Hip dysplasia. Dysplasia of the hip joint - symptoms and signs of pathology

Often, during the examination of a newborn child, some features are found, including some asymmetry of the legs. This can be due to both minor problems and serious illnesses that require decisive action. It is very important to detect the pathology in time and seek help from a specialist, as it may be hip dysplasia.

You will learn

What is TPA?

Hip dysplasia (HJD) is a developmental abnormality of the joint that can cause hip dislocation. It is expressed in the wrong proportion of the size of the femoral head and the acetabulum (the depression where it is located).

The synonymous name that was used earlier to describe this congenital problem has the same name - congenital dislocation of the hip. Now it is customary to use a different name, since dysplasia becomes the root cause of the disease, that is, the entire process of development of the constituent parts of the joint is disrupted during the period of a person's physical development.

The presence of the term "dysplasia" in the name of the disease indicates that this problem appeared even before the birth of a person.

Statistics show that the disease occurs in many countries. The disease is associated with environmental factors, some swaddling traditions and even with racial and ethnic characteristics of the body.

Since over the last decades of the twentieth century, the classification of the disease has been changed and its diagnosis has been clarified, the statistics have increased significantly. This is due to the fact that doctors began to attribute pathologies such as preluxation and subluxation to dysplasia of the hip joint.

According to the international classification of diseases of the tenth revision, hip dysplasia has a code Q65 (Congenital deformities of the hips).

TPA in children

Children with a developmental pathology such as hip dysplasia need immediate treatment, since in only 3% of cases it is impossible to cure this problem. But even this 3% is amenable to some adjustment, because of which many serious consequences can be avoided.

If the treatment of a child with dysplasia is delayed until the second half of the year, then the cure rate becomes only 30%. Therefore, it is very important to identify the disease before 6 months. This can be done by both the parents of the child, and it should be done by the pediatricians who examine him.

The sooner a problem is discovered, the shorter the treatment period will be. It is important to note that in cases where it is discovered before three months, it will only take two more to solve it. In the event that parents notice dysplasia after the first year before the full formation of the body, which occurs at about 20 years old, they will have to resort to certain measures and methods of treatment.

Interestingly, experts note a direct relationship between the methods of swaddling a child and the possibility of the origin of congenital hip dislocation. The tighter this is done by aligning the child's legs, the more likely it is that this will happen. Statistics confirm this, including the policy adopted in Japan to abolish the traditions of tight swaddling, which significantly reduced the rates of this problem.

Causes

Due to a number of reasons, the exact causes of this disease are unknown. Scientists are inclined towards several theories, among which are:

• Hereditary

It means that due to a genetic predisposition to dysplasia in a child, it can occur through transmission from one or two parents.

• Hormonal

This theory is confirmed by the fact that the basis for the formation of dysplasia is the level of hormonal levels in the last trimester of pregnancy. This primarily concerns progesterone. Because of this, there may be a decrease in the musculo-ligamentous tone of the apparatus, which leads to underdevelopment of the child's joints.

• Exogenous

This reason suggests that taking certain medications, as well as toxic effects on the body, can affect the development of the child's musculoskeletal system. This theory is also confirmed by the fact that in areas with severe air pollution and various other similar factors, the level of frequency of dysplasia is much higher.

• Multifactorial

This theory is based on the fact that only by the confluence of various factors together can a disease manifest itself. Depending on how pronounced each of them is, this will be the degree of development of dysplasia.

Dysplasia of the hip joints on x-ray

There are also some factors that, in one way or another, affect the development of the disease:

1. Breech presentation in the womb.
2. Malnutrition, which caused vitamin deficiency and deficiency of micro- and macronutrients important for the development of the child.
3. Abnormal development of the acetabulum of the joint.
4. Limited mobility of the fetus at different stages of pregnancy.
5. As mentioned earlier, the peculiarities of swaddling, which are common in some countries and peoples, affect the possibility of correcting a congenital problem. That is, if a child was born with a problem expressed only by mild symptoms, over time they may disappear without making themselves felt. But this can happen only in those cases when the swaddling does not greatly restrict the movement of the child or does not do it at all.

Diagnostics and symptoms

In order to diagnose congenital dysplasia of the hip joint, which has not yet led to dislocation of the hip, it is necessary to examine the child in a state of relaxation. Therefore, this is often done in a calm and quiet environment during the feeding period.

Some clinical tests can indicate an orthopedic problem, among which experts distinguish:

• Asymmetry of skin folds.
• Shortening of one of the thighs.
• Marx-Ortolani slip symptom.
• Impossibility or limited possible hip sideways.

The indicators of all tests are taken into account, since in the case of a problem, for example, on two legs, asymmetry may not be manifested. This also applies to the age of the child, since at the age of two to three months this symptom may be more pronounced than at birth.

The difference in skin folds lies in what levels they are at, what is the difference in depth between them, as well as the shape. Pediatricians on examination pay attention to the gluteal, popliteal and inguinal fold features of the skin. If a child has a problem, they are deeper and there are much more of them. But due to the fact that this symptom is not common among half of patients, it is not a clear indicator that the problem exists.

One of the most reliable tests that indicates the most severe form of the disease is hip shortening. In the prone position with the same flexion of both knees, the bottom of them is lower than the second. This is due to the fact that the femoral head is displaced from behind, depending on the acetabulum.

The symptom of slipping, which was independently described by two scientists in the thirties of the last century, is a characteristic indicator of the presence of hip dysplasia. To do this, you need to take the child's hips to the sides, and then carefully monitor how they will behave. In this case, it turns out that the head of the femur enters the acetabulum, where it behaves more tightly and slowly, while there is a quick push when it leaves it. In the first weeks of life, such a positive test does not always indicate the presence of a disease.

There are some indirect symptoms that may not confirm the disease, but bring some caution to the examination. Among them are:

1. The softness of the bones of the skull.
2. Crooked neck.
3. Polydactyly.
4. Squamous valgus or valgus installation of the feet.
5. Violation of some reflexes (searching, sucking and cheinotonic).

To identify mild degrees of development of the disease, X-ray diagnosis can be carried out, followed by its description by an experienced specialist.

Degrees

Orthopedists distinguish three degrees of DTS development, which are characterized by various forms of the disease:

• First degree dysplasia in the form of pre-dislocation

At the first degree, the first symptom of the problem is the inability to spread the child's legs, bent at right angles at the knees and hip. This is due to the fact that the child has increased muscle tone in the areas around the joints, therefore full dilution is not possible. It can be expressed in varying degrees due to the localization of the center of the femoral head. Other signs to look out for are the asymmetry of the folds of the skin on the buttocks and thighs.

• Second degree dysplasia in the form of subluxation

The second degree is clearly defined by the symptom of slipping, when the head cannot be held in the acetabulum. When entering and leaving it, a characteristic jolt is felt and a small sound, indicating that the head goes over the edge of the bed. This is due to the fact that its back is not completely developed and formed. The leg can be located in the outward position, and also be slightly shortened when bent behind the second. At the same time, changes in the pattern of skin folds are present.

