky splint was removed, and dosed static loading was allowed.

A control radiograph showed a complete absence of signs of hip dysplasia on the left.

The mobility of the joint is completely restored, there is no pain.

The above case confirms that hip dysplasia is a treatable pathology. Complete restoration of the functions of the musculoskeletal system is possible with timely contact with an orthopedist and following the recommendations in full.

Hip dysplasia (HJ) is a congenital pathology of newborns, during which the normal formation of joint tissue is disrupted. If this pathology is not detected and treated in time, adults may develop dysplastic arthrosis - a serious disease of the hip joints, for which they are given disability:

high risk of disproportionate development of limbs;
the legs will be weak and will not be able to withstand the load,
constant risk of dislocation or fracture,
there is a gait disturbance, a decrease in the range of motion in the joint;
walking and standing without support will cause pain.

Hip dysplasia is a congenital joint disorder

These include:

Heredity. Gynecological diseases in mother. Pathologies during pregnancy.
Birth ahead of schedule. In premature babies, some tissues and organs do not have time to fully form.
Incorrect position of the fetus during pregnancy. Any restrictions on the mobility of the fetus in the uterus are the reasons for the appearance of congenital anomalies child's joints.
Taking various medications by the mother during pregnancy, oligohydramnios, large weight of newborns.
Hormonal imbalance. If there is too much progesterone in the mother’s body before birth, this can subsequently cause muscle weakness.

A connection has been established between poor ecology and the number of diseases in newborns. In many ways, the cause of exacerbation of dysplasia is the harsh options for swaddling children. Hip dysplasia is much less pronounced in countries where it is not customary to swaddle newborns.

Diagnostics

The most appropriate time to determine the disease of a newborn is up to 3 weeks. Afterwards, it is impossible to notice signs of hip dysplasia, since there are no external symptoms. The first signs of a complicated dislocation appear in older children, when they begin to learn to walk.

It is necessary to carry out timely treatment of the hip joint

Only specialists can pre-diagnose pathology - even in the maternity hospital. Hip dysplasia in children has the following external symptoms:

The asymmetrical arrangement of the inguinal, gluteal and popliteal skin folds is clearly visible in children from two to three months.
Symptom of shortened thigh.
The “clicking” symptom - the femoral head may move out of the acetabulum with a loud sound and then return back again.
Limited hip movement or painful sensations when trying to spread the half-bent legs of babies to the sides (for infants normal position legs when spread - up to 90 degrees).
Increased mobility of the hip joint - the legs can take an unnatural position, turning inward or outward.

In older children, hip dysplasia may have the following symptoms: “duck-like” swaying gait, lameness, painful stepping on the heels.

If you have any suspicions, you should definitely consult a doctor. The sooner hip dysplasia is detected in newborns, the greater the chance of quickly curing it. To confirm the diagnosis, X-ray examination and ultrasonography are performed, which can detect the presence of pathology:

Deformation of the acetabulum (acetabular dysplasia), abnormal development of the head of the bone and cartilage.
Too stretched ligaments or capsule.
Dislocation of the hip bone.
Partial or complete displacement of the bone from the acetabulum.

All of these symptoms are good reasons for making a diagnosis of hip dysplasia (HJD).

Development of pathology

There are three degrees of development of hip dysplasia

If diagnosed late and without appropriate treatment, hip dysplasia can cause severe complications and even disability. Therefore, signs of hip joint pathology need to be identified and treated promptly. initial stage development. At early diagnosis With the right course of treatment, the prognosis can be favorable.

There are three degrees of pathology - preluxation, subluxation and dislocation:

Pre-luxation of the joint: minor disturbances in the development of the joint in the acetabulum. As a rule, this process is diagnosed in newborn babies.
Subluxation of the joint: In this degree, there is displacement of the femoral head, but it is still at least partially located in the acetabulum. Disturbances in normal functioning and development are noticeable not only in the acetabulum, but also in the femur.
Joint dislocation: At this stage, the femoral head is completely displaced beyond the boundaries of the acetabulum. The voids formed during dislocation are quickly filled with connective tissue. Dislocation is the most difficult stage, difficult to correct. Surgery is often required to correct a dislocation.

