- This 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 becomes the cause of a violation of the correspondence between 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. So, in Northern Europe, hip dysplasia occurs in 4% of children, in Central Europe - in 2%. In the United States - 1%, moreover, among the white population, the disease is more common than among African Americans. In Russia, 2 - 4% of children suffer from hip dysplasia, in ecologically unfavorable areas - up to 12%.

Hip joint anatomy

The hip joint is formed by the acetabulum of the pelvis and the head of the femur.

The acetabulum looks like a semicircular cup. Cartilage runs along its edge in the form of a rim, which complements it and restricts movement in the joint. Thus, the joint is 2/3 of the ball. The cartilaginous rim, which complements the acetabulum, is covered from the inside by articular cartilage. The bone cavity itself is filled with fatty tissue.

The femoral head is also covered with articular cartilage. It has a spherical shape and is connected to the body of the bone through the neck of the thigh, which has a small thickness.

The articular capsule attaches along the edge of the acetabulum and covers the head and neck at the hip.

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:

• amortization of loads on the femur during walking, running, jumping injuries;
• in it are the vessels that feed the head of the femur.

Due to the fact that the hip joint has a bowl-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 the 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(the fetus is in the womb, not with its head towards the exit from the uterus, with the pelvis);
• large fruit;
• the presence of hip dysplasia in the parents of the child;
• toxicosis of pregnancy in the expectant mother, especially if the pregnancy began 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 detect hip dysplasia, the child should be examined by an orthopedist. Visits to this specialist in a polyclinic in the first year of a child's life are mandatory at certain times.
It should be warm in the office where the examination will be carried out. The child is completely undressed and laid on the table.

The main symptoms of hip dysplasia, which are revealed during examination:

If dysplasia of the hip joint and congenital dislocation of the hip persist, gait disturbance is noted in older age. When the child is in an upright position, the 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 primarily by ligaments and a cartilaginous rim around the acetabulum.

Anatomical disorders that occur with hip dysplasia:

• abnormal development of the acetabulum, it partially loses its spherical shape and becomes flatter, has smaller dimensions;
• underdevelopment of the cartilaginous rim that surrounds the acetabulum;
• weakness of the ligaments of the hip joint.
• Grades of hip dysplasia
• Dysplasia itself... There is an 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 when examining a child; this can only be done with the help of additional diagnostic methods. Previously, this degree of dysplasia was not considered a disease, was not diagnosed or treated. Today such a diagnosis exists. Relatively often, overdiagnosis occurs when doctors "detect" dysplasia in a healthy child.
• Pre-dislocation... The capsule of the hip joint is stretched. The femoral head is slightly displaced, but it easily "snaps" back into place. In the future, pre-dislocation is transformed into subluxation and dislocation.
• Subluxation of the hip... The head of the hip joint is partially displaced relative to the glenoid cavity. She flexes the cartilaginous rim of the acetabulum, shifts it up. The femoral head ligament (see above) becomes tense and stretched
• Dislocation of the hip. In this case, the head of the femur is completely displaced relative to the acetabulum. It is located outside the depression, above and outside. The upper edge of the cartilaginous rim of the acetabulum is pressed by the head of the femur and bent inside the joint. The joint capsule and ligament of the femoral head are stretched and tense.

Types of hip dysplasia

• Acetabular dysplasia... Pathology that is associated with a violation of the development of only the acetabulum. It is flatter, reduced in size. The cartilaginous rim is underdeveloped.
• Femoral dysplasia... Normally, the femoral neck articulates with his body at a certain angle. Violation of this angle (decrease - coxa vara or increase - coxa valga) is the mechanism for the development of hip dysplasia.
• Rotational dysplasia... It is associated with a violation of the configuration of the anatomical formation in the horizontal plane. Normally, the axes around which all joints of the lower limb move do not coincide. If the misalignment of the axes goes beyond the normal value, then the position of the femoral head in relation to the acetabulum is disturbed.

X-ray diagnosis of hip dysplasia

In young children, some parts of the femur and pelvic bones have not yet ossified. In their place are cartilage that is not visible on x-rays. Therefore, in order to assess the correctness of the configuration of the anatomical structures of the hip joint, special schemes are used. Take pictures in direct projection (full face), on which conditional auxiliary lines are drawn.

Additional lines to aid in the diagnosis of hip dysplasia on radiographs:

• median line- 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 ilium;
• Perkin line- a vertical line that passes through the upper outer edge of the acetabulum to 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 values ​​of the acetabular angle in children of different ages:

• in newborns - 25 - 29 °;
• 1 year of life - 18.5 ° (for boys) - 20 ° (for girls);
• 5 years - 15 ° in both sexes.

The 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 value of h is 9 - 12 mm. Dysplasia is indicated by enlargement or asymmetry.

The 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) dysplasia of the hip joint is the method of choice in children under 1 year of age.

The main advantage of ultrasound as a diagnostic method is that it is quite accurate, does not harm the child's body and has practically no contraindications.

Indications for ultrasonography in young children:

• the presence of factors in the child that make it possible to classify him as a risk group for hip dysplasia;
• identification of signs characteristic of the disease during the examination of the child by a doctor.

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

Indicators that are assessed during ultrasound diagnostics 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 to assess the degree of development and the angle of inclination of the cartilaginous part of the acetabulum.

For young children, ultrasound diagnostics is the preferred type of examination for suspected hip dysplasia and congenital hip dislocation due to its high information content and safety. Despite this, in most cases, radiography is used in polyclinics, since it is an easier and faster diagnostic method.

Types of hip joints that are distinguished depending on the picture obtained during the ultrasound examination:

Joint type	Norm		Hip dysplasia						Subluxation		Dislocation
Classification within a type	A	B	A	B				C	A	B
The shape of the edge of the acetabulum, which is located above the femoral head	In the form of a rectangle		In the form of a semicircle						Beveled		Beveled
Position of the edge of the acetabulum, which is located above the femoral head	Located horizontally.		Horizontal but shortened						Slightly bent inside the joint cavity.		Strongly bent inside the joint cavity.
Cartilage covering the femoral head			Covers the head of the femur normally						Shortened, reshaped		Shortened, deformed. Does not completely cover the femoral head. 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 a normal position;		Is in a normal position;						Rejected outward; Rejected outward.		Rejected outward; Rejected outward.
			It is in its normal position.			Slightly deflected outward.