• The third degree of dysplasia in the form of dislocation

The third degree of dysplasia is the most difficult. All symptoms, characteristic of other stages, are more pronounced and easily noticeable. When walking is carried out, some other symptoms begin to appear, of which limited movement, muscle tension, a significant trochanter above the Roser-Nelaton line are distinguished. Due to the shortening and incorrect rotation of the limb, walking occurs with some limp, and the body bends towards the dislocation. Because of this, functional scoliosis appears as a consequence of dysplasia. If the disease has a bilateral nature of its spread, then the lordosis of the spine is clearly visible. To prevent such problems from arising, at a very early age, it is necessary to begin non-surgical treatment for any symptoms and not to bring the deterioration of the condition to the manifestation of clear signs of the disease.

Treatment

Methods and methods of treatment for different types of diseases are slightly different from each other. It is necessary to make a decision based on the clear clinical manifestations of dysplasia, as well as a comprehensive diagnosis of the disease. Treatment can be conservative and radical surgical. The second method is used only in the most severe cases.

With conservative treatment, various technologies and methods of eliminating the problem are used, including:

1. Carrying out a wide swaddling, which allows you to keep the joints active and not restrict the movement of the limbs.
2. The installation of special struts that allow the child's legs to be taken away.
3. Influence by the method of applying special plaster casts that fix the legs in certain positions.
4. Physiotherapy methods. Physiotherapy for hip dysplasia can include many techniques aimed at reducing the activity of inflammation, improving trophic processes in the muscles, preventing the formation of contractures and reducing pain. In this case, electrophoresis, amplipulse therapy, ultrasound, mud treatment, magnetic laser therapy, hyperbaric oxygenation, therapeutic massages and acupuncture are used.

In this video, you can learn how to massage yourself for both a child and an adult.

In the case of indications for surgery, one of two decisions can be made, including open surgery on the joint with the aim of reducing it, or endoscopic treatment, which does not leave significant marks on the body and is much less radical. To access the joint during endoscopy, only a few small incisions are made, through which they pass into the area that needs to be corrected.

After treatment, it is mandatory to undergo rehabilitation, selected in accordance with the age of the child and the degree of development of the disease that has been eliminated.

For any problems with joints, especially in a child, it is necessary to contact specialists, who may be surgeons or orthopedists. Self-treatment may not lead to the desired result, delay the further treatment process, or even aggravate the situation. If the treatment and detection of the disease is timely, the situation can be corrected completely or in some cases partially. This will significantly improve a person's lifestyle and increase his opportunities.

The main symptoms are:

• Violation of the depth of skin folds
• Violation of the position of skin folds
• Limited hip abduction
• Shortening one leg

Dysplasia of the hip joint is a congenital pathology of the formation of the joint, which causes the subsequent possible subluxation or dislocation of the femoral head. Dysplasia of the hip joint, the symptoms of which can manifest itself either in the form of underdevelopment of the joint, or in the form of its excessive mobility in combination with insufficiency relevant for connective tissue, usually develops against the background of unfavorable heredity, pathology of the course of pregnancy or gynecological diseases that the mother has.

general description

The danger of hip dysplasia lies in the fact that the delay in its detection, along with the lack of the required treatment, can lead to subsequent impairment of the functions performed by the affected lower limb, which is possible up to the development of pathology to such an extent that it will determine the appropriate form of disability for the child. Considering this, the pathology that is relevant for hip dysplasia should be eliminated within the early period of its detection and, in fact, the child's life.

The degree of joint underdevelopment against the background of dysplasia can vary significantly in each case, that is, it can be both gross forms of disorders and excessive mobility, combined with a general weakness of the ligamentous apparatus.

Hip dysplasia is a fairly common pathology found in newborns. On average, the detection rate is 2-3% in 1000 newborns. What is noteworthy, in this pathology, a dependence on the part of race was revealed. So, representatives of the African American race are faced with such a pathology less often than Europeans, while the American Indians, for example, are faced with it more often than any other race. It was also revealed that hip dysplasia in girls is diagnosed many times more often than hip dysplasia in boys - on average, girls account for about 80% of cases of this disease.

It will not be superfluous to dwell on the anatomical features of the area to be affected with hip dysplasia, as well as on what changes this area undergoes against the background of the current pathological process.

The hip joint is formed by the combination of the acetabulum and the femoral head. From the upper part of the cavity, the acetabular lip is fixed in the form of a cartilaginous plate, due to which the area increases when the articular surfaces come into contact, and the depth of the acetabulum also increases. The femoral head contributes to the performance of two main functions, in particular, it absorbs the loads that fall on the femur during running, jumping and walking in order to avoid injury, as well as ensuring the passage of the joints through it, due to which the femoral head is nourished.

Due to the special configuration of the hip joint, the most varied types of movement become possible: turns outward and inward, abduction and adduction, flexion and extension. Under normal conditions, these movements are performed at a low amplitude, which is achieved by limiting the ligament of the femoral head and the cartilaginous rim. In addition to this, the joint is surrounded by many muscles and ligaments, with whose help mobility is also limited to a certain extent.

In a newborn child, the hip joint, even in its normal state, differs from the anatomical features of the joint of an adult. So, in a child, the acetabulum has a flatter shape, its location is also different, in particular, it is not in an inclined position, as in an adult, but practically in an upright position, in addition to this, the child's ligaments have greater elasticity here. Retention of the femoral head is ensured in the cavity due to the rounded ligament, acetabular lip and joint capsule.

There are three main forms of hip dysplasia, these are the acetabular form (the development of the acetabulum is subject to violation), rotational dysplasia (characterized by a violation of the geometric features of the position of the bones along the horizontal plane) and dysplasia of the femur from the side of the upper sections.

If the development of any of the sections in the hip joint is impaired, then the ligaments, the articular capsule and the acetabular lip lose the ability to adequately hold the femoral head, that is, to keep it in the required place. This, in turn, leads to an upward and outward displacement of the femoral head. The acetabular lip is also subject to displacement, in connection with which its ability to ensure fixation of the femoral head is finally lost. In the event that there is a partial exit of the articular surface of the head beyond the location of the cavity, the child develops a condition defined as subluxation.

Later, if the pathological process progresses, the femoral head is displaced higher, due to which it completely loses any connection with the glenoid cavity. The position of the acetabular lip in this case is concentrated below the head, with a curvature inside the joint, which already speaks of such a pathological condition as dislocation.

Ultimately, if, against the background of the progression of this picture, no attempts are made in terms of treatment, the acetabulum begins to fill with adipose and connective tissue, which, in turn, leads to serious difficulties in further attempts to reposition the dislocation.

Dysplasia of the hip joint: degrees and types

Dysplasia of the hip joint can be accompanied by the following anatomical abnormalities:

• abnormal development of the acetabulum - here the acetabulum is partially corrected in its own spherical shape, acquiring a more flattened shape, becoming smaller in size;
• weakness of the ligaments in the area of ​​the hip joint;
• underdevelopment of the cartilaginous rim surrounded by the acetabulum.

