Do not treat hip dysplasia. What to do if hip dysplasia is detected in adults? Anatomical structure of the hip joint and its disorders

A widespread congenital pathology, which is diagnosed more often in girls than in boys. Clinically, it is manifested by shortening of one leg relative to the other, and impaired hip abduction. Treatment is usually conservative, physiotherapeutic and massage procedures, wearing orthopedic devices. Only if these methods are ineffective is surgical treatment for hip dysplasia (HJ) in children.

General description of hip dysplasia in children

With dysplasia of the hip joint, its underdevelopment or increased mobility is noted, which is combined with insufficiency of connective tissues. The danger of the pathology lies in frequent subluxations and. Underdevelopment of the joint varies in severity - it can be gross violations or excessive mobility against the background of weakness of the ligamentous-tendon apparatus. In the absence of medical intervention, severe complications arise, therefore, in pediatric orthopedics, special attention is paid to timely detection.

The pathology is characterized by a violation of the development of one of the hip joint sections. This leads to the loss of the ability of the acetabular labrum, articular capsule, and ligaments to hold the head of the femur in the anatomically correct position. As a result, it moves outward and at the same time upward - a subluxation occurs. And in the complete absence of contact of the femoral head with the acetabulum, dislocation occurs.

Deviation classification

Hip dysplasia is classified depending on the severity of the resulting disturbances in its development. Dysplasia itself, or inferiority of the hip joint, is distinguished. This form of pathology does not manifest itself clinically, so it is difficult to diagnose it in a child only by external examination. Previously, it was not considered a disease, and its treatment was not carried out. Now it is impossible to do without therapy, as this can become a prerequisite for the development of complications. There are three degrees of severity of hip dysplasia:

• preluxation - a slight return displacement of the femoral head due to weakness of the joint capsule;
• subluxation - partial displacement of the head of the femur relative to the acetabulum with bending of the cartilaginous rim and tension of the ligaments;
• dislocation - complete displacement of the femoral head beyond the glenoid cavity.

The treatment tactics depend on the severity of hip joint underdevelopment. If special swaddling is sufficient for pre-dislocations, then for frequent dislocations surgical correction is often required.

Causes of the disease

The cause of hip dysplasia in children is a number of factors. Orthopedists especially highlight hereditary predisposition. If one of the parents was once diagnosed with congenital underdevelopment of the hip joint, then the likelihood of its occurrence in the child is 10 times higher.

The risk of dysplasia increases significantly with breech presentation of the fetus - its longitudinal location in the uterus with the legs or buttocks facing the entrance to the pelvis. The following factors can provoke underdevelopment:

• severe toxicosis during pregnancy;
• the mother's intake of drugs from certain clinical and pharmacological groups, for example, immunosuppressants, cytostatics;
• large fruit;
• oligohydramnios;
• some gynecological pathologies that were untreated at the time of conception.

A relationship has been established between the frequency of births of children with hip joint underdevelopment and parents’ residence in an environmentally unfavorable region. Not least among the factors provoking acquired pathology is traditional tight swaddling.

Signs of pathology

Congenital underdevelopment of the hip joint can be diagnosed in the maternity hospital by a pediatric orthopedist based on its characteristic signs. He must also examine the child at the age of one, three, six and twelve months. Special attention given to children without any symptoms of dysplasia, but at risk. These include newborns with a large weight or those who were in the breech position before birth.

In children older than one year, underdevelopment of the hip joint is indicated by gait disturbance (claudication), weakness of the gluteal muscles (Duchenne-Trendelenburg symptom), as well as higher localization of the greater trochanter.

Slipping symptom

The sliding symptom (clicking symptom, Marx-Ortolani symptom) is detected only in children under 2-3 months of age in the supine position. When the doctor moves the child’s hip to the side evenly and gradually, a specific push is felt. Its appearance indicates the reduction of the head of the femur into the articular cavity, eliminating the condition of dislocation.

Lead limitation

This sign of dysplasia is detected in children under one year old in a supine position. The doctor bends the child's legs and then carefully spreads them to the side. With a correctly formed hip joint, the hip abduction angle is 80–90°. This symptom is not always informative. In healthy children, abduction limitation can be triggered by a physiological increase in muscle tone.

Leg shortening

This diagnostic sign allows you to identify the most severe form of TBS -. To do this, the child is placed on his back, and the doctor bends his legs, pressing him to his stomach. If dysplasia affects one hip joint, then the knee joints will not be located symmetrically due to shortening of the hip.