Complex of therapeutic measures

If you have the slightest suspicion of the presence of pathology, you should contact a pediatric traumatologist or orthopedist. If the diagnosis is confirmed, treatment begins immediately. Its duration, measures taken and prognosis depend on the degree of development of the pathology in the baby.

The goal of the course to get rid of hip dysplasia in newborns is to securely fix the head of the bone in the acetabulum. The first step in this direction is to fix the limbs in a certain position (stirrups, splints, special pants, and wide swaddling are used for this). Since ligaments and bones are too mobile during dysplasia, the next step is the general strengthening of cartilage tissue and the muscular-ligamentous apparatus.

The following methods are usually used in the treatment of joints with acetabular dysplasia:

A set of exercises required to strengthen muscles and return normal range of motion. At different stages of children's development they are used various types gymnastics Exercises in water show good results.
Therapeutic massage. The massage is done in two positions: children are placed on their backs, then on their stomachs. The procedure begins with stroking and kneading the limbs, body, and abdomen, followed by more intense massaging of the area of the sore joint.
Thermal procedures using ozokerite or paraffin applications.
Physiotherapy: electrophoresis with calcium and chlorine, use of ozokerite applications to strengthen the joint.

Timely treatment in 95% of cases leads to a complete recovery of the child

Attention! Gymnastics, massage and warming cannot be done at home. They should only be performed by qualified personnel. Without certain skills and knowledge, you can only harm children.

Orthopedic treatment

Until the first signs of recovery are visible, it is important to help the child tolerate doctors’ orders more easily. For example, in order to help keep the legs in the abduction position for a long time, many auxiliary corrective devices have been invented. Special attention Frame's pillow, Pavlik's tight pants and stirrups deserve:

The Freika pillow is a special product that can be used to fix your hips in the desired position. Use the pillow for children from a month and earlier. The size must be selected by a specialist.
Becker's pants are an alternative to the Freik pillow and also allow you to support your baby's legs in the "frog" position. Compared to hard tires, they do not cause discomfort to children.
Pavlik stirrups. Stirrups consist of several parts - a chest fixation bandage and straps that hold the feet and hips in the desired position. You need to make sure that the stirrup belt fits snugly to the body, but is comfortable.

In the first months of life, the separation of infants' legs is ensured by wide swaddling and soft pads. Rigid and solid structures are not used at this age. It is recommended to use a sling, which creates the same effect as therapeutic stirrups.

Surgical methods

Surgical treatment in children is used extremely rarely, only in cases of dislocation (advanced hip dysplasia). Or when all other methods do not give any effect.

Massage is one of the most effective ways strengthening the muscles of the buttocks and thighs

Hip surgeries can be performed in different ways:

Carrying out an osteotomy in the pelvic area or on the femur: the bone is divided into two halves in order to ensure further proper fusion.
Palliative interventions to equalize the length of asymmetrical limbs.
Endoprosthetics is the replacement of a diseased joint with an implant.

After surgical intervention the legs will be fixed with a rigid splint. Of course, the child is unlikely to like this, and he will be capricious, but, believe me, splints are needed - they will allow for normal fusion of the joints and alignment of the position of the bones (the baby can bend his legs at the knees, but the angle between the hips remains fixed). In the future, to prevent residual manifestations of the disease, you can use therapeutic stirrups or pillows.

Features of caring for a sick child and prognosis

In addition to professional treatment, children with dysplasia require proper care, which is slightly different from the care of healthy babies. It is worth remembering some rules:

If the baby is lying on his back, then his feet should hang slightly - this will relieve excess tension from the joints.
When carrying, you need to take the children so that they are facing you and their legs are wrapped around you.
Do not try to put the baby on his feet - even minimal vertical loads are completely prohibited until the end of treatment.
When transporting children in a car, use car seats that will not compress their legs. When sitting on a high chair (for example, during feeding), use bolsters from a towel or pillow to keep the legs slightly apart.