The degrees of dysplasia of the hip joint are determined on the basis of pathological changes accompanying this condition, in general consideration we have highlighted them above, we will add some more details to their features:

• Dysplasia. With dysplasia itself, we are talking about the inferiority and incorrect development of the hip joint, but so far without concomitant changes in terms of its configuration. It can be difficult to determine pathology only by visual examination, because here it is found mainly due to additional diagnostic procedures. Somewhat earlier, dysplasia within this period was not considered as a disease at all, it was not diagnosed and, accordingly, the necessary treatment was not prescribed. Now dysplasia is a full-fledged diagnosis, moreover, it also happens that doctors carry out the so-called overdiagnosis, which is explained by the "detection" of this disease in a perfectly healthy child, which, as is clear, is also not correct.
• Pre-dislocation. In this case, we are talking about the previous subluxation and dislocation condition. The capsule of the hip joint is here in a stretched state, and the head of the femur, although slightly displaced, but easily returns to its original, normal anatomical position. The gradual progression of pathological changes leads to the fact that pre-dislocation, as already noted, is transformed into subluxation, and then into dislocation (if the necessary measures of therapeutic action are excluded).
• Subluxation of the hip. There is a partial displacement of the head of the hip joint relative to the cavity. In particular, it bends the cartilaginous rim in the acetabulum while simultaneously displacing it upward. Because of this, the ligament in the femoral head becomes stretched, it loses its inherent tension.
• Dislocation of the hip. In this case, there is a complete displacement of the femoral head in relation to the acetabulum, with which, as is clear, it is initially associated anatomically. That is, the head of the femur in this case is located outside the cavity, and outside, above it. The cartilaginous rim along its upper edge is in the pressed position by the head of the thigh, which is why it is bent into the depth of the joint. The ligament of the femoral head and the joint capsule are in a tense and stretched state.

Let's also highlight the main types of dysplasia:

• Acetabular dysplasia. This type of pathology is caused by a violation of the development of only one acetabulum, in which it has a reduced size, a flatter shape, its cartilaginous rim is in an underdeveloped state.
• Dysplasia of the femur. If we consider the normal anatomical position of the femoral neck, then here it articulates with the body of the femur, which occurs at an appropriate angle. If such an angle is violated, increasing or, conversely, decreasing, then this determines the main mechanism in the disease we are considering, that is, in hip dysplasia.
• Rotational dysplasia. This form of dysplasia is due to a violation of the configuration along the horizontal plane of the anatomical structures. The axes in the environment of which the movement of each of the joints in the lower extremities is carried out, in the normal anatomical position, do not coincide with each other. If the axes do not coincide when they go beyond the normal values, the femoral head is positioned incorrectly relative to the acetabulum.

Hip dysplasia: causes

As the reasons in this case, one can designate the predisposing factors that contribute to the development of such a pathology in a newborn child:

• incorrect position of the fetus, in particular - breech presentation, in which in the womb the fetus is in the position of the pelvis towards the exit from the uterus, and not, as it should be, with the head;
• large size of the fruit;
• heredity - that is, the presence of the pathology in question in the parents;
• toxicosis in a pregnant woman, which is especially important when it appears in a young future woman in labor.

A separate role is assigned to some more factors. As one of the options, we can designate the features of the ecological environment in the region of the child's birth. It was revealed that dysplasia is diagnosed on average 6 times more often in those regions where such a situation is defined as unfavorable. Another factor is the peculiarities of swaddling children. So, in countries that do not swaddle a baby, due to which the legs can be in a bent and abducted position for a significant period of time, dysplasia is diagnosed at times less often than in countries where tight swaddling is preferred.

In the presence of at least one of the predisposing factors, the child at birth becomes registered according to the risk group regarding the development of pathology, and even if the child is in a normal, healthy state, in the absence of anatomical abnormalities inherent in dysplasia.

Hip dysplasia: symptoms

The symptomatology, which will be discussed below, is detected during the examination, therefore this item can also be attributed to the diagnosis of dysplasia, this symptomatology consists of the following features:

• Violation of the location of folds on the skin, violation of their depth. During the examination, the doctor pays attention to the location of the folds under the left and right buttocks, inguinal and popliteal folds. They should normally be at the same level. Accordingly, with a deeper position of the folds on one side, when compared with the other, we can assume the relevance of the disease we are considering. Meanwhile, this symptom cannot be called a reliable indicator of the disease, because in most newborns, there are certain differences in the position of the folds in such a comparison. As a rule, folds are smoothed out until the child reaches the age of 2-3 months. In addition, we note that if such a diagnosis as bilateral dysplasia is relevant, then asymmetries in the position of the folds will most likely not be detected.
• Shortening of one of the legs compared to the other. Such a sign can be considered the most reliable, but it can be identified only in the case of a severe form of the disease, with an already formed hip dislocation. The displacement of the femoral head occurs backward, which contributes to the shortening of the limb. To check this symptom, during the examination, the doctor stretches both legs of the baby, comparing the level at which the kneecaps are located.
• Sliding symptom ("click symptom" or Marx-Ortolani symptom). No less reliable and, at the same time, reliable method for identifying the disease we are considering. Here, the child must be laid on the back, after which the doctor takes his legs so that the thumbs are gripped from the inside, and the rest of the fingers, respectively, are gripped from the outside. Further, attempts are made to breed them to the sides. In the absence of violations in the configuration of the joints, that is, normally, the baby's hips can practically be laid on the surface on which he is laid (on the table), that is, it turns out to be diluted to 80-90 degrees. If there is dysplasia, then the thigh from the side of the lesion can be retracted only to a certain position, and then with the hand of the doctor, during such manipulations, he feels a characteristic click, indicating the reduction of the femoral head. In the future, if the leg is released, then it will again be in its original position, then, in a certain period of time, with a sharp movement, its dislocation will again occur. The detection of dysplasia by a doctor on the basis of this symptom is allowed only at the age of a child about 2-3 weeks, in other cases the diagnostic method is uninformative.
• Limited abduction of the thigh. This symptom can be detected in a child from the age of 3 weeks. It is defined similarly to the previous “click” symptom. From the healthy side, the child's leg can sink to the table surface almost to the very end, while with the affected leg it will not be possible to achieve the same result.

It should be borne in mind that the persistence of dysplasia in congenital dislocation of the hip subsequently becomes the cause of gait disturbances at an older age. The adoption of an upright position by the child subsequently determines the asymmetry of the position of the folds (popliteal, inguinal and gluteal).

As additional methods for diagnosing hip dysplasia, an X-ray examination (allowed to be carried out from a 3-month-old baby) or an ultrasound scan (without age restrictions) is mandatory. Also, diagnostics can be supplemented by MRI or ultrasonography of the joint.

Hip dysplasia: consequences

As is clear from the specificity of the pathology, in the absence of an appropriate approach to the disease, its further course determines the development of complications. So, children with dysplasia begin to walk later than their peers, gait is characterized by instability, clubfoot, rolling from foot to foot, lameness. In frequent cases, an increase in lordosis from the lumbar side with compensatory development of kyphosis from the thoracic segment is revealed.

