HIP DYSPLASIA IN CHILDREN: WHAT PARENTS SHOULD KNOW

Inflexibility is a virtue that passes over the years into a diagnosis. This is what they say about adults who are stubborn in their youth and joint problems in old age. But what if a small child has defective joints? How not to miss the timely diagnosis of a baby’s joint disease and is it possible to solve this problem at an early age?

Today we will talk about a disease such as hip dysplasia in children.

So let’s figure it out.

WHAT IS HIP DYSPLASIA?

   Dysplasia of the hip joint – congenital joint deficiency caused by its abnormal development, which leads to subluxation or dislocation of the femoral head – to “congenital dislocation of the hip”. In this condition, there can be either underdevelopment of the joint, or its increased mobility in combination with a lack of connective tissue.

METHOD FOR DETERMINING DYSPLASIA

As a rule, it is possible to determine or sometimes suspect in advance the pathology in children by the following main classical signs:

1. a) Shortening of the hip syndrome.
2.   b) The presence of asymmetric folds on the legs of the child ((not always a sign of a disease).
3. c) Difficulty abducting the child’s hip to the side.
4. d) Symptom of sliding (Marx-Ortolani).

It is the last symptom that is most important in the diagnosis of this disease. The method for determining it is as follows. The child’s hips are slowly removed evenly in both directions. In normal joint relationships, both thighs in the extreme abduction position almost touch the outer surfaces of the table plane. 

In case of dislocation, the femoral head slides into the acetabulum at the time of abduction, which is accompanied by a characteristic push – the moment when the femoral head from the dislocation position is set into the acetabulum.

SYMPTOMS OF THE DISEASE

The main symptoms of dysplasia are:

• Visible shortening of the toddler’s affected leg.
• Instability of the hip joint itself.
• Displacement and return to the original position of the child’s femoral head.
• Limited abduction of the affected hip joint.
• Asymmetrical folds at the back of the thighs.
• Another important symptom indicating joint pathology is partial limitation of movement.

It is important to note that in healthy newborn babies, the legs are retracted to a position of 80-90 ° and freely fit on a horizontal table surface or other surface.

When limiting the abduction of the legs only to 50-60 °, there is every reason to suspect a congenital pathology. In a healthy child aged 7-8 months, each leg is usually retracted by 60-70 °, and in a baby with congenital dislocation – only 40-50 °, which is a reason to sound the alarm to parents.

ASYMPTOMOUS DYSPLASIA: DOES IT HAPPEN?

Yes, in this pathology there is also an asymptomatic course. That is why often parents cannot independently suspect dysplasia, since there is no restriction of movement in the hip joint. In this case, the disease is detected only by a pediatrician. Therefore, at the age of one month, the child must be examined by a qualified orthopedist. Such examination can be done in the specialized medical center “Ladisten Clinic”.

IS IT POSSIBLE TO LEARN ABOUT THE DISEASE DURING PREGNANCY USING USE? HOW TO AVOID ITS DEVELOPMENT?

During an ultrasound of a pregnant woman, as a rule, this diagnosis is not revealed.

Therefore, nothing depends on the woman in this case. Often, dysplasia is detected during medical correction of pregnancy, during pregnancy complicated by toxicosis. The main thing here is the timely diagnosis of the child and the correct chosen further treatment.

DIAGNOSTICS AND ITS BASIC METHODS

A preliminary diagnosis of a child can be made in the hospital during his initial examination.

In this case, it is imperative to consult a pediatric orthopedist during the first 3 weeks of life, who will conduct an examination and draw up a treatment regimen. It is important to note that to exclude this pathology, all children are examined at the age of 1-4 months. Particular attention is paid to children who are at risk. This group includes all patients with a history of maternal toxicosis during pregnancy, a large fetus, breech presentation, as well as those whose parents also suffer from dysplasia. If signs of pathology are detected, the child is sent for additional research.

As a rule, techniques such as radiography and ultrasonography are used to clarify the diagnosis of dysplasia. In young children, a significant part of the joint is formed by cartilage, which is not displayed on radiographs, therefore, this method is not used until 2-3 months of age. Ultrasound diagnostics is a good alternative to X-ray examination in children during the first months of life. This technique is practically safe and quite informative in practice.

STATISTICAL DATA

Statistics say: up to 25% of newborn babies have some form of hip dysplasia, in other words, they are born with subluxation. In most cases, under the constant supervision of an orthopedist, the joints “grow” on their own and return to the anatomical norm. In the rest, they just need a little help.

So, one of the reasons leading to a violation of the normal development of the joint is its incorrect development even in utero. The disease begins to develop at 5-6 weeks of gestation. It is also important to note that genetic and hormonal factors have an impact on the presence of dysplasia in a child, since hip dysplasia is 10 times more common in children whose parents had signs of congenital hip dislocation.