If hip dysplasia has not been detected in children under one year of age, then the risk of further complications increases, treatment and recovery become more complicated. If the treatment complex takes effect in the first weeks of life, then the prognosis for getting rid of hip dysplasia for children is 100%. Until the first year of life, modern conservative treatment methods (stirrups, massage, exercises, etc.) help cure about 95% of patients.

Abnormal structure and improper functioning of the pelvic bones are the first signs of hip dysplasia in infants. This is the most common type of musculoskeletal pathology in children in early childhood.

Statistics show that this disease develops in 2.5% of newborns. In regions where there are poor environmental conditions, the indicator can increase significantly. In addition, experts note that the disease more often affects girls than boys.

Joint dysplasia - what is it?

According to medical terminology, hip dysplasia is a pathology in which unformed parts of the joint are observed:

ligaments;
cartilage tissue;
bones;
muscle tissue;
nerves.

Some experts call this disease congenital hip dislocation. Doctors distinguish three stages of development of pathology in children:

Stage 1 - osteochondral tissues are not formed, muscles and ligaments are developed normally. There is no deviation of the femoral head;
Stage 2 - against the background of the abnormal structure of the osteochondral segments, a displacement of the bone head to the top and outward is formed.
Stage 3 is the most severe type of pathology. There is no contact of the femoral head with the acetabulum.

Depending on clinical picture diseases, experts identify several forms of pathology in newborns:

acetabular - there is an irregular structure of the acetabulum. The head of the femur puts pressure on the cartilage and deforms it. Ossification of the cartilage tissue and displacement of the femoral head occurs;
epiphyseal - diagnosed when the mobility of the pelvic joints is impaired and pain appears;
rotational - there is an incorrect location of the pelvic bones. The child has clubfoot.

Incorrect formation of the hip joints in infants occurs against the background of disturbances in the intrauterine development of the embryo. Most often, the development of this pathology begins at 4-5 weeks of pregnancy. Experts identify several factors that influence negative influence on the development of the musculoskeletal system in the fetus:

a genetic mutation caused by a disorder in the primary formation of pelvic joints;
exposure to negative substances on the embryo (chemicals, poisons, toxins, some groups medications etc.);
large size of the fruit;
breech presentation, which causes damage to the pelvic bones during delivery.
intrauterine infections or renal failure in the fetus. Against the background of such deviations, a violation of water-salt metabolism is observed.

Factors for the development of dysplasia on the part of the expectant mother are:

chronic pathologies in which dysfunction is observed internal organs women (heart, kidneys, liver, stomach, etc.);
lack of vitamins;
nervous shocks 1-2 weeks before birth;
taking hormonal medications;
sedentary and inactive lifestyle;
metabolic disorders;
first birth;
narrow pelvis of a woman;
premature birth;
threat of miscarriage;
development of infectious pathologies during pregnancy;
toxicosis and gestosis;
unhealthy lifestyle (use of alcohol, cigarettes and drugs);
unbalanced diet.

In addition, experts note the relationship between the development of pathology and tight swaddling. In those regions where doctors recommend not restricting the child’s movement, this disease is less common.

As a rule, this pathology can be noticed by a specialist (neonatologist, surgeon, pediatrician) during the initial examination of the newborn. But many parents are interested in: “how to diagnose the disease yourself and what to do if the development of the pathology is confirmed?” Most often, the disease is latent for the first 2-3 weeks, and then may manifest itself with one or more symptoms:

asymmetrical arrangement of folds in the gluteal area, they can be noticed if you turn the baby onto his stomach;
difference in the length of the lower extremities, usually the leg on the side of the unformed joint is shorter than in the healthy area;
stiffness of movement when spreading the child’s legs, this can be noticed in the process of performing gymnastics for the baby;
incorrect posture;
constant tilt of the head to one side;
asymmetrical arrangement of the feet, they can be turned in different directions;
the appearance of a click when spreading the child’s hips.