Disability with hip dysplasia can occur literally from an early age of the baby. Lack of treatment also leads to a number of diseases in adulthood, which is caused by the progression of this pathology, combined with osteochondrosis.

An important feature that is relevant for the lower extremities with dysplasia is that they are simply not capable of withstanding prolonged loads.

Due to the hypermobility of the hip, a general "looseness" of the musculoskeletal system develops. Without timely elimination of congenital dislocation, the joint, gradually adapting to the distorted motor function, will acquire slightly different outlines, both from the side of the femoral head and from the side of the acetabulum. A joint corrected in this way will not be complete, because it is simply not adapted to provide the limbs with support or adequate abduction. In this case, we are already talking about such a pathology as neoarthrosis.

The development of dysplastic coxarthrosis can be designated as the most unfavorable complication of the disease under consideration. This disease develops by the age of 25-35, if, when it appears, no surgical intervention with joint replacement is performed, then the person loses the ability to work.

Treatment

As noted, treatment for hip dysplasia should be started as early as possible. It uses a variety of means, due to which the baby's legs are fixed in the desired position, in particular, these are various tires and devices, special pillows, pants, stirrups, etc. Treatment of babies during the first months of their life is carried out only with the use of elastic and soft structures, the impact of which will not interfere with the normal movement of the limbs.

Pavlik's stirrups have proven to be one of the most effective options in the treatment of dysplasia. This product is in the form of a breast bandage, the basis of which is made up of soft tissues; special strips are attached to this bandage, thanks to which the appropriate effect on the child's legs is ensured to take the desired position. With this fixation, not only the necessary impact on the legs is provided, but also sufficient freedom for movement.

3 out of 1000 newborns are diagnosed with dysplasia of the joints - a disease associated with a violation of their functions of a congenital nature. Most often, the largest joints in the human body - the hip joints - are subjected to such damage, the consequences of their dysfunctions can be very serious and even lead to disability. Therefore, it is important to diagnose the disease on time and start treatment before the development of irreversible processes.

Table of contents:

Causes of hip dysplasia in children

In medicine, there are three main reasons for the development of the considered pathology of the hip joint:

• genetic predisposition;
• disorders of tissue formation during intrauterine development of the fetus;
• hormonal influence.

According to statistics, hip dysplasia (hip dysplasia) is diagnosed in 25% of cases in children whose parents have a history of the same disease. Quite often, the disease under consideration is diagnosed simultaneously with myelodysplasia - a disorder in the formation of blood cells in the red bone marrow. Doctors associate this disorder directly with hip dysplasia.

We are talking about an unstable hormonal background of a pregnant woman - there is a high level of progesterone in the body. This hormone has a relaxing effect on the ligaments, joints and cartilage - this is necessary for labor and successful delivery. But the "trick" is that progesterone has a high placental permeability and enters the fetal bloodstream - this provokes a softening of the ligamentous apparatus of the unborn child.

Note:this negative effect of the hormone progesterone is of particular intensity in the event of an abnormal position of the fetus or delivery in breech presentation.

Abnormal tissue formation in the fetus

The rudiment of the hip joint is observed already at the age of 6 weeks of the fetus; the unborn child makes the first movements with it at the 10th week of its intrauterine development. And if at these stages negative / harmful factors affect the pregnant woman (and therefore the fetus), then the likelihood of developing hip dysplasia increases significantly. Such harmful factors may include:

• various chemicals, this includes certain drugs;
• unfavorable ecological situation;

Note:the biggest role in the formation of tissues in the fetus is played by viral diseases - if a woman has had such a disease in the 1st trimester of pregnancy, then the risk of having a child with hip dysplasia increases sharply.

In addition, the disease in question is diagnosed in the following cases:

• the fruit is too large;
• the mother is diagnosed with oligohydramnios;
• presentation of the fetus is pelvic;
• diseases of the mother of a gynecological nature - for example, adhesions and others.

Classification of hip dysplasia

There are three degrees of development of the disease in question, each of which is characterized by certain symptoms.

1 degree - immaturity of joint tissue components

Most often observed in the case of the birth of a premature baby, doctors define it as a transient condition between a healthy and diseased joint.

Often, grade 1 hip dysplasia is diagnosed in full-term babies, but those born with low birth weight. This happens if the mother had fetal-placental insufficiency during the period of gestation.

2 degree - preluxation of the hip joint

Doctors note a change in the shape of the acetabulum, but the femur itself does not leave the cavity, it remains within its limits. There are no pathological changes in the anatomical structure of the acetabulum.

Grade 3 - subluxation of the hip joint

At this stage of hip dysplasia, a change in the shape of the femoral head is already noted, it moves freely inside the joint, but does not go beyond its limits.

Very important: The most serious option is a dislocation of the hip joint, which is characterized by:

• gross violation of the anatomical structure of the joint;
• changes are observed in the ligaments, and in the muscles, and in the joint capsule;
• the femoral head extends beyond the glenoid cavity and is located either laterally or behind it.

Most often, the disease in question is diagnosed in girls, moreover, in the first year of life.

Symptoms of hip dysplasia

Signs of hip dysplasia can be divided into two large groups:

• characteristic clinical picture in children of the first year of life;
• symptoms inherent in children over the age of 12 months.

It is very difficult to diagnose 1 and 2 degrees of hip dysplasia - there are no obvious signs, a pediatrician or orthopedist can pay attention to the manifestations during a routine examination. But the parents themselves must carefully monitor the appearance and behavior of the newborn. The following factors should be alerted:

• asymmetrical arrangement of folds on the buttocks and popliteal hollows;
• to separate the legs bent at the knees is problematic;
• the child shows obvious dissatisfaction, cries loudly when raising his legs with bent knees.

With such signs, parents should visit a doctor and undergo a full examination by an orthopedist. The specialist will definitely prescribe an ultrasound examination of the hip joint, which will help identify late ossification of the femoral head. In some cases, it is advisable to carry out an X-ray examination - the image will clearly show the skewness of the outer edge of the acetabulum and the flattening of its roof.

Dysplasia of the hip joint is manifested much more intensively in the 3rd degree of the course and with dislocation. In these cases, the following characteristic signs will be present:

1. Click symptom... This sound is heard when the doctor or parent begins to spread the legs, bent at the knees, to the sides - the head of the femur at this moment begins to enter the glenoid cavity and does it with a characteristic click. With the reverse movement, the same sound is heard - the head of the femur again extends beyond the glenoid cavity.
2. Asymmetry of skin folds... This symptom is checked in a child lying on his stomach and lying on his back. Pay attention not to the number of folds (it differs even in healthy children), but to their depth and height.