Treatment of hip dysplasia

Wide swaddling 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 of a newborn child, immaturity of the hip joint was revealed;
• there is dysplasia of the hip joint, while other methods of treatment are impossible for one reason or another.

Wide swaddling technique:

• the child is laid 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 by the third.

Free swaddling allows you to keep the baby's legs in a divorced state by about 60 - 80 °.

Wearing orthopedic structures

Pavlik's stirrups- orthopedic construction developed by the Czech physician Arnold Pavlik in 1946. Before that, rigid structures were mainly used, which were poorly tolerated by young children and led to complications in the form of aseptic necrosis of the femoral head.
Pavlik's stirrups are soft construction. It allows the child to exercise more freedom of movement in the hip joints.

The structure of Pavlik's stirrups:

• chest band, which is fastened with straps thrown over the shoulders of the child;
• shin bandages;
• strips, connecting the braces on the chest and lower legs: the two rear ones spread the lower 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)
Frejk's panties work on the principle of wide swaddling. They are made of dense material and provide a constant dilution of the child's legs by 90 ° or more.

Indications for wearing Frejka's splint:

• dysplasia of the hip joint without dislocation;
• subluxation of the hip.

In order to determine the size of Freud's splint for a child, you need to spread his legs and measure the distance between the popliteal fossa.

Vilensky busis an orthopedic construction, which consists of two leather straps with lacing and a metal spacer between them.

The first dressing of Shina Vilensky on a child is carried out at an appointment with an orthopedic surgeon.

Correct dressing of Vilensky's bus on a child:

• lay the child on his back;
• spread the legs to the sides as shown by the doctor at the reception;
• slip one leg into a leather strap on the corresponding side of the tire, lace up securely;
• put the other leg into the other strap, lace up.

Vilensky tire sizes:

Basic rules for wearing Vilensky's splint:

• Meticulous lacing. If the straps are laced correctly and tight enough, they should not slip.
• Constant wearing. Usually Vilenskiy tires are prescribed for 4 - 6 months. They cannot be removed during the entire given time. This is only allowed while the baby is bathing.
• Precisely adjusted strut length. The adjustment is carried out by the doctor using a special wheel. During the game, the child can move it. In order to prevent this, you need to fix the wheel with electrical tape.
• The tire must not be removed even while changing the child's clothes... For convenience, you need to use special clothing with buttons.

Bus CITO

We can say that this tire is a modification of the Vilenskiy tire. It also consists of two cuffs that are fixed on the lower legs, and a spacer located between them.

Tubinger splint (orthosis)

Can be viewed as a combination of Vilenskiy bus and Pavlik stirrups.

Tubinger bus device:

• two saddle leg struts connected by a metal rod;
• shoulder pads;
• The pearl strands that connect the braces to the shoulder pads in the front and back are of adjustable length and allow you to change the degree of flexion in the hip joints;
• special Velcro, with which the orthosis is fixed.

Tubinger tire dimensions:

• for the age of 1 month with a spacer length 95-130 mm;
• for age 2 - 6 months. with a spacer length 95-130 mm;
• for ages 6 - 12 months. with a spacer length 110-160 mm.

Shina Volkova

The Volkova splint is an orthopedic design that is practically not used now. It is made of polyethylene and consists of four parts:

• a cot that fits under the child's back;
• the upper part, which is on the tummy;
• the lateral parts, which fit the shins and thighs.

The Volkova splint can be used in children under the age of 3 years. Available in 4 sizes.

Disadvantages of Volkov's bus:

• it is very difficult to choose the right size for a particular child;
• the hips are fixed in only one position: it cannot be changed depending on the change in the configuration of the hip joint on radiographs;
• the design restricts the movement of the child quite strongly;
• high price.

Above were listed 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 hard to say which one is the best. Rather, such a wide variety suggests that there is no better option. Each has its own advantages and disadvantages. It is better for the parents of the child to be guided by the prescriptions given by the orthopedic doctor.

Massage for hip dysplasia

Massage for dysplasia of the hip joint is carried out only as prescribed by an orthopedic surgeon, who is guided by the results of examination and X-ray data, ultrasound. Massage can be performed with orthopedic structures (splints, see above), without removing them.

• The child should be placed on a firm, level surface. A changing table works best.
• During the massage, an oilcloth is placed under the child, since stroking the tummy and other actions of the masseur can provoke urination.
• A massage course usually consists of 10 - 15 sessions.
• The massage is performed 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 morning.
• In order for the effect to become noticeable, you need to carry out at least 2 - 3 courses of therapeutic massage.
• The break between courses is 1 - 1.5 months. This is a prerequisite, since massage is a fairly high load for children in the first year of life.

For massage in children with hip dysplasia, you need to use the services of a massage therapist who has experience and specializes in diseases of young children. On their own, parents can daily, before bedtime, perform a general relaxing massage for the child.

An approximate massage scheme for a child with hip dysplasia

Starting position	Manipulation
Lying on your back.	General massage: stroking and lightly rubbing the tummy, chest, arms, legs (thighs, legs, feet, soles).
Lying on his stomach with legs apart and bent at the knees.	Foot massage: stroking, rubbing, alternating abduction to the sides (as if a child is crawling). Back and lumbar massage: stroking and rubbing. Buttock massage: stroking, rubbing, pinching, light finger tapping and patting. Massage the area of ​​the hip joint and the outer surfaces of the thighs: stroking, rubbing. Abduction of the legs to the sides - "crawling". "Soaring" - the masseur takes the baby under the breast and under the pelvic area, lifts it over the changing table.
Lying on your back with legs apart.	Massage the front and inner surfaces of the legs: stroking and rubbing. Flexion and extension of the legs to the sides. The masseur must act carefully, avoid sudden movements. Circular movements of the legs in the hip joints inward. Sole massage: stroking, rubbing, kneading.

Massage for children under the age of one year 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.

The goals of therapeutic exercises for hip dysplasia:

• promote the normal formation of the hip joint, restore its correct configuration;
• strengthen the thigh muscles, which will support the femoral head in the correct position relative to the acetabulum;
• to ensure the normal physical activity of the child;
• promote the normal physical development of a child with 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 old, remedial gymnastics is carried out passively. It is part of the therapeutic massage complex (see above).