In the absence of proper treatment, the disease progresses to a more severe stage and is accompanied by more severe symptoms:

pain when moving;
increased tone or complete atrophy of the pelvic muscles;
thinning of muscle tissue in the area of development of the pathological process;
frequent falls when trying to step;
swaying when walking;
stiffness of joint mobility.

If you do not start timely treatment of dysplasia, this can lead to the development of various complications, from incorrect posture to disability.

According to statistics, children suffering from this disease begin to walk much later than healthy ones. They have an unsteady gait, accompanied by swaying. This becomes especially noticeable in children aged 1.5-2 years. In addition, other abnormalities are observed in children:

the occurrence of arthrosis of the hip joint at an older age;
poor posture;
flat feet;
disturbances in the mobility of joints and the spine;
death of joint tissues;
osteochondrosis.

Diagnostic measures

Many parents are interested in: “how to treat dysplasia in children?” To select a treatment method, it is necessary to make an accurate diagnosis and establish the stage of the pathology. To do this, the doctor will examine the baby and prescribe additional examinations, based on the results of which he will decide how to cure the pathology and avoid consequences.

X-ray examination.
Arthrography.
Arthroscopy.
UAC and OAM.
Biochemical blood test.

In order to have an idea of what dysplasia looks like in infants, you can familiarize yourself with the photo that shows the diseased joint.

Treatment

The choice of treatment method for this pathology directly depends on the stage inflammatory process. If the baby is diagnosed with pre-luxation, then it is enough to massage the joint. At more advanced stages, the child requires complex treatment, which includes the use of several techniques:

orthopedic;
physiotherapy;
surgical.

In order to get rid of dysplasia at an early age, it is necessary to fix the hip joint in the correct position. For this purpose, specialists prescribe the wearing of special devices. The duration of such treatment depends on the degree of deformation of the hip joint.

Pavlik stirrups. This is a special device that was invented in the last century by a Czech scientist. It is made of soft fabric that does not irritate the baby’s skin and is a device made of straps and a chest bandage. Thanks to it, it is possible to fix the normal position of the femoral head and gradually the hip joint takes on the correct shape. It does not limit the baby’s movements at all and the child can take a position that is comfortable for him.
Freyka's pillow. This is a special device that is placed between the baby’s legs and secured with special belts. In this case, the child’s legs are fixed in a spread state and are in a bent state.
Vilensky tire. Another name for this device is a spacer. It consists of a pipe and a special cuff with lacing. This device is worn daily for 4-6 months and is removed only before taking water procedures.
Tire Volkova. This design is made of plastic and has several parts. The child's legs are fixed in a stationary position using a special corset.

Physiotherapeutic treatment

If the baby is diagnosed with acetabular dysplasia, then the baby is prescribed physiotherapy:

therapeutic gymnastics - consists of a set of exercises that parents can carry out for the child even on their own;
massage - to carry out the procedure, the child is first laid on his stomach, and then on his back, and not only the hip joint, but also other parts of the body (stomach, back, arms, etc.) are kneaded;
thermal procedures - the inflamed joint is treated with ozokerite or paraffin;
electrophoresis - a solution with calcium and chlorine is used for the procedure.

You should not try to carry out these procedures at home, as this may worsen the child’s condition. The procedure must be performed by a highly qualified specialist, taking into account the form of the disease and all possible contraindications.

Surgical treatment

This method of therapy is used only in extreme cases, if an advanced stage of the pathology (dislocation) is diagnosed or in the case when the treatment did not bring the desired result. There are several ways to perform surgery in young children:

osteotomy of the hip joint - femur divide into two parts and ensure its proper fusion;
palliative surgery - with the help of surgery, specialists align the child’s asymmetrical limbs;
endoprosthetics - the inflamed joint is replaced with a plastic implant.

After the operation, the child’s lower limbs are fixed in a stationary position using a splint. This equipment will cause discomfort to the baby, but it is necessary to ensure proper fusion of the joint. After some time, the splint can be replaced with more comfortable devices: stirrups or Freik’s orthopedic pillow. The duration of wearing these devices is determined by the attending physician.

Preventive measures

If a mild stage of the pathology is diagnosed, then in order to get rid of hip dysplasia, it is enough to do regular massage. In addition, Dr. Komarovsky advises following some recommendations that will be useful for caring for children with any stage of dysplasia.

It is not recommended to use tight swaddling of a child's lower extremities. It is better if the baby's legs are free.
The transfer of a child must be carried out according to a certain rule. Give the baby a vertical position and press him to your body, while spreading his legs.
Carry out lower limb exercises daily. Very good exercise is considered a “bicycle”, since during the process the baby’s legs are in motion.
It is better to lay the baby so that his lower limbs partially hang down. This will reduce the load on the area of inflammation and give the sore joint some rest.
You should not place a child with dysplasia on his legs, since even minimal load can cause curvature of the joint.
When transporting a baby in a car, you must have a special seat. It will not only protect the child in the event of a collision, but will also prevent the legs from twisting.
If a child eats in a special highchair, then a roll made from a towel should be placed between his legs.

If the pathology is diagnosed late, the duration of treatment is prolonged, and the risk of complications increases significantly. If therapy was started in the 2nd week of life, then the chance of complete recovery is 100%. In the treatment of dysplasia in children under one year old, it is enough to use conservative methods therapy: orthopedic, physiotherapeutic. At an older age, more serious treatment is required and surgical intervention is possible.

Article publication date: 04/29/2016

Article updated date: 12/05/2018

Hip dysplasia in children is a congenital underdevelopment of the articular cavity and head of the femur or congenital increased mobility of the joint due to weakness of the ligamentous-muscular system. Such a violation of the development of the elements of the hip joint (one or both at once) leads to an incorrect relative position of the articular structures, as a result of which the femoral head is displaced relative to the articular surface, and a subluxation, preluxation or dislocation of the joint is formed.

Click on photo to enlarge

Four main causes of pathology:

hereditary predisposition,

early birth (prematurity),

toxicosis or other pathologies of pregnancy,

hormonal disorders in the mother during pregnancy.

The pathology must be identified and treated from the first days of the baby’s life - this is the only way to avoid serious disorders of the motor functions of the legs. At an early age, dysplasia practically does not bother the baby, but if it is not eliminated in time, then later it can lead to significant difficulties in walking and disability.

According to statistics, dysplastic process of the hip joints (abbreviated HJ) is diagnosed in 2–3% of newborns. In 80% of cases, girls are affected.

Dysplasia of one or both hip joints can be successfully treated. An integrated approach plus developed modern techniques make it possible to successfully eliminate pathology in early childhood. Parents need to be patient, because treatment, depending on the degree of underdevelopment of joint elements, can be lengthy.

Causes of hip dysplasia in children

Doctors do not know the exact causes of this congenital disease. There are several theories, the most substantiated of which are genetic and hormonal:

Genetic predisposition to orthopedic abnormalities is the reason for the formation of malformations of bone and joint structures in the fetus at the stage of its intrauterine development. Heredity through the female line has been statistically proven in 25–30% of newborns with diagnosed hip dysplasia.

The hormonal theory is confirmed by the fact that pathology is detected more often in girls than in boys. During pregnancy, progesterone (the so-called “pregnancy hormone”) softens the cartilage and ligaments of the woman’s pelvis, preparing her birth canal for childbirth. Getting into the blood of the embryo feminine, the same hormone relaxes the ligaments of his hip joints.

Risk factors for the formation of dysplasia

Provoking factors	Comment
Features of the fetus	Large size, transverse position, breech presentation
Pathological course of pregnancy	Oligohydramnios, threatened miscarriage, toxicosis, taking medications, multiple pregnancy
Gynecological and other diseases of the expectant mother	Uterine anomaly, fibroids, anemia, rheumatic disease complicated by heart disease
Acute viral and other infections suffered by a woman during pregnancy	ARVI, influenza, syphilis, etc.
Poor nutrition and unhealthy image life of the expectant mother	Smoking, drinking alcohol during pregnancy
Unfavorable environment
First or difficult birth
Tight swaddling

Classification of dysplasia

Three main forms of pathology:

Acetabular - a violation of the development of the acetabulum.

Dysplasia of the upper femur with a change in the angle between the head and the acetabulum.

Rotational – a violation of the geometry of the femur in the horizontal plane in relation to the socket.

Four degrees of severity of pathology:

Immaturity of the hip joint is a borderline condition, more often observed in premature infants. Characterized by delayed development of articular structures.

Pre-luxation - the acetabulum is beveled, there is no displacement of the femoral head.

Subluxation - the cavity is more flattened and beveled, the head of the bone moves up and out, and with certain movements it is able to come out of the acetabulum.

Dislocation is the most severe form, in which the femoral head moves even higher, emerging from the socket.

Dysplasia can be unilateral or bilateral. Bilateral is diagnosed 7 times less often than unilateral, and right-sided - 1.5–2 times less often than left-sided.

Symptoms of the disease

1. Signs of dysplasia when the child is not walking yet

At the initial stage, the disease does not cause any discomfort or pain to the newborn. Outwardly, the child is practically no different from healthy babies, but characteristic signs of the problem can be detected by an orthopedic doctor or pediatrician during an examination in the maternity hospital, or by an attentive mother already at home.

Hip dysplasia in children under one year of age is determined by the following symptoms (which can be noticed while bathing, changing clothes or swaddling the baby):

asymmetry of skin folds on the buttocks and thighs,
different leg lengths,
turning the foot from the side of the affected joint outward,
limited mobility in the hip joints or easy and unnatural abduction of the leg with a click.

2. Symptoms when the child began to walk

Obvious symptoms of the dysplastic process appear in a child when he begins to walk:

with bilateral dysplasia, the baby sways from side to side while walking (duck gait), walks on tiptoes, without stepping on his heels;
with one side - limping;
with congenital dislocation, pain occurs from the first steps,
untreated subluxation manifests itself as pain by 3–5 years.

3. Symptoms in adolescents and adults

If for some reason the pathology was not identified and eliminated early childhood, then over the years it turns into a more severe form - dysplastic coxarthrosis. In this case, the symptoms become pronounced:

In adolescents or adults, dislocation of one or both femoral heads significantly affects gait: normal walking is difficult, and jumping, running, squatting or other actions are sometimes completely impossible.
Movements of the legs are painful; with a one-sided process, atrophy of the leg muscles occurs, curvature of the spinal column in the lumbar region, and possible dysfunction of the pelvic organs.
Reduction of the dislocation becomes more and more difficult over time due to the gradual filling of the articular cavity with connective and fatty tissue.
Often the patient is given disability group 3 or 2.

Diagnostic methods

The first examination of a newborn is carried out by a neonatologist and an orthopedic doctor in the maternity hospital. Children aged 1, 3, 6 and 12 months are required to be examined on an outpatient basis by a pediatric orthopedist to detect dysplasia.

Diagnosis during examination in infants up to one year old

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Criteria for early diagnosis	Description
Marx-Ortolani sign	The most reliable sign indicating congenital hip dislocation. This symptom is determined by simultaneously gradually moving the baby’s hips to the sides while he lies on his back. A characteristic click indicates the reduction of the femoral head when it is dislocated.
Hip abduction limitation	In healthy babies, the legs, bent at the knees and hip joints, are freely spread 80–90 degrees, laying on the horizontal surface of the couch. In case of congenital pathology, the abduction is no more than 50 degrees.
Shortening the thigh	The child lies on his back, on a flat surface, with his legs bent at the knees and hips. Keeping your knees on at different levels speaks of shortening of one leg due to congenital dislocation of the hip joint. This symptom is relevant for diagnosis in children after a year of life.
Asymmetry of inguinal, popliteal, buttock skin folds	These signs are checked when the child lies on his stomach and back with his legs maximally extended and brought together. The doctor pays attention to the number, level of location, depth, and shape of the folds. The difference is more clearly noticeable in babies older than 2–3 months. These signs are nonspecific, because with bilateral pathology, the folds can be symmetrical, and in some children younger than 2 months. asymmetry may be a variant of the norm.
External rotation of the foot	Characteristic of unilateral dislocation, rarely subluxation of the hip. External rotation is determined with the legs straightened at the knee and hip joints.

The doctor assumes dysplasia if one reliable or three nonspecific signs are detected. To confirm the diagnosis, the doctor prescribes an x-ray and ultrasound of the hip joint.

Ultrasound and X-ray of the hip joints for diagnosis

X-ray of healthy hip joints

X-ray of healthy hip joints with bilateral dysplasia

Ultrasound of the hip joints is a highly informative and safe technique and is an excellent alternative to x-rays in newborns.

X-rays are prescribed for babies older than 3 months. due to the fact that in children younger than this age, a significant part of the glenoid cavity and femoral head consists of cartilage and is therefore not visible on the picture. To read children's X-rays, special diagrams with horizontal and perpendicular lines are provided.

X-ray and ultrasound diagnostics in adults are the main classical methods of examination for suspected dislocation or coxarthrosis of the hip joints.

Treatment of hip dysplasia in children

Treat this congenital pathology pediatric orthopedist together with a chiropractor, physical therapy doctor, and physiotherapist. Therapy for hip dysplasia in children is a long process that begins from the first months of the baby’s life (with early diagnosis). The choice of treatment methods, their combination, and duration of therapy depend on the degree of dysplasia and the age of the patient.

Standard conservative treatment

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Method of therapy	Details
Wide swaddling	This method allows you to secure the hip joint in the correct position; it is used from the first days of life in cases of mild pathology. The newborn's legs are fixed in a bent and spread state, and a diaper folded in several layers or a Freika pillow is placed between the legs. Freyka's pillow
Pavlik stirrups	This is a special orthopedic device in which the baby remains permanently until the formation of the hip joints is completed. The device consists of a chest bandage and spacers that are attached with Velcro to the ankles. Pavlik stirrups
Various modifications of abduction splints	Indicated for remaining defects at the final stage of treatment.
Therapeutic exercise	Special exercises are prescribed in combination with other methods from the first days of life. They strengthen the muscles and ligaments of the hip joint, promoting the full development of the child.
Physiotherapy	UV irradiation, applications with paraffin, electrophoresis with cocarboxylase, calcium chloride, ascorbic acid.
	Prescribed after the first week of a baby’s life. It improves blood supply to a defective joint, preventing muscular dystrophy.
Plaster cast	Apply after reduction of the dislocation, which is possible until the child is 5–6 years old.

Operation

Surgical treatment is necessary in the following five cases:

ineffectiveness of conservative treatment;

late detection of pathology;

severe form of dysplasia with true dislocation of the hip joint with the impossibility of its reduction;

re-dislocation after closed reduction;

dysplastic coxarthrosis with joint destruction in adults.

Surgical intervention is performed on the child after reaching 1 year of age.

In severe cases, open reduction of the dislocation is performed or corrective surgery is performed on the hip bone and acetabulum. In severe cases, adults undergo endoprosthesis replacement of the affected joint.

Conclusion

Hip dysplasia in infancy is treated within a few months, after which the child grows and develops healthy. The later it is discovered, the more time and effort will be spent on treatment. Correction of dislocations in adolescence or adulthood usually does not occur without surgery and long-term rehabilitation.

Therefore, parents should visit a pediatric orthopedist and follow his recommendations. Only timely examination and treatment will help to avoid the serious consequences of the congenital dysplastic process.

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