Symmetry of folds

With severe dysplasia, the inguinal, popliteal, and gluteal skin folds in a child older than 3 months are located asymmetrically. They also differ from each other in depth and shape. But such a symptom is informative only with unilateral damage. If two hip joints are underdeveloped at once, then the folds may well be located symmetrically. In addition, such a diagnostic sign is often absent in children with dysplasia and can be detected in a healthy child.

Diagnosis of the disease

A doctor may suspect underdevelopment of the hip joint in a child immediately during his first external examination in his life. The examination is carried out after feeding, when the newborn is calm and relaxed. The primary diagnosis is made when one or more specific signs of dysplasia are detected, for example, limited hip abduction.

To confirm it, instrumental studies are prescribed, usually ultrasonography (). Used in diagnosis and, but only in older children. The fact is that up to 3 months there is still a lot of cartilaginous tissue in the hip joint that is not visible on radiographic images.

Which doctor should I contact?

In most cases, congenital dysplasia of the hip joint is immediately detected by a pediatric orthopedist or pediatrician at the next routine examination. But sometimes parents themselves notice the child’s unphysiological gait when he takes his first steps. In this case, you should contact a pediatrician, who, after a short examination, will write a referral to a specialist doctor - a pediatric orthopedist.

How to properly treat a child

The sooner treatment begins, the faster the correct formation of the hip joint will be achieved. For this purpose they use various methods and means to help secure the child’s legs in flexion and abduction. This is a special wide swaddling blanket, stirrups, splints and other devices. How younger child, the softer and more elastic the orthopedic products that hold the legs should be.

Wide swaddling

This is more of a preventative measure rather than a curative one. Wide swaddling is recommended for parents of children who are at risk or who have been diagnosed with underdevelopment of the hip joint, which has not yet become the cause of pre-luxations, subluxations and dislocations. For the treatment of dysplasia, it is carried out only if it is impossible to use other, more effective methods of treatment.

To perform a wide swaddling, the baby is laid on his back, and two diapers are placed between his legs. They wrap loosely around each leg when flexed in abduction. The diapers are secured with a third, attached to the belt. This method of swaddling helps to keep the legs apart at 60-80°.

Orthopedic structures

In the treatment of hip dysplasia in the youngest children, it is more often used. Outwardly, it looks like a dense cushion located between the knees. And to secure the legs in a physiological position for the “ripening” of the hip joint, the design provides fixing straps.

Another frequently used device is Pavlik stirrups. This is the name of an orthopedic product that resembles a chest bandage. To securely fasten the legs, it is equipped with straps located on the child’s shoulders and behind the knees, ankle locks, and straps. Less commonly used is the Vilensky splint - two leather cuffs with a metal telescopic spacer between them.

Massage treatment

Restorative massage is an important component of therapy. The pediatric orthopedist writes out a referral for sessions. The massage is performed approximately an hour after the last feeding, in a calm, relaxing environment. It begins with stroking, light kneading and rubbing. Then the massage therapist begins more intense, energetic movements. This is necessary to strengthen the muscles of the thighs and legs and improve blood circulation. At the final stage, stroking is performed again.

Therapeutic exercise

Daily physical therapy exercises are necessarily indicated for dysplasia. A set of exercises is compiled by a pediatric orthopedist, taking into account the severity of the disease, the age of the child, general condition his health. He shows parents how to perform the movements correctly to avoid excessive stress on the hip joint. What exercises are most effective:

• the legs are retracted to the sides, and then they perform circular movements with a small amplitude;
• when lying on your stomach, the legs are smoothly moved to the sides and then brought together;
• lying on the back, the legs are raised and the child's feet are brought together.

Regular exercise (up to 4 times a day) helps strengthen the muscles that support the head of the femur, preventing its displacement from the acetabulum. They also become an excellent prevention of the development of complications. Exercises are performed only as prescribed by a doctor, as there are contraindications to exercise, for example, an umbilical hernia.

Physiotherapy

To accelerate the “ripening” of the hip joint in its anatomical position, physiotherapy is used. Electrophoresis is prescribed with solutions of calcium, phosphorus, iodine - elements necessary for the proper formation of bone and cartilage structures. In total, about 10 sessions are performed, but if necessary, the course of treatment is extended.

UV irradiation of joints is also practiced according to a scheme determined individually. Thanks to penetration ultraviolet rays into the skin to a depth of 1 mm, local immunity is strengthened, metabolic and regenerative processes are accelerated.

Dysplasia is treated with applications of ozokerite or paraffin. These loose powders are preliminarily melted, cooled and applied layer by layer to the TBS. A thick film forms on the surface of the skin, retaining heat for a long time.