1. Breeding the legs to the sides is carried out with restriction... It is this symptom that makes it possible to diagnose hip dysplasia in newborns in the first 5-7 days of life with 100% confidence. The following indicator is adhered to: if the limitation reaches 50%, then the disease in question is definitely present.
2. Shortening of the leg of a relative nature... This symptom is checked as follows: the baby is laid on the back, the legs are bent at the knees and their feet are placed on the table / sofa. In a healthy child, the knees will be at the same level, but if one knee is clearly higher than the other, then this means the presence of a shortening of the leg.
3. Erlacher's symptom... Doctors determine it by bringing the straightened leg of the newborn to the other leg, then try to lead the examined limb behind the other (fold the legs crosswise). In a healthy newborn, the crossing of the legs occurs in the middle or lower part of the thigh, with hip dysplasia, this phenomenon is observed in the upper third of the thigh.

In the case of a congenital dislocation of the hip, the sore leg will be turned outward (unnaturally). This is determined when the newborn lies on the back with a straightened leg in both the hip and knee joints.

Signs of hip dysplasia in children over 12 months of age

It is very easy to identify the disease in question in children over 1 year old - a characteristic sign is a violation of gait: the child limps on one leg if hip dysplasia develops on one side, or has a "duck" gait if pathology develops on both sides.

In addition, small forms of the gluteal muscles from the affected side will be noted, and if you press on the heel bone, then the mobility will be noticeable from the foot to the femur (the child should lie on his back with straightened legs).

As soon as the diagnosis of hip dysplasia is made, treatment should be started immediately - this will guarantee recovery.

In the first month after birth, doctors prescribe a wide swaddle for the child. It is done as follows: a regular flannel diaper is folded into a rectangle 15 cm wide (approximately, + - 2 cm is allowed), it is laid between the baby's legs, which are bent at the knees and spread apart by 60-80 degrees. The edges of the diaper reach up to the knees, and it is fastened with strings on the baby's shoulders.

Note:the newborn quickly gets used to this type of swaddling, is not capricious and calmly transfers the moments of "packing" the legs into the desired position. After a while, the child himself begins to put his legs in the right position before swaddling, but you will need to be patient - at first it will be difficult to calm the child.

Wide swaddling is almost always combined with remedial gymnastics - it is elementary: with each diaper change or the next swaddling, it is necessary to spread the legs to the side at a slow pace and return them to their place. Swimming on the stomach will also be effective.

Any procedures for diagnosing hip dysplasia can only be prescribed by a specialist! Therapeutic exercises are performed by a medical worker for the first few times, and parents learn to do the procedure correctly.

The orthopedic doctor (or pediatrician) conducts dynamic monitoring of the child's condition, and if no positive changes are observed, then the wearing of specific orthopedic devices may be prescribed. These include:

Treatment with specific orthopedic devices is aimed at fixing the child's hip joints in the correct position of the legs.

The doctor prescribes adaptations as the child grows and develops:

• from 1 month to 6 months- it is advisable to use Pavlik's stirrups, in some cases a splint with popliteal splints will be effective;
• from 6 to 8 months the doctor prescribes a splint with hip splints;
• between the ages of 8 months and up to 12 months if in the future the child is allowed to walk, the child must wear a walking abduction splint.

Specific orthopedic devices must be worn daily, so parents are always worried about caring for a child in this position. To facilitate your own work, you must remember the following rules:

1. At the time of changing the diaper, you cannot lift the baby by the legs - you need to put your hand under the buttocks and gently lift them.
2. To change the undershirt, there is no need to remove the orthopedic device - you just need to untie the ties on the shoulders.
3. Top of the splints / stirrups can be worn with suits, dresses, vests and any clothing.
4. If the doctor has prescribed the wearing of tires, then get ready for a more rare bathing of the child: 3 times a day, parents should examine the baby's skin under belts and garters to avoid irritation on the skin, diaper rash. Instead of bathing, you can use regular rubdowns with a rag soaked in warm water. If it is necessary to completely wash the child, you can unfasten one strap, but hold the leg in a given position during the hygiene procedure, and then wash the other side of the body identically.
5. Constantly monitor the condition of the tire itself - it should not be wet, and talcum powder, baby powder or cream should not get under its belt / strap, as this can irritate the skin.

Note:while feeding the child, the mother must ensure that his legs are not brought together by the hips to each other, if this process is carried out without specific orthopedic devices.

The duration of wearing such supporting devices is quite long, so parents should be patient, be prepared for the whims and unnecessary anxiety of the baby, and in no case be faint-hearted! The option “let the child rest from these terrible tires” and “nothing terrible will happen in 30-60 minutes” may turn into disability in the future.

Paying attention to the dynamics of the disease in question, seeing the results of wearing specific orthopedic devices, the doctor can prescribe therapeutic exercises and massage.

In no case should such procedures be carried out on their own - this can significantly worsen the health of the baby. Only a specialist who constantly monitors the little patient can give any recommendations.

Therapeutic gymnastics for hip dysplasia

If such a procedure is prescribed, then the parents of a child with a diagnosis of hip dysplasia should attend several sessions with a physiotherapist - a specialist will show you how to do the exercises correctly, and give a specific schedule of classes. There is a general description of the exercises:

1. The child lies on the back, the parents lift the baby's legs alternately up, while bending the knee and hip joints.
2. The baby remains on his back, and the parent bends his legs at the knee joints and in the hip joints, without raising them above the surface. Next, you need to dilute the child's legs in moderation, giving a minimum load, and also do rotational movements with the hips.
3. In a similar starting position, the child's legs, bent at the knees and hip joints, are spread apart as much as possible, trying to get closer to the table surface with our knees.

Note:each of the exercises described should be performed at least 8-10 times, and on the day of such "approaches" should be done at least 3.

You will receive more complete information on the diagnosis of dysplasia and exercises for hip dysplasia in a child by watching this video review:

With regard to massage, we can say the following:

• despite the fact that for newborns and children under the age of 12 months it is carried out in a sparing mode, the benefits from it are enormous - the disease in question is quite possible to cure;
• if you do the recommended exercises with a frequency prescribed by a specialist, then the first results can be seen after a month of such treatment;
• massage by itself is unlikely to have any positive effect on the child's health - it is important to carry out complex therapy.

The doctor will tell the rules of massage for hip dysplasia, and the physiotherapist will show and teach the parents how to perform all the procedures correctly. Recommended set of massage exercises:

1. The baby lies on the back, the parent strokes his feet, thighs, kneecaps, arms and stomach. Then the child needs to be turned over on his stomach and, in the same way, with soft strokes, the whole body should be warmed up. Do not forget to "work" on the inner part of the legs, especially the thighs - for free access to these places, you just need to push the child's legs apart.
2. The child lies on his stomach, and the parent strokes / rubs the lower back, smoothly moving to the buttocks, at the end we carry out soft pinching of the gluteal muscles.
3. We turn the child over on its back and begin to work on the muscles of the thighs - we stroke the legs, shake, gently pinch. In no case should you apply any effort during this part of the massage - the muscles of the thigh can contract sharply (spasm), which will provoke severe pain. After rubbing and relaxing the muscles, you can begin flexion / extension of the legs in the knee and hip joints, but only within those limits that were indicated by the orthopedist.
4. Rotation of the hip inward - the parent should fix the hip joint with his hand, the second should grab the knee and, with slight pressure, rotate the hip to the inside. Then work on the other hip joint.

After the massage, it is necessary to give the child rest - stroke him, rub the little body without effort.

Note:massage is done once a day, each exercise must be performed at least 10 times. It is impossible to take breaks in the massage course - it is fraught with stopping the positive dynamics. The duration of the massage course is determined by the doctor.

During therapeutic exercises and massage, it is important to understand that physiotherapeutic procedures will also be effective - paraffin applications, electrophoresis using drugs that include calcium and phosphorus.

If the diagnosis of dysplasia of the hip joints was carried out with a delay, or if the above-described therapeutic methods do not give a positive result, then doctors prescribe a long-term phased cast. In especially severe cases, it is advisable to carry out surgical treatment. But such decisions are made exclusively on an individual basis, after a thorough examination of the patient and long-term monitoring of the progression of the disease.

In the case of severe forms of hip dysplasia, disturbances in the operation of this apparatus are lifelong, even if the diagnosis and treatment were carried out in a timely manner.

Recovery period

Even if the treatment is successful, a child diagnosed with hip dysplasia remains on the dispensary with an orthopedic surgeon for a long time - in some cases, until growth stops completely. Experts recommend performing a control X-ray examination of the hip joints once every 2 years. Restrictions on physical activity are imposed on the child, it is recommended to visit special orthopedic groups in preschool and school institutions.

Dysplasia of the hip joints is a rather complex disease; many parents literally panic after hearing such a verdict from doctors. But there are no reasons for hysteria - modern medicine copes well with pathology, timely treatment started and the patience of parents make the predictions quite favorable.

Comprehensive information on the signs of hip dysplasia, methods of diagnosis and treatment of hip dysplasia in children - in the video review of the pediatrician, Dr. Komarovsky:

Tsygankova Yana Aleksandrovna, medical columnist, therapist of the highest qualification category.

Hip dysplasia- This is a congenital disorder of the formation of the joint, which can cause dislocation or subluxation of the femoral head. There is either underdevelopment of the joint, or its increased mobility in combination with a lack of connective tissue. At an early age, it is manifested by the asymmetry of the skin folds, shortening and limitation of the abduction of the hip. In the future, pain, lameness, and increased limb fatigue are possible. Pathology is diagnosed on the basis of characteristic signs, ultrasound data and X-ray examination. Treatment is carried out using special fixation and muscle development exercises.

ICD-10

Q65.6 Q65.8

General information

Dysplasia of the hip joint (from the Greek dys - violation, plaseo - form) is a congenital pathology that can cause subluxation or dislocation of the hip. The degree of joint underdevelopment can vary greatly - from gross disorders to increased mobility in combination with weakness of the ligamentous apparatus. To prevent possible negative consequences, hip dysplasia must be identified and treated early - in the first months and years of a baby's life.

Dysplasia of the hip joint is one of the widespread congenital abnormalities. According to specialists in the field of traumatology and orthopedics, the average incidence is 2-3% per thousand newborns. Dependence on race has been noted, with African Americans less often than Europeans, and American Indians more often than other races. Girls get sick more often than boys (about 80% of all cases).

Causes

The onset of dysplasia is due to a number of factors. There is a clear hereditary predisposition - this pathology is observed 10 times more often in patients whose parents suffered from congenital developmental disorders of the hip joint. The likelihood of developing dysplasia is 10 times increased with breech presentation of the fetus. In addition, the likelihood of this pathology increases with toxicosis, medical correction of pregnancy, a large fetus, lack of water and some gynecological diseases in the mother.

Researchers also note a link between the incidence of disease and unfavorable environmental conditions. In ecologically unfavorable regions, dysplasia is observed 5-6 times more often. The development of dysplasia is also influenced by the national traditions of swaddling babies. In countries where newborns are not swaddled, and the legs of the child are in the abduction and flexion position for a significant part of the time, dysplasia is less common than in countries with traditions of tight swaddling.

Pathogenesis

The hip joint is formed by the head of the femur and the acetabulum. In the upper part, a cartilaginous plate is attached to the acetabulum - the acetabular lip, which increases the contact area of ​​the articular surfaces and the depth of the acetabulum. The hip joint of a newborn baby, even normally, differs from the joint of an adult: the acetabulum is flatter, located not obliquely, but almost vertically; the ligaments are much more elastic. The femoral head is held in the socket by the round ligament, the articular capsule and the acetabulum.

There are three forms of hip dysplasia: acetabular (impaired development of the acetabulum), dysplasia of the upper femur and rotational dysplasia, in which the geometry of the bones in the horizontal plane is disturbed.

If the development of any of the parts of the hip joint is impaired, the acetabular lip, articular capsule and ligaments cannot hold the head of the femur in place. As a result, it shifts outward and upward. In this case, the acetabular lip also shifts, finally losing the ability to fix the head of the femur. If the articular surface of the head partially extends beyond the cavity, a condition occurs, which is called subluxation in traumatology.

If the process continues, the femoral head moves even higher and completely loses contact with the glenoid cavity. The acetabulum is below the head and wraps around the inside of the joint. Dislocation occurs. If untreated, the acetabulum is gradually filled with connective tissue and adipose tissue, which makes it difficult to reposition.

Dysplasia symptoms

Hip dysplasia is suspected in the presence of hip shortening, asymmetry of skin folds, limitation of hip abduction, and Marx-Ortolani slip symptom. Asymmetry of the groin, popliteal, and gluteal skin folds is usually better detected in children older than 2–3 months. During examination, pay attention to the difference in the level of location, shape and depth of folds.

It should be borne in mind that the presence or absence of this symptom is not enough to make a diagnosis. With bilateral dysplasia, folds can be symmetrical. In addition, the symptom is absent in half of children with unilateral pathology. The asymmetry of the groin folds in children from birth to 2 months is not very informative, since it sometimes occurs even in healthy babies.

A symptom of a shortening of the hip is more reliable in diagnostic terms. The child is placed on the back with the legs bent at the hip and knee joints. The location of one knee below the other indicates the most severe form of dysplasia - congenital dislocation of the hip.

But the most important sign of congenital dislocation of the hip is the “click” or Marx-Ortolani symptom. The kid is lying on his back. The doctor bends his legs and grabs his thighs with his palms so that the II-V fingers are located on the outer surface, and the thumbs on the inner. Then the doctor evenly and gradually moves the hips to the sides. With dysplasia, a characteristic shock is felt on the diseased side - the moment when the head of the femur from the dislocation position is set into the acetabulum. It should be borne in mind that the Marx-Ortolani symptom is not informative in children during the first weeks of life. It is observed in 40% of newborns, and subsequently often disappears without a trace.

Another symptom indicating joint pathology is limitation of movement. In healthy newborns, the legs are retracted to a position of 80-90 ° and fit freely on the horizontal table surface. If the abduction is limited to 50-60 °, there is reason to suspect a congenital pathology. In a healthy child of 7-8 months, each leg is retracted by 60-70 °, in a baby with congenital dislocation - by 40-50 °.

Complications

With minor changes and the absence of treatment, any painful symptoms at a young age may be absent. Subsequently, at the age of 25-55 years, it is possible to develop dysplastic coxarthrosis (arthrosis of the hip joint). As a rule, the first symptoms of the disease appear against the background of a decrease in physical activity or hormonal changes during pregnancy.

The characteristic features of dysplastic coxarthrosis are acute onset and rapid progression. The disease manifests itself as unpleasant sensations, pain and limitation of movement in the joint. In the later stages, a vicious setting of the thigh is formed (the leg is turned outward, bent and adducted). Joint movements are severely limited. In the initial period of the disease, the greatest effect is provided due to a properly selected physical activity. In case of severe pain syndrome and faulty positioning of the hip, arthroplasty is performed.

With an unreduced congenital dislocation of the hip, over time, a new defective joint is formed, combined with a shortening of the limb and dysfunction of the muscles. Currently, this pathology is rare.

Diagnostics

A preliminary diagnosis of hip dysplasia can be made in the hospital. In this case, you need to contact a pediatric orthopedist within 3 weeks, who will conduct the necessary examination and draw up a treatment regimen. In addition, to exclude this pathology, all children are examined at the age of 1, 3, 6 and 12 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.

Clinical examination of the baby is carried out after feeding, in a warm room, in a calm, quiet environment. To clarify the diagnosis, methods such as radiography and ultrasonography are used. In young children, a significant part of the joint is formed by cartilage, which is not displayed on radiographs, therefore, until the age of 2-3 months, this method is not used, and subsequently, when reading the images, special schemes are used. Ultrasound diagnostics is a good alternative to X-ray examination in children during the first months of life. This technique is practically safe and informative enough.

It should be borne in mind that the results of additional studies alone are not enough to diagnose hip dysplasia. The diagnosis is made only when both clinical signs and characteristic changes on radiographs and / or ultrasonography are detected.

Treatment of hip dysplasia

Treatment should begin as early as possible. Various means are used to hold the child's legs in the flexion and abduction position: apparatus, splints, stirrups, pants and special pillows. When treating children in the first months of life, only soft elastic structures are used that do not interfere with the movements of the limbs. Wide swaddling is used when it is impossible to carry out a full-fledged treatment, as well as during the therapy of children at risk and patients with signs of an immature joint identified during ultrasonography.

One of the most effective methods of treating young children is Pavlik's stirrups, a soft tissue product that is a chest bandage to which a system of special strips is attached to keep the child's legs out to the sides and bent at the knee and hip joints. This soft design keeps the baby's feet in position and at the same time provides the baby with sufficient freedom of movement.

Special exercises to strengthen the muscles play an important role in restoring range of motion and stabilizing the hip joint. At the same time, for each stage (breeding the legs, keeping the joints in the correct position and rehabilitation), a separate set of exercises is drawn up. In addition, during treatment, the child is prescribed a gluteal muscle massage.

In severe cases, a one-stage closed reduction of the dislocation is performed, followed by immobilization with a plaster cast. This manipulation is performed in children from 2 to 5-6 years old. When the child reaches the age of 5-6 years, reduction becomes impossible. In some cases, with high dislocations in patients aged 1.5-8 years, skeletal traction is used. If conservative therapy is ineffective, corrective operations are performed: open reduction of dislocation, surgical interventions on the acetabulum and the upper part of the femur.

Forecast and prevention

With an early start of treatment and timely elimination of pathological changes, the prognosis is favorable. In the absence of treatment or in case of insufficient effectiveness of therapy, the outcome depends on the degree of hip dysplasia; there is a high likelihood of early development of severe deforming arthrosis. Prevention includes examinations of all young children, timely treatment of the identified pathology.

Dysplasia of the hip joints in children is quite common. According to official statistics, this pathology is diagnosed in 3-4% of newborn babies. One or both hip joints can suffer. The prognosis and consequences of such a congenital disease depend on how timely the problem was detected, as well as on the degree of underdevelopment of the joint components and on compliance with all medical recommendations for treatment. Therefore, every parent should know about the existence of such an ailment, since it is mom or dad who can be the first to notice that something is wrong with the child.

What it is?

Dysplasia of the hip joints in children is a congenital inferiority of the components of the hip joint, its underdevelopment, which can lead or has already led to a congenital dislocation of the hip in a newborn.

The hip joint consists of 2 main components: the acetabulum of the pelvic bone and the head of the femur. The acetabulum has the form of a half-shell, along its contour is the rim of their cartilaginous tissue, which complements the shape and helps to keep the femoral head inside. Also, this cartilaginous lip performs a protective function: it limits the amplitude of unnecessary and damaging movements.

Scheme of the formation of congenital hip dislocation in hip dysplasia

The femoral head is in the shape of a ball. It connects to the rest of the thigh through the neck. The head is normally located inside the acetabulum and is securely fixed there. A ligament extends from the apex of the head, which connects the head and the acetabulum, in addition, in its thickness there are blood vessels that feed the bone tissue of the femoral head. The inner surface of the joint is covered with hyaline cartilage, its cavity is filled with adipose tissue. Outside, the joint is additionally reinforced with extra-articular ligaments and muscles.

With dysplasia in a child, one or more of the described structures are underdeveloped due to certain circumstances. This contributes to the fact that the head of the femur is not fixed inside the acetabulum, as a result of which its displacement, subluxation or dislocation occurs.

In most cases of dysplasia in infants, one of these anatomical birth defects occurs:

• Pathological shape of the acetabulum (too flat), violation of its normal size (too large or, conversely, small). Such circumstances do not make it possible to reliably hold the head of the femur inside, which is why it is displaced.
• Underdevelopment of the cartilaginous ridge along the perimeter of the acetabulum, too long a ligament of the femoral head, lack of adipose tissue inside the joint.
• Abnormal angle between the neck and head of the femur.

Any of these defects, along with weakness of muscles and intra-articular ligaments in infants, leads to dysplasia or congenital dislocation of the hip.

Breech presentation of the fetus is a risk factor for the development of hip dysplasia

Causes

Unfortunately, the true reason for the development of such a pathology has not yet been established. But experts were able to find a number of factors that contribute to an increased risk of hip dysplasia in newborns:

• incorrect position of the fetus inside the uterus during pregnancy, especially with regard to breech presentation;
• too large a child at birth;
• the presence of the same disease in close relatives (genetic tendency);
• the onset of pregnancy at a very young age;
• toxicosis in the mother while carrying a child;
• hormonal disruptions in the female body during pregnancy.

If at least one of the above risk factors is present, then such a child automatically falls into the risk group for hip dysplasia, even if there are no signs of abnormality at birth, and during the first months of life should be regularly examined by a pediatric orthopedist.

How to suspect a problem?