Physical activity necessary for the normal formation of the hip joint in children under 3 years of age:

• flexion of the hips in a divorced state in the supine position;
• independent transitions from a lying position to a sitting position;
• crawl;
• transition from a sitting position to a standing position;
• walking;
• the formation of the throwing skill;
• a set of exercises for the muscles of the legs;
• a set of exercises for the abdominal muscles;
• a set of breathing exercises.

A set of exercises after the reduction of dislocation or surgery 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 direct electric current. Calcium and phosphorus contribute to the strengthening, proper formation of the joint.	the procedure consists in applying two electrodes moistened with a solution of medicinal substances on the joint area; electrophoresis can be carried out 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, mineral oils. When heated (about 50 ° C) it has the property of improving blood circulation and tissue nutrition, and accelerating 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 in much the same way 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.
UFO therapy	Ultraviolet rays penetrate the skin to a depth of 1 mm, stimulating protective forces, regenerative processes, and improving blood circulation.	UFO 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

For the first time, closed bloodless reduction of congenital hip dislocation was performed in 1896 by the physician Adolf Lorenz.

Indications for reduction of congenital hip dislocation:

• The presence of a formed hip dislocation, which is determined by X-ray and / or ultrasound.
• The child is over 1 year old. Prior to this, the dislocation can be relatively easily adjusted using functional techniques (splints and orthoses, see above). But there is no single unambiguous algorithm. Sometimes the dislocation after 3 months of age can no longer be corrected by any means other than surgical intervention.
• Child's age is not more than 5 years. At an older age, it is usually necessary to resort to surgery.

Contraindications to closed reduction of congenital hip dislocation:

• strong displacement of the femoral head, volvulus of the joint capsule into the joint cavity;
• pronounced underdevelopment of the acetabulum.

Method essence

Closed reduction in congenital dislocation of the hip is performed under anesthesia. The doctor, guided by the data of X-ray and ultrasound, performs reduction - the return of the femoral head to the correct position. Then, for 6 months, a coxite (on the pelvis and lower extremities) plaster cast is applied, which fixes the child's legs in a divorced position. After removing the bandage, massage, therapeutic exercises, physiotherapy are performed.

Forecast
In some children, after closed reduction of congenital hip dislocation, a relapse develops. The older the child is, the more likely it is that they will eventually have to resort to surgery anyway.

Surgical treatment of congenital hip dislocation

Types of surgical interventions for congenital hip dislocation:

• Open reduction of dislocation. During the operation, the doctor dissects 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 pre-deepened with a cutter. After surgery, a plaster cast is applied for 2 to 3 weeks.

• Operations on the thigh bone. An osteotomy is performed - a dissection 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 point is to create a support above the head of the thigh, which will prevent it from moving up.
• Palliative operations. They are used in cases where it is impossible to correct the configuration of the hip joint. Aimed at improving the general condition of the patient, restoring his working capacity.

Indications for surgery for congenital hip dislocation:

• Dislocation in a child was first diagnosed at the age of 2 years.
• Anatomical defects that make closed reduction of dislocation impossible: infringement of the joint capsule inside the cavity of the hip joint, underdevelopment of the femur and pelvic bones, etc.
• Pinching of the articular cartilage in the joint cavity.
• Severe displacement of the femoral head that cannot be closed in a closed manner.

Complications after surgical treatment of congenital hip dislocation:

• shock state as a result of loss of large amounts of blood;
• osteomyelitis (purulent inflammation) of the femur and pelvic bones;
• suppuration in the area of ​​surgical intervention;
• aseptic necrosis (necrosis) of the femoral head is a fairly common lesion due to the fact that the femoral head has some features of the blood supply (the only vessel passes in the ligament of the femoral head, and it is easy to damage it);
• nerve damage, development of paresis (restriction of movement) and paralysis (loss of movement);
• injuries during surgery: fracture of the femoral neck, pushing the bottom of the acetabulum and penetration of the femoral head into the pelvic cavity.

Summary: problems in the treatment of hip dysplasia

Modern methods of diagnosis and treatment of hip dysplasia are still far from perfect. In outpatient institutions (polyclinics), cases of underdiagnosis (the diagnosis is not made during the existing pathology) and overdiagnosis (the diagnosis is made to healthy children) are still common.

Many orthopedic constructions 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 pursued.

Sometimes hip dysplasia and congenital hip dislocation are detected in adulthood. Most types of operations can be used up to 30 years old, until signs of arthrosis begin to develop.

Forecast

If hip dysplasia was detected at an early age, then with proper treatment, the disease can be completely eliminated.

Many people live with hip dysplasia their entire lives without any problems. If this condition was detected by chance during an X-ray, then the patient should be constantly monitored by an orthopedist, and should be present for examinations at least once a year.

Complications of hip dysplasia

Disorders of the spinal column and lower extremities

With dysplasia of the hip joint, the motility of the spinal column, pelvic girdle, and legs is impaired. Over time, this leads to the development of postural disorders, scoliosis, osteochondrosis, flat feet.

Dysplastic coxarthrosis

Dysplastic coxarthrosis is a degenerative, rapidly progressive disease of the hip joint that 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);
• cessation of sports;
• overweight;
• low physical activity;
• pregnancy and childbirth;
• injury.

Symptoms of dysplastic coxarthrosis:

• a feeling of discomfort and discomfort in the hip joint;
• difficulty in turning the hip and taking 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 rotates outward, locking in 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 currently relatively rare. If the dislocation of the hip persists for a long time, then with age, a restructuring of the joint occurs. The femoral head becomes flatter.

The acetabulum decreases in size. Where the head of the femur rests against the femur, a new articular surface forms and a new joint forms. He is quite capable of providing various movements, and to some extent such a state can be considered as self-healing.

The femur on the affected side is shortened. But this violation can be compensated, the patient is able to walk and maintain efficiency.

Aseptic necrosis of the femoral head

Aseptic necrosis of the femoral head develops due to damage to the blood vessels that run 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 circulatory disorders, the femoral head is destroyed, movements in the joint become impossible. The older the patient is, the more severe the disease progresses, the more difficult it is to treat.

Treatment of aseptic necrosis of the femoral head - surgical arthroplasty.

Why does hip dysplasia develop?

The reasons for the development of hip dysplasia remain unclear. Orthopedists cannot explain why, under equal conditions, some children develop this pathology, while others do not. Modern medicine puts forward several versions.