It is worth noting that in girls, hip dysplasia occurs twice as often and is especially difficult. As for the joints, the left hip joint is more often affected (60%), less often the right (20%), or both (20%). Also, in medical practice, when diagnosing it, a connection between morbidity and environmental problems was noticed.

FORMS OF DISPLASIA

Hip dysplasia can manifest itself in many different forms.

There are three main forms of dysplasia:

– dysplasia of the acetabulum – acetabular dysplasia (insufficient depth of the cavity);

– dysplasia of the proximal femur;

– rotational dysplasia;

– subluxation and dislocation of the hip joints.

CONSEQUENCES OF THE DISEASE

Dysfunction of the lower limb, gait, pain in the hip joints and a high risk of disability are the consequences of advanced dysplasia. Therefore, all parents need to know the first symptoms of this ailment and understand the importance of timely visits to a pediatric orthopedist.

DISEASE PREVENTION

1) Wide swaddling.

It is this that is the main method for the prevention of hip dysplasia. As soon as in 1971, according to the national health program, they carried out the promotion of wide swaddling, after a few years only 0.2% of children aged 1 year and older suffered from this ailment.

2) Orthopedic devices that securely fix the baby’s legs in bent and divorced form.

Such devices include all kinds of splints (a kind of spacers between the legs), plastic corsets and even plaster retainers.

The most popular fixation device is the so-called stirrups of Pavlik, a Czech orthopedic surgeon who came up with the idea of ​​fixing the baby’s legs with a special harness.

3) Massage and gymnastics.

Our attending orthopedist of the «Ladisten» clinic will teach you specific exercises and techniques for daily massage and gymnastics, since the set of manipulations strictly depends on how undeformed the joint is.

4) Use of carriers, slings, backpacks and car seats.

But only those models that allow the baby to hold on freely, legs wide apart.

TREATMENT

Treatment of hip dysplasia is usually carried out either by repositioning the dislocation and treating it with a coxitis dressing, or by skeletal traction or surgery.

DISCONTINUATION DIRECTION AND COXITIC BAND TREATMENT (this method is not used in our clinic)

Back in 1896, A. Lorenz published the first cases of curing congenital dislocation of the hip with the help of bloodless reduction, followed by long-term fixation of the legs with a coxitis plaster cast in the position of flexion and abduction in the hip joint at a right angle (the first position of Lorenz). Closed reduction of dislocation is usually carried out in children aged 2 to 5-6 years.

After 5 years of age, bloodless reduction of the dislocation is technically difficult or even impossible. In these cases, surgical treatment is used – open reduction.

SKELETAL EXTENSION

In some cases, the reduction of high dislocations of the hip is possible by the method of skeletal traction. It is carried out in children aged 1.5 to 6-8 years. The older the child is, the more likely it is to complete surgical treatment.

SURGERY

For the treatment of congenital hip dislocation, a large number of surgical methods are used, which can be divided into the following groups:

1. Open reduction of dislocation.
2. Operations on the proximal femur (corrective varizing and derotation osteotomies).
3. Operations on the pelvic component (Chiari osteotomy of the pelvis).
4. Palliative operations (Shantsa, Koenig).

HOW IS IT TREATED AT LADISTEN CLINIC MC?

In the medical center “Ladisten Clinic” in 2004, the candidate of medical sciences Veklich V.V. a surgical method was developed for the treatment of diseases such as hip dysplasia, subluxations and dislocations.

This method consists in low-traumatic treatment. The operation is performed with punctures, lasts 40 minutes, an external fixation device is installed. At the same time, the child can walk in the apparatus. The duration of treatment is only 2.5-3 months, while the child is in the clinic for only 7 days. The treatment does not require anesthetic therapy while wearing the apparatus. The device is removed in 5 minutes.

HOW IN OTHER COUNTRIES?

It is interesting to note that in the countries of Asia and Africa, where women from ancient times carry their babies on themselves, tying them on their backs or on their stomachs (that is, the child spends all the time in a sitting position, with widely spaced legs), such a phenomenon as hip dysplasia in children does not exist at all.

FORECAST

With timely detection and proper treatment of the disease, the prognosis is conditionally favorable.

WHERE DO CHILDREN HAVE DYSPLASIA TREATED?

If your children have a problem with joints and the child has suspected or has already been diagnosed with hip dysplasia, you can always contact the specialized medical center “Ladisten Clinic” world, doctors – orthopedists, who will always professionally advise and help in the treatment of this and related diseases of your children.

Your Ladisten Clinic.