The symptoms of dysplasia are not always possible to identify in time, since they are often barely noticeable or even absent. Among the signs that can be seen during an external examination of a child, it should be highlighted:

1. Violation of the location of skin folds on legs, the appearance of their asymmetry. Carefully examine the folds under the buttocks, under the knees, groin. In the case of their unevenness (both in location and in depth), one can suspect pediatric hip dysplasia. But this is not a completely reliable sign, since up to 2-3 months the folds can be asymmetrical and normal due to the uneven development of the subcutaneous fatty tissue in the baby.
2. Various leg lengths child. This is a more reliable symptom, but it occurs already at the stage of hip dislocation; in case of dysplasia, it may be absent. To check the length of the legs in a baby, you need to stretch them out and compare them by the location of the kneecaps. There is a second way: we bend the legs at the knees of the baby who is lying on his back and pull the heels to the buttocks. Moreover, if the legs have different lengths, then one knee will be higher than the second. The leg is shortened on the side where the dislocation is located.
3. Click symptom... To check it, the newborn needs to be laid on his back, bend his knees and spread them at the hip joints. In this case, a characteristic click occurs on the side of the dysplasia, which corresponds to the reduction of the femoral head. This sign is informative only up to 2-3 weeks of age of the baby.
4. Restriction of hip abduction... This feature is checked in the same way as the previous one. Informative after 2-3 weeks of life. Normally, the baby's legs can be diluted 80-90º or laid on the surface. If dysplasia occurs, then this cannot be done.

It's important to know! In children up to 3-4 months, increased muscle tone is observed, which sometimes leads to difficulty in breeding the legs in the hip joints and creates a false-positive picture of the disease.

Unfortunately, no other symptoms exist until the baby starts to walk. At an older age, attention is drawn to different leg lengths, gait disturbance, asymmetry of anatomical landmarks, and the development of duck walking in bilateral dysplasia. Treatment at a later age is difficult and the situation can be corrected, but not always, it is possible only with the help of an operation. Therefore, it is important to identify pathology from the first months of a child's life, when conservative therapy is effective.

This is how you need to check the click symptom and the amount of dilution of the legs in the hip joints

Dysplasia

There are 4 degrees of this congenital disease:

1. Dysplasia itself- congenital underdevelopment of some joint structures, but there is no displacement of the femoral head. Previously, such a diagnosis did not exist, since it was impossible to diagnose it. Today, thanks to modern techniques, dysplasia is often diagnosed and is an indication for conservative treatment in order to prevent possible congenital dislocation of the femur.
2. Pre-dislocation. It is diagnosed when the femoral head is slightly displaced, but does not go beyond the acetabulum; during movement, it easily takes its normal position. If you do not take any measures, then the disease progresses and transforms into dislocation.
3. Incomplete hip dislocation... It is installed when the femoral head is displaced, but does not completely protrude from the acetabulum. In this case, the ligament of the head is strongly stretched, which negatively affects its blood supply. When moving, she does not fall into place.
4. Congenital dislocation of the hip... This is an extreme degree of dysplasia, when the femoral head extends completely outside the acetabulum. The joint capsule is tense, the ligament inside is tense.

Grade of hip dysplasia

Diagnostics

There are 2 methods that can confirm or deny the diagnosis of hip dysplasia:

• radiography,

X-ray examination is very informative, but it is performed only from 3 months of age. The reason is that in newborns, complete ossification of the structures of the hip joints is not yet observed, which can cause false-positive or false-negative results. Up to 3 months it is recommended to carry out an ultrasound of the hip joints. This is an absolutely safe and highly informative research method that allows you to diagnose dysplasia in infants with great accuracy.

X-ray allows you to accurately confirm the diagnosis of dysplasia in a child

Treatment

The main key to the success of the treatment of hip dysplasia is timely diagnosis. They always begin therapy with conservative methods that are successful in most babies. Surgical treatment may be needed if the diagnosis is late or if complications develop.

Conservative therapy

Includes several groups of therapeutic measures:

• physiotherapy;
• massage;
• wide swaddling;
• wearing special orthopedic structures;
• physiotherapy procedures;
• closed reduction of hip dislocation.

Exercise therapy is prescribed in each case of hip dysplasia, not only as a therapeutic measure, but also as a preventive measure. This very simple method, which all parents can master, has absolutely no contraindications and is painless. A pediatrician or pediatric orthopedist should teach how to perform leg exercises. You need to do it every day 3-4 times for 5-6 months. Only in this case exercise therapy will bring a positive result.

A few simple exercises to treat hip dysplasia:

Massage for dysplasia should be prescribed and performed only by a specialist. It allows you to achieve stabilization of the process, strengthening of muscles and ligaments, reduction of dislocation, improvement of the general condition of the child. But there is also a general massage that parents can use. It should be done in the evening after bathing before going to bed.

Important to remember! In infants, not all massage techniques are used, but only stroking and light rubbing. Vibrations, vibrations are prohibited.

Wide swaddling is most likely a preventive rather than a curative measure. It is indicated in the case of the birth of a child from the risk group, in the presence of the 1st stage of pathology, with immaturity of the joint structures according to ultrasound data.

If it is not possible to correct the dislocation with the help of massage and exercise therapy, then they resort to the use of special orthopedic structures that allow fixing the legs in a position divorced in the hip joints. Such designs are worn for a long time without removing. As the child grows, the structures of the joint mature and reliably fix the head of the thigh inside, which does not pop out from there, thanks to various stirrups and splints.

The main orthopedic structures that are used to treat dysplasia:

• stirrups Pavlik,
• bus CITO,
• Volkov's tire,
• Vilensky bus,
• Freyk's bus,
• Tubenger bus.

All of these devices are worn and adjusted by an orthopedic surgeon. Parents cannot remove or change the parameters on their own. Modern stirrups and splints are made from natural, soft and hypoallergenic fabrics. They absolutely do not affect the condition of the child and the ability to care for him.

The complex of medical and rehabilitation measures is always complemented by physiotherapy procedures. Especially effective: ultraviolet irradiation, warm baths, applications with ozokerite, electrophoresis.

With the formed dislocation and the absence of the effect of conservative therapy, they can resort to closed bloodless reduction, which is carried out under anesthesia at the age of a child from 1 to 5 years. The doctor returns the head of the femur to the acetabulum, after which a coxite plaster cast is applied to the child for 6 months. Further rehabilitation continues. It is important to emphasize that the child does not tolerate such treatment well.

Surgery

The operation is resorted to in the case when the disease is diagnosed late, with the ineffectiveness of all previous therapeutic measures, as well as in the presence of complications. There are several options for surgical intervention, among which there are palliative ones.

Forecast

As a rule, with timely diagnosis and adequate conservative therapy, the prognosis is favorable. By the age of 6-8 months, all components of the joint mature, and the dysplasia disappears. If the disease is not eliminated in time, then an operation and a long rehabilitation period may be needed, and in some children after surgery, a relapse may develop. If the pathology has not been completely eliminated, then with age such complications may arise: dysplastic coxarthrosis, impaired walking and gait, the formation of neoarthrosis, aseptic necrosis of the femoral head, etc.

Prevention of congenital hip dysplasia, first of all, consists in avoiding the risk factors described above. If this cannot be done, then it is necessary to proceed with secondary measures, among which daily therapeutic exercises and massage are especially effective.