1. The effect of the hormone relaxin. It is excreted in a woman's body just 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 enters the fetal bloodstream, 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 in girls 7 times more often.
2. Breech presentation of the fetus. When a baby stays in this position for a long time in late pregnancy, the hip joint is under intense pressure. The uterus resembles an inverted triangle and there is less space in the lower part of it 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, therefore, 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 movement 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 the hormonal, digestive and nervous systems complicate the course of pregnancy and affect the formation of the fetus.
5. Large fruit over 4 kg- in this case, the fetus experiences significant pressure from internal organs during pregnancy, and it is more difficult for him to pass through the birth canal.
6. First birth under 18 years of age. Primiparous women have the highest levels of the hormone relaxin.
7. The mother's age is over 35 years old. At this age, women often have chronic diseases, suffer from circulatory disorders in the small pelvis and are more prone to toxicosis,
8. Infectious diseases, transferred during pregnancy, increase the risk of fetal pathologies.
9. Pathology of the thyroid gland negatively affect the formation of joints in the fetus.
10. Heredity- Dysplasia of the hip joints in relatives increases the risk of developing dysplasia in a child by 10-12 times.
11. External influences- radiation, X-rays, medication and alcohol have a negative effect on the formation of joints during the prenatal period and their maturation after childbirth.

How to prevent hip dysplasia?

Maturation and formation of the hip joint occurs within several months after birth. Based on this, the American Academy of Pediatrics has developed guidelines to help prevent hip dysplasia.

How to recognize hip dysplasia in newborns?

Congenital subluxation or dislocation is a severe stage of dysplasia that requires urgent treatment. Usually they are diagnosed even in the hospital during the examination by an orthopedic pediatrician. Parents should also know how to recognize hip dysplasia in newborns, since early detection of the pathology and timely treatment ensure complete recovery within 3-6 months.

Signs of dysplasia in newborns

• Click 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 are bent at the hip and knee joints at right angles. The specialist's hands lie on the knee joints: the thumbs cover the inner surface of the joint, the rest lie on the outer surface of the thigh. The knees are kept to the midline. The doctor slowly spreads them to the sides, while feeling, and sometimes audible, a click from the sore side - this is the head of the femur 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 head of the femur leaving the acetabulum. The click is due to the slipping of the lumbosacral muscle from the anterior surface of the femoral head, if there is a dislocation and the head does not enter the acetabulum.
• Shortening one leg... The child lies on his back, his legs are bent at the knees and placed on his feet. If at the same time one knee is higher than the other, then there is a high probability of congenital dislocation of the hip.
• Asymmetrical arrangement of skin folds, their increased number. The child's folds are checked with legs straightened in front and back.
• Restriction of hip abduction. However, in some children, this symptom does not develop until 3-4 weeks. In healthy children, the knees fit effortlessly on the table surface until the age of 4 months.

Examination of the newborn is mandatory after feeding in a warm room, when the child is relaxed. During a cry or cry, the baby's muscles are tense and tight; in such a situation, the newborn tightens his legs and does not allow the hips to be pulled apart.

Indirect symptoms, which testify to the pathology of the musculoskeletal system and often accompany dysplasia. By itself, their detection does not indicate problems with the hip joint, but should be a reason for a thorough examination of the child.

• The softness of the bones of the skull (craniotabes);
• Polydactyly - more than normal number of fingers;
• Flat feet and displacement of the axis of the foot;
• Violation of reflexes characteristic of newborns (search, sucking, cheinotonic).

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. Given the difficulties in diagnosing dysplasia, in doubtful cases, parents are advised to consult 3 independent specialists.

When a diagnosis of subluxation or dislocation is made, treatment is started immediately. If we hope that the child will "outgrow", leave him without treatment, then without close contact of the articular surfaces, joint deformation occurs:

• The acetabulum becomes flatter and is unable to fix the femoral head;
• The roof is lagging behind in development;
• Stretching the joint capsule.

With each passing month, these changes become more pronounced and more difficult to treat. If children under 6 months old use soft stirrups and spacer splints, then in the second half of the year semi-rigid crib splints are already needed (Volkov splint, Polonsky crib splint). In addition, the younger the child, the easier he tolerates treatment and the faster he gets used to it.

Can dysplasia be treated 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 slowed down its maturation and there is a delay in ossification of the heads of the pelvic bones. For treatment, a variety of methods 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 much as possible, using diapers or diapers 1-2 sizes larger. A multi-layered starched diaper is placed between the child's legs. It should be of such width that with the legs apart, its edges would be in the popliteal hollows.
• Massage and physiotherapy exercises- strengthen the muscles and ligaments that fix the joint, promote the early maturation of the joint. It is advisable that the massage be 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 bent to the sides 100-300 times a day.
• Physiotherapy: warm baths, paraffin applications improve blood supply to the joint, eliminate muscle spasm. Electrophoresis with calcium and phosphorus contributes to the saturation of the joint with the minerals that are necessary for its formation.
• Homeopathic remedies(Growth-rate in conjunction 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 legs wide apart.
• Swimming or water aerobics 3 times a week. Swimming on the stomach. For older children, swimming with fins is recommended, without bending the knees.
• Limiting the vertical load on the joints... Do not allow your child to stand or walk for as long as possible. Actively encourage belly play and crawling.
• Wearing a sling in a hip position... In this position, the head fits tightly with the glenoid cavity, taking the correct physiological position.

Practitioners consider these methods rather as prevention of complications in the early stages of dysplasia, and not as treatment in advanced stages. Therefore, if a child has been diagnosed with subluxation or dislocation, then stirrups are indispensable.

Dynamic gymnastics, which some authors include in the complex of treatment, is contraindicated in all 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 stay in rigid stirrups or the Gnevkovsky apparatus for 6 to 12 months. If a child is diagnosed with subluxation or dislocation, it means that the weak muscles and ligaments are unable to hold the head of the pelvic bone in the acetabulum. Therefore, when the joint is adjusted using manual therapy, the head will not be fixed and the dislocation will occur again in a few hours. It takes a long time to reduce the ligamentous apparatus, therefore, 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 dysplasia in the stage of dislocation or subluxation is improperly treated in childhood. 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 - it develops dysplastic coxarthrosis... Usually dysplasia of the hip joints in adults appears during pregnancy, hormonal disorders, a sharp decrease in physical activity. As a rule, the onset of the disease is acute and the patient's condition deteriorates rapidly.

Manifestations of hip dysplasia in adults

Treatment of the consequences of hip dysplasia in adults

• Chondroprotectors (Vitreous humor, Rumalon, Osteochondrin, Arteparon) are injected directly into the joint or as intramuscular injections in courses 2 times a year.
• Non-steroidal anti-inflammatory drugs(Diclofenac, Ketoprofen) relieve pain and reduce inflammation.
• Physiotherapy aimed at strengthening the muscles in the hip joint: abdominal muscles, gluteal muscles, 4-headed thigh muscle, back extensor muscles. Swimming, skiing, yoga are suitable.
• Eliminate joint stress: weight lifting, running, jumping, parachuting.
• Surgery necessary in severe cases. Hip arthroplasty - replacement of the head and neck of the femur, and in some cases the acetabulum, with metal prostheses.

The birth of a child is a holiday for the family. The sadder is the illness of a small newborn. Often among babies, there is a disease known as hip dysplasia 2a.

The best weapon against disease is information. Consider the concept of the disease, signs, causes of occurrence and control measures.

Recently, hip dysplasia has become more common in newborn babies under the age of one year. The reasons are established:

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

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

What is hip dysplasia

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

Type 2a - initial stage. At the first stage, the hip joint is in a relatively free, healthy position, but some negative shifts are already outlined. At this stage of the stage, the ligaments and articular tissues do not adhere to the joint, do not hold, because of this, the connection begins to "wobble", loosens like a flimsy bolt.

Chosen people believe that the birth of a baby with incorrect joints in the joint means a life-long defect. The opinion is wrong. The truth is more complicated: it will continue to expand, turning into other types, leading to serious illnesses. Here are some examples:

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

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

Distinguishing pathology is difficult, the disease does not show a presence. The baby does not get hurt, seizures and other vivid symptoms of the disorder do not develop. An attentive parent will notice the disease in speaking manifestations:

• Different leg lengths;
• The buttocks are asymmetrical;
• Characteristic clicks are emitted from the hip joint: the head of the femur jumps out of the acetabulum.

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

• The kid loves to walk on tiptoes;
• "Duck" waddling gait.

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

How is dysplasia diagnosed?

Self-diagnosis and treatment are prohibited for the benefit of the child. Diagnosis is pending, without clear evidence of the onset of dysplasia, treatment will not begin. A frequent detection procedure is an ultrasound scan.

The procedure shows clear advantages. Firstly, it does not cause discomfort to children (and adults). Secondly, you don't need to pay big money to get an ultrasound scan, the procedure is quite affordable.

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

How is the treatment going

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

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

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

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

Fortunately, treatments are available and doable with positive results. The main thing is to visit a doctor on time, without starting the disease.

How to help a child before a diagnosis is made

If the baby was born healthy, hip dysplasia is not terrible.

For newborns, a monthly examination by a pediatrician becomes mandatory. Three times a year, parents bring their child to an orthopedist. If doctors don't notice warning signs, don't worry.

An interesting preventive method is known -. You cannot swaddle a baby so that the legs of the wrapped baby remain straightened, like a tin soldier. Recent studies show that there is a relationship between the two methods — tin soldier swaddling and pathology of the hip joint. Such swaddling was adopted in the days of great-grandmothers, do not let the older generation swaddle the baby in the wrong way.

It is better if the toddler is wrapped up in the likeness of the children of ancient tribes: the baby simply "sits" in a swaddling cloth hung around his mother's neck. The mother supports the child, and the baby's legs hang freely above the ground. If the baby is behind the back - the method is correct, the child wraps his legs around his mother's back, the thigh bones are constantly in a divorced, fixed state. The Japanese noticed that when the swaddling method began to be widely used in families with newborn children, the percentage of dysplasia decreased significantly!

Hip dysplasia, type 2a, is more common in newborn babies. It is better for expectant mothers to closely monitor their health during pregnancy, without stopping caring for the baby after birth.

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

What is hip dysplasia

Definition of the concept

Translated from Greek, the word "dysplasia" means "educational disorder". In medicine, this term refers to pathological conditions caused by impaired development of tissues, organs and systems.

This method is safe for health and provides enough information to confirm the diagnosis.

In the study, attention is paid to the condition of the bony roof, cartilaginous protrusion (how much it covers the head of the femur), the centering of the head at rest and during provocation is studied, the angle of inclination of the acetabulum is calculated, indicating the degree of its maturation.

For the interpretation of the results, there are special tables with which the degree of deviation from the norm is calculated.

Ultrasound for hip dysplasia is a worthy alternative to X-ray examination up to six months of a baby's life.

X-ray diagnostics

X-ray examination is the most informative method for diagnosing hip dysplasia in children starting from the seventh month of life.

Most of the acetabulum and femoral head in infants is filled with cartilaginous tissue and is not radiologically visualized. Therefore, for X-ray diagnostics of hip dysplasia, a special marking is used to calculate the angle of the acetabulum and the displacement of the femoral head.

Of great importance for the diagnosis of hip dysplasia in infants is also the delay in ossification of the femoral head (normally, the ossification nucleus appears in boys at four months, and in girls at six).

Treatment of hip dysplasia in children

Conservative treatment of hip dysplasia in infants

Modern conservative treatment of hip dysplasia in infants is carried out according to the following basic principles:

• giving the limb an ideal position for reduction (flexion and abduction);
• the earliest possible start;
• preservation of active movements;
• long-term continuous therapy;
• the use of additional methods of influence (remedial gymnastics, massage, physiotherapy).

It was noticed for a long time that when the child's legs are in the abducted state, self-alignment of dislocation and centering of the femoral head is observed. This feature is the basis of all currently existing methods of conservative treatment (wide swaddling, Frejk's pillow, Pavlik's stirrups, etc.).

Without adequate treatment, dysplasia of the hip joints in adolescents and adults leads to early disability, and the result of therapy directly depends on the timing of the start of treatment. Therefore, the primary diagnosis is carried out in the hospital in the first days of the baby's life.

Today, scientists and clinicians have come to the conclusion that it is unacceptable to use rigid fixing orthopedic structures that restrict movement in the abducted and flexed joints in infants under six months of age. Maintaining mobility helps center the femoral head and increases the chances of healing.

Conservative treatment involves long-term therapy under the control of ultrasound and X-ray examination.

At the initial diagnosis of hip dysplasia in the hospital, based on the presence of risk factors and positive clinical symptoms, therapy is immediately started without waiting for confirmation of the ultrasound diagnosis.