Surgical intervention

Indications for surgical intervention include severe hip dysplasia, detected at the age of 24 months, and the presence of anatomical defects in which it is impossible to reduce the dislocation. Surgeries are performed when the joint capsule is pinched, underdevelopment of the pelvic bones, hip bones. If it is impossible to reduce the head of the femur using a closed method, then surgical intervention is also used. What operations are performed for dysplasia:

• open reduction of dislocation - reduction of the femoral head into the acetabulum after dissection of the articular capsule, followed by casting for 3 weeks;
• surgery on the femur bone - giving the proximal end of the femur the correct configuration using osteotomy;
• surgery on the pelvic bones - creating a support for the head of the femur, preventing it from slipping out of the glenoid cavity.

If for some reason it is impossible to correct the configuration of the hip joint, then palliative operations are performed. Their goals are to improve the child’s well-being and restore some functions of the hip joint.

What are the complications?

In the absence of medical intervention, hip dysplasia becomes the cause of the development of numerous complications. The functional activity of one or two hip joints is reduced, which leads to disruption of the entire musculoskeletal system.

Disorders of the spinal column and lower extremities

Hip dysplasia provokes impaired motor skills of the spine, large and small joints of the legs. As the child grows up, the gait becomes disturbed due to the development of the gait; a persistent curvature of the spinal column to the side relative to its axis occurs. This leads to an uneven distribution of loads on the vertebral structures during movement, and the appearance of characteristic.

Dysplastic coxarthrosis

This is the name of severe degenerative-dystrophic pathology of the hip joint, which occurs due to the destruction of cartilage tissue with further deformation of the bones. In patients with dysplasia, the hip joints are formed incorrectly; under the influence of certain factors, the cartilage lining begins to thin out. After 25 years it can be caused by low physical activity, excessive loads on the hip joint, changes in hormonal levels and even taking drugs of certain clinical and pharmacological groups, for example, glucocorticosteroids.

Neoarthrosis

Neoarthrosis is a condition characterized by the formation. With long-term dislocation, the femoral head flattens and the size of the acetabulum decreases. Where the head rests on the femur bone, a new joint gradually begins to form. Some doctors even consider this as self-healing, since the formed hip joint is capable of performing certain functions.

Aseptic necrosis of the femoral head

This pathology develops as a result of damage to the vessels supplying the head of the femur with nutrients. in most cases it occurs after surgery on the hip joint, including for the treatment of dysplasia. The femoral head begins to collapse, making independent movement impossible.

Prevention of DTS

Most best way prevention of hip dysplasia - regular examination of the child by a pediatric orthopedist. Even if at some stage problems with the functioning of the hip joint are detected, timely treatment will allow you to completely get rid of the pathology.

Doctors strongly recommend that parents do not use tight swaddling, and often carry the child on his side in the “rider” position. In this position, he tightly clasps his mother or father with his legs, which helps correct formation joints.

The birth of a child is a holiday for the family. The sadder the illness of a small newborn becomes. A common condition among children is known as hip dysplasia 2a.

The best weapon against disease is information. Let's consider the idea of ​​the disease, its symptoms, causes of occurrence and control measures.

Recently, hip dysplasia has become more common in newborns under the age of one year. The reasons have been established:

• Unfavorable atmosphere for fetal development (environmental);
• Disturbances 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 disease.

What is hip dysplasia

Dysplasia is a disorder 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 at birth, judging by the latest estimates, too often. Interestingly, dysplasia appears more often in little girls.

Type 2a – initial stage. At the first stage, the hip joint is in a relatively free, healthy position, but individual shifts in negative side. At the mentioned stage, the ligaments and articular tissues do not adhere to the joint, do not hold it, because of this, the connection begins to “wobble”, loosens like a flimsy bolt.

Select people believe that giving birth to a baby with a misaligned joint means a lifelong disability. 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-luxation (types 3a and 3b). At this stage, the head of the femur protrudes 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 leg.

There are 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 occurs more often.

It is difficult to distinguish pathology; the disease does not show its presence. The baby is not in pain, and does not develop seizures or other clear symptoms of the disorder. An attentive parent will notice the disease in telling manifestations:

• Different leg lengths;
• The buttocks are asymmetrical;
• A characteristic clicking sound is heard from the hip joint: the head of the femur pops 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 baby loves to walk on his toes;
• "Duck" waddling gait.

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

How is dysplasia diagnosed?

Independent diagnoses and prescription of treatment are prohibited for the benefit of the child. Diagnosis is pending; without clear evidence of the appearance of dysplasia, treatment will not begin. A common detection procedure is an ultrasound scan.

The procedure shows clear benefