Congenital dislocation of the hip

Causes of congenital dislocation of the hip

The main causes that provoke the appearance of congenital dislocations of the hip joints include:

• underdevelopment of the acetabulum that occurs in early pregnancy. The impact of adverse environmental factors or toxic substances can affect its improper development;
• hereditary relaxation of the ligamentous-muscular apparatus of the hip joint, which is not able to hold the femoral head in the acetabulum, resulting in its prolapse;
• limitation of joint movement during fetal development, which often occurs with multiple pregnancies, oligohydramnios, breech presentation of the fetus, large fetus or cramped uterus;
• birth of a premature baby (before 36 weeks), with low birth weight or as a result of a caesarean section;
• Anemia during pregnancy – a decrease in hemoglobin in the blood can lead to a delay in fetal development and premature birth.

Classification and symptoms of the disease

According to the International Classification of Diseases ICD 10, congenital hip dislocation is:

• unilateral (Q65.0) – this pathology most often affects the hip joint of the left leg. Congenital dislocation of the left hip occurs 3 times more often than the right one (in 60% of cases);
• bilateral (Q65.1) – according to statistics, hip dislocation on both legs is recorded in 20% of cases.

Symptoms of congenital hip dislocation

• asymmetry of the popliteal, gluteal and inguinal folds, when there is an asymmetrical arrangement, a different number and depth of skin folds on the left and right legs;
• Leaving one or both legs to the side at an insufficient angle. The legs of a baby with healthy hip joints, bent at a right angle at the knee and hip joints, should be easily spread apart to the stop, forming an angle of 160-180o between the hips. If a noticeable resistance of one of the legs is felt during abduction, this may be a sign of a unilateral dislocation of the hip;
• shortening of the leg – it can be determined by the different level of positioning of the knee joint, if you bend the legs of a child lying on his back brought together and press them against his stomach;
• Symptom “click” (Marx-Orlani) – a characteristic click is clearly audible when trying to press the child’s hips to the stomach.

In the absence of proper treatment, in children older than 1 year, additional symptoms appear:

• limping;
• “duck” gait (with bilateral dislocation of the hip);
• distortion of the pelvis due to a violation of the tone of the muscles of the back and buttocks;
• Incorrect foot placement.

Consequences of congenital dislocation of the hip

In the absence of preventive orthopedic examinations and parents ignoring the first symptoms of hip dislocation in a child, the pathology progresses. The correct arrangement of the TBS components under load is violated. The cartilage and ligaments of the neglected acetabulum of the pelvic bone are replaced by scar tissue, and the femoral head forms a kind of articular cavity in the place of the pelvic bone on which it rests. Such changes affect the entire body of the child, which leads to catastrophic consequences:

• development of scoliosis, osteochondrosis, impaired posture;
• pain in the hip joint when walking, which makes it difficult to move freely;
• a noticeable shortening of the leg, the development of flat feet;
• appearance of aseptic necrosis of the femoral head;
• partial or complete contracture – loss of hip joint functionality;
• development of dysplastic coxarthrosis.

If congenital hip dislocation is not cured in a timely manner, even in childhood, it will be much more difficult to treat this pathology in adults. And most often, this will require a difficult surgical operation of hip arthroplasty.

Diagnosis of congenital hip dislocation

It should be borne in mind that treatment for hip dislocation is considered timely if it is started in the first three months of a child’s life. Therefore, to diagnose this pathology, it is necessary to examine an orthopedist during the first days after the birth of a baby with a mandatory ultrasound scan, which will help determine the relative position of the femoral head and the acetabulum, taking into account the cartilaginous parts. During the examination, the doctor specifies:

• whether the child has a genetic predisposition to HDS;
• Were any factors contributing to the development of pathology observed during the course of pregnancy:
  – anemia in the mother;
  -intrauterine infections;
  -breech presentation of the fetus;
  – oligohydramnios;
  -large fruit
  – intrauterine growth retardation.

Repeated orthopedic examination with ultrasound is carried out in the third month of a child’s life.

After 3 months after the birth of a child, radiography can be used to diagnose hip dislocation, but treatment started at this time is already considered belated. If the diagnosis was established earlier with the help of ultrasound, X-ray of the congenital hip dislocation is used to control the course of treatment.

Treatment of congenital dislocation of the hip

Congenital dislocations of the hip joints are treated for quite a long time – from several months to a year. For this, both conservative and surgical methods can be used, depending on whether treatment is started on time or late. The main methods of treatment of hip dislocation:

• Functional reduction of hip dislocation related to conservative treatment. This method involves gradual, atraumatic reduction of the femoral head using soft Pavlik stirrups or abduction splints. For high hip dislocation in infants, functional rigid casts may be applied. All these orthoses fix the child’s hips in a functionally correct position until the joint is fully reduced and the joint matures;
• bloodless, closed reduction of dislocation with long-term subsequent fixation of the legs with a plaster coxite bandage at a right angle – the Lorenz method, it is used to treat children 2-5 years old;
• skeletal traction after reduction of the femoral head into the acetabulum (closed reduction of the dislocation is most commonly used). This method is used for high hip dislocations in children 1.5-8 years old;
• surgical methods such as:
  – open reduction of dislocation of the femoral head – it is used for children from 1 to 3 years of age in the absence of progress in conservative treatment;
  – open reduction of dislocation with arthroplasty according to the Column method – used to treat children older than 3 years;
  – corrective osteotomy of the pelvis or femur;
  – palliative operations aimed at creating additional support for the femoral head (Schanz operation) or forming a canopy over the femoral head (Kennig operation).

Treatment of congenital dislocation of the hip joints is always complex. It provides not only the use of conservative and surgical methods, but also physiotherapy, massage and physiotherapy exercises.

In the medical center Ladisten Clinic, for the treatment of hip joint dislocation, a minimally invasive author’s surgical method is used with the installation of an external fixation device, developed by Dr. Veklich V.V. The operation is performed for 40 minutes on both joints, without skin incisions, with punctures. Treatment takes 2.5-3 months. If your child has been diagnosed with congenital dislocation of the hip, contact our clinic! You can make an appointment with us by calling the numbers listed on the website.