The most widespread was the standard treatment regimen: wide swaddling for up to three months, Frejk's pillow or Pavlik's stirrups until the end of the first half of the year, and later - various diverting splints for after-treatment of residual defects.

The duration of treatment, and the choice of certain orthopedic devices, depends on the severity of dysplasia (pre-dislocation, subluxation, dislocation) and the time of initiation of treatment. Therapy during the first three to six months of life is carried out under the supervision of an ultrasound scan, and later - an X-ray examination.

Exercise therapy (physiotherapy exercises) with dysplasia of the hip joint, it is used from the first days of life. It not only helps to strengthen the muscles of the affected joint, but also ensures the full physical and mental development of the child.

Physiotherapy procedures (paraffin baths, warm baths, mud therapy, underwater massage, etc.) are prescribed in consultation with the pediatrician.

Massage for dysplasia of the hip joints also begins from the first week of life, since it helps prevent secondary muscle dystrophy, improves blood supply to the affected limb, and thus contributes to the early elimination of the pathology.

It should be borne in mind that exercise therapy, massage and physiotherapy procedures have their own characteristics at each stage of treatment.

Surgical treatment of hip dysplasia in children

Operations for dysplasia of the hip joint are indicated in the case of a gross violation of the structure of the joint, when conservative treatment will be obviously ineffective.

Surgical methods are also used when the reduction of dislocation without surgery is impossible (overlapping the entrance to the acetabulum with soft tissues, muscle contracture).

The reasons for the above conditions can be:

• so-called true congenital dislocation of the hip (hip dysplasia caused by impaired early embryogenesis);
• untimely treatment started;
• mistakes during therapy.

Operations for dysplasia of the hip joint are of varying degrees of complexity and volume: from myotomy (incision) of the muscles that caused the contracture to joint plastic surgery. However, the general rule remains: the best results are provided by the timely intervention.

Preoperative preparation and postoperative rehabilitation for hip dysplasia include exercise therapy, massage, physiotherapy procedures, prescription of drugs that improve joint trophism.

Prevention of hip dysplasia

Prevention of dysplasia is, first of all, the prevention of pregnancy pathologies. The lesions caused by disorders of early embryonic development are the most difficult and least treatable. Many cases of dysplasia are caused by the combined effect of factors, among which not the last place is occupied by the irrational nutrition of the pregnant woman and the pathology of the second half of pregnancy (increased uterine tone, etc.).

The next direction of prevention is to ensure timely diagnosis of the disease. The examination must be carried out in the hospital in the first week of the child's life.

Since there are often cases when the disease is not diagnosed in time, parents should be aware of the risks associated with tight swaddling of an infant. Many practicing doctors, including the famous doctor Komarovsky, advise not to swaddle the baby, but from birth to dress and cover him with a diaper. This care provides free movement, which contributes to the centering of the femoral head and the maturation of the joint.

Residual effects of hip dysplasia can suddenly appear in adults, and cause the development of dysplastic coxarthrosis.

The impetus for the development of this disease can be pregnancy, hormonal changes in the body or a sharp change in lifestyle (refusal to play sports).

As a preventive measure, patients from the risk group are prohibited from increasing loads on the joint (lifting weights, doing track and field athletics), and constant dispensary observation is recommended. Sports that strengthen and stabilize joints and muscles (swimming, skiing) are very useful.

Women at risk during pregnancy and in the postpartum period must strictly follow all the recommendations of the orthopedist.

Before use, you must consult a specialist.

What is it - congenital malformations caused by pathologies of the musculoskeletal system, which are elements of the hip joint, in medicine is called hip dysplasia (HJD).

All of its elements can be subject to vice, to one degree or another:

• acetabulum;
• femoral head and capsule;
• underdevelopment of the surrounding muscles and ligaments.

a brief description of

The role of the hip joints is very important, they experience the main stress when a person walks, runs or just sits. A huge variety of movements are performed.

The joint is a spherical head located in a deep crescent acetabulum. The neck connects it with the rest of the parts. The normal, complex work of the hip joint is ensured by the configuration and the correct internal structure of all its components.

Any violations in the development of at least one of the components of the link expressed:

• pathology and changes in the outlines of the femoral head, the discrepancy between its size and the size of the cavity;
• stretching the joint capsule;
• not the normative depth and structure of the depression itself, its acquisition of an ellipsoidal, flat shape, thickening of the bottom or sloping of the “roof”;
• pathology of the cartilaginous edge - limbus;
• shortening of the femoral neck with a change in its antivision and diaphyseal angle;
• ossification of articular cartilage elements;
• pathologies of the ligamentous apparatus of the head, manifested by hypertrophy or aplasia

This leads to a violation of the functional development of the entire hip "apparatus", which is a disease of TPA. Depending on the nature of the pathology, hip dysplasia is divided into different types.

TPA classification

Three main types characterize TPA pathology.

1) To acetabular dysplasia include a violation in the structure and pathology in the acetabulum itself, mainly pathology in the cartilage of the limbus, along the edges of the cavity. Under the action of the pressure of the head, it is deformed, forced outward or wrapped in the joint. That contributes to the stretching of the capsule, the development of ossification of the articular cartilage and an increase in the displacement of the femoral head.

2) Mayer's dysplasia or epiphyseal- characterized by pinpoint ossification of cartilage tissue, causing joint stiffness, pain and deformity of the legs. Lesion of the proximal femur, expressed by pathological changes in the position of the femoral neck of two types - dysplasia due to an increase in the angle of inclination, or dysplasia with a decrease in the diaphyseal angle.

3) Rotational dysplasia- characterized by delayed articular development and pathologies, pronounced violations in the relative position of the bones relative to the horizontal plane. By itself, such a situation is not considered dysplasia; most likely, it is a borderline condition.

The degree of development of the disease depends on the severity of the pathological process.

1. The 1st, mild degree of TPA is called preluxation - it is characterized by small deviations due to the beveled acetabular corners of the acetabular roof. In this case, the position of the femoral head, located in the articular cavity, is slightly displaced.
2. 2nd degree - subluxation - only part of the head of the femoral joint is located in the articular cavity. In relation to the cavity, it shifts outward and upward.
3. 3rd - degree - dislocation, characterized by the complete exit of the head from the cavity upward.

Causes of hip dysplasia

The reasons resulting in the formation of articular pathological processes in the hip joints are due to several theories:

1) Theories of heredity - assuming inheritance at the genetic level;

2) Hormonal - an increase in the level of progesterone in the last stages of pregnancy causes functional and structural changes in the musculo-ligamentous structures of the fetus, pronounced instability in the development of the hip apparatus.

3) According to the multifacterial theory, the development of TPA is influenced by several factors at once:

• gluteal position of the fetus;
• lack of vitamins and minerals;
• limited movement of the child in the bosom of the uterus - usually, the mobility of the child's left leg is limited by pressing it by the wall of the uterus, therefore, the left hip joint is more often susceptible to dysplasia.

As a result of long-term research, a direct link between the development of the disease and the swaddling of children has been proven. For example, in African and Asian countries, children are carried on their backs without swaddling, maintaining relative freedom of motor functions.

Taking this as a basis, the Japanese violated their age-old foundations (tight swaddling with TPA). The results amazed even the most distrustful of scientists - the growth of the disease decreased by almost ten times against the usual.

Symptoms of hip dysplasia in children

A large role in identifying the early symptoms of hip dysplasia belongs to parents if they pay due attention to the characteristic signs of dysplasia in children, which are pronounced:

1. 1) Asymmetry of the location of the folds on the thighs... There should be three of them in front and behind. On examination, the legs should be straightened with the feet brought to each other. In case of pathology, additional, deeper folds are added on the affected side, both in front and on the gluteal side.
2. 2) Restricted leg abduction- typical for the second and third degree of dysplasia. In a normal state, the legs of the child, in a bent state, can be fully diluted by ninety degrees, with dysplasia by no more than sixty.
3. 3) By the definition of Marx Ortolani- a symptom of a head slipping with a characteristic click during dilution and adduction of the legs.
4. 4) Shortening of the affected leg... It can be determined by comparing the height of the knee joints.

Concomitant symptoms of dysplasia in children may include:

• softening of the bones of the skull;
• x-shaped legs or clubfoot;
• curvature of the neck;
• suppression of unconditioned reflexes (sucking and searching)

Diagnosis of hip dysplasia

The diagnosis of hip dysplasia is determined during an examination by an orthopedist during a profile examination, more often at the age of up to six months. The diagnosis is based on a physical examination of the baby, certain tests and accompanying symptoms are used.

In confirmation, in outpatient settings, ultrasound is used, less often X-ray.

1. 1) Ultrasound has an advantage among many other research methods, since it is used from birth. It is the safest (non-invasive) method available, and is reusable.
2. 2) The X-ray method is not inferior in reliability, but has a number of features. Firstly, irradiation is not recommended for children under one year old (except for cases when ultrasound diagnostics is in doubt or there is no possibility of its implementation). Secondly, it is necessary to place the child under the apparatus in compliance with symmetry, which is difficult in childhood.
3. 3) Computed tomography or magnetic resonance imaging is used when there is a question about surgical treatment. Gives a more complete, structured picture.
4. 4) Arthrography and arthroscopy are used to complement the full picture when making a diagnosis in advanced conditions. The methods are invasive, performed under general anesthesia, and are not widely used.

What to do with hip dysplasia in children: Dr. Komarovsky.

Treatment of hip dysplasia in newborns

In pediatric orthopedics, there are many treatments for hip dysplasia in a child.

Each doctor chooses a treatment program individually for his little patient, based on the severity of the disease. These are methods, from basic wide swaddling to plastering a baby.

So. In order, about some of the methods of treating dysplasia.

1. 1) Wide swaddling- the most affordable way, even a young mother can do it, it is used for non-complicated forms.
2. 2) Becker's panties- the same as wide swaddling, but more convenient to use.
3. 3) Freyk's splint or pillow- the functionality is the same as the pants, but it has stiffening ribs.
4. 4) Pavlik's stirrups- came to us from the last century, but are still in demand.
5. 5) Splinting- use a Vilensky or Volkov splint (refer to an elastic type of splinting), also a spreading splint for walking, and plaster splinting.
6. 6) Operative treatment- this method is used in severe forms, frequent relapses, in children over one year of age.

Additional methods of treating dysplasia, they can also be the main ones, if we are talking about the immaturity of the articular elements, or about the prevention of TPA in children with a predisposition include:

• general massage with an emphasis on hips;
• gymnastics of newborns;
• physiotherapy (using vitamin, lidase, calcium);
• paraffin therapy, applications on the hip joint area;
• dry heat, mud therapy.

The main principle of treatment is the timeliness and adequacy of the chosen method.

What are the consequences of dysplasia?

Children with dysplasia are not threatened with a recumbent lifestyle, but they begin to walk much later than their peers. Their gait is characterized by instability, lameness. Children waddle like ducks and clubfoot.

If you do not start early treatment of hip dysplasia, this threatens the development of pathologies of the spine in the form, or. With age, unresolved hip articular pathologies lead to the inability to withstand prolonged loads.

The formation of new outlines of the joints and hollows begins, the formation of a false joint, which cannot be complete, since it is not able to perform the function of support and full abduction of the leg. Develops - neoarthrosis

The most serious complication is the formation of a dysplastic one, in which joint replacement surgery is inevitable. If early treatment of dysplasias takes up to a maximum of six months in time, then treatment after twelve years can last twenty years.

Which doctor should I go to for treatment?

If, after reading the article, you assume that you have symptoms characteristic of this disease, then you should

Dysplasia of the hip joint (from ancient Greek δυσ - "violation" and πλάθω - "form") is a pathology caused by a violation of the formation of elements of the joint itself and its auxiliary apparatus in the prenatal period.

Stages of joint dysplasia

The hip joint is the largest and most loaded movable joint in the body. Its articular surfaces are made by the acetabulum of the pelvic bone and the head of the femur, fixation of which (prevention of upward displacement) is provided by the acetabular lip (another name - "limbus") - a cartilaginous element that limits the cavity.

Anatomically and physiologically full-fledged interposition of articulating surfaces is provided by the articular capsule and ligamentous apparatus. The correct structure of the auxiliary structures protects the joint from subluxation and dislocation (displacement of the articular surfaces relative to each other) under conditions of increased stress.

During the neonatal period, the hip joint, even in healthy children, is a structure that is rather unstable in biomechanical terms, which is due to a number of age characteristics:

• flattened, shallow acetabulum;
• larger size of the femoral head in relation to the size of the cavity;
• poorly developed muscular frame in the gluteal region;
• insufficient compaction of the joint capsule.

Additional development of the joint occurs during the first year of life, almost completing by the age when the child begins to move independently.

With dysplasia of the anatomical structures that form the joint and its auxiliary apparatus, there is a high probability of abnormal development of the hip joint in the first months of life; as a result, the risk of trauma increases, the appearance of difficult-to-correct defects in gait, posture, and subsequent disability is possible.

The incidence of pathology in different countries is from 2 to 10%. Girls are more susceptible to the disease (8 out of 10 cases), the left hip joint is involved in the process most often - more than half of all diagnosed dysplasias, pathologies of the right joint and combined (with damage to both joints) occur equally, in about 20% of patients. In the case of diagnosing a breech presentation of the fetus, the risk of dysplasia increases 10 times.

Causes and risk factors

The main cause of the pathological condition is connective tissue dysplasia, manifested by increased extensibility of connective tissue structures, a decrease in their strength.

The disease can be either hereditary, transmitted from parent to child in an autosomal dominant way, or acquired, due to the effect on the fetus of a number of the following pathological factors:

• ionizing radiation;
• unfavorable ecological situation;
• professional harm;
• taking certain medications during pregnancy;
• acute viral infections (rubella, ARVI, influenza) transferred in the first trimester of pregnancy;
• chronic infectious diseases of the urogenital area of ​​the mother;
• toxicosis, preeclampsia.

With timely diagnosis and complex treatment, the prognosis of hip dysplasia is favorable in 100% of cases.

Forms of the disease

Depending on the localization of the pathological process, several forms of the disease are distinguished:

• dysplasia of the acetabulum (acetabular). It manifests itself in a flat shape, abnormally shallow depth, small size of the anatomical formation, deformation of the acetabular lip is possible;
• dysplasia of the femur (head, neck). Expressed in an increase or decrease in the cervico-shaft angle;
• rotational dysplasia - a change in the formation of the joint in the horizontal plane.

Depending on the severity:

• pre-dislocation of the hip joint - the ratio of the capsular-ligamentous apparatus and the articulated surfaces remains, nevertheless, due to the failure of the connective tissue structures, the femoral head may go beyond the acetabulum with subsequent slight reduction;
• subluxation - displacement of the femoral head upward without leaving it beyond the acetabulum, can be primary or residual;
• dislocation - manifested by overstretching of the capsule of the joint and the ligamentous apparatus with the divergence of the articular surfaces and the exit of the head of the bone outside the acetabulum (lateral or anterolateral, nadacetabular, high iliac).

Symptoms

Symptoms of the disease are caused by a violation of the structure and, as a result, the functions of the articular apparatus. In this pathology, the articular capsule is overstretched, the acetabular lip is often deformed, the cavity is beveled, its depth is reduced, the ligamentous apparatus is not able to maintain the anatomical relationship of the articular surfaces.

The main manifestations of hip dysplasia:

• shortening of the thigh on the diseased side, due to the exit of the femoral head beyond the acetabulum;
• asymmetry of the gluteal, inguinal, popliteal skin folds of the thighs, when comparing a healthy limb and limb with the alleged dysplasia, their inconsistency in shape and number is noted (for the side of the lesion, more pronounced, deep and numerous skin folds are characteristic);
• a positive symptom of slipping, or clicking (Marx-Ortolani), revealed during an objective examination by an orthopedist;
• difficulty in abducting the involved hip, manifested by incomplete dilution of the limbs bent at the hip and knee joints. Normally, in children under 3 months of age, in this case, the outer surface of the thigh should touch the surface on which the child lies;
• external rotation of the affected limb.

In addition to dysplasia of the hip joint, asymmetry of skin folds and limitation of abduction of the lower extremities can be detected in some neurological pathologies accompanied by impaired muscle tone (dystonia, hypertonicity, hypotonia). These tests are most informative in the first 2-3 months of life, further these methods do not demonstrate objective results.

The incidence of hip dysplasia in different countries is from 2 to 10%. Girls are more susceptible to the disease (8 out of 10 cases).

After reaching 1 year, the following signs may indicate pathology:

• a characteristic violation of gait with a fit on a dislocated leg and a deviation of the body to the affected side (Duchenne symptom with unilateral dislocation);
• tilt of the pelvis towards the lesion;
• characteristic "duck" gait in bilateral lesions;
• Trendelenburg's symptom, determined when standing on a limb with an affected joint and manifested by the omission of the gluteal fold on the opposite side.

Diagnostics

Diagnosis of hip dysplasia is possible only on the basis of a comprehensive assessment of the data obtained during an objective examination of the patient and carrying out such instrumental research methods:

• Ultrasound examination of joints (mandatory screening of a newborn at 1 month);
• radiography.

Hip dysplasia on x-ray

Treatment

Therapy for hip dysplasia is based on giving the lower extremities a forced position of full abduction in the corresponding joints with their flexion to an angle of 90º while maintaining active movements.

For corrective purposes, special devices are used: prophylactic pants, wide swaddling clothes, stirrups, diverting splints, Frejk-type pads and pillows. The use of such means is possible only if there is no displacement of the articular surfaces relative to each other (subluxation, dislocation); otherwise, an aggravation of the pathological condition is noted.

The terms of wearing retainers for mild dysplasia are 3-4 months, although in some cases they can reach 8-10.

After removing the abduction devices, it is necessary to carry out a complex of rehabilitation measures (exercise therapy, massage, swimming, magnetic therapy, electrical stimulation, etc.), then (after 2-4 months) walking is allowed, in the first months - exclusively in the abduction orthopedic splint.

With the ineffectiveness of therapeutic methods of correction and in severe cases, surgical treatment is indicated.

In the case of diagnosing a breech presentation of the fetus, the risk of dysplasia increases 10 times.

Possible complications and consequences

Complications of hip dysplasia can be:

• violation of joint mobility;
• lameness;
• dysplastic coxarthrosis;
• the formation of neoarthrosis;
• pathological dislocation of the hip;
• violation of posture.

Forecast

With timely diagnosis and complex treatment, the prognosis is favorable in 100% of cases. Early initiation of physiotherapy in the first weeks of life will usually ensure a complete recovery for the child.

After the completion of the correctional course, an orthopedic surgeon must be observed until 15-17 years of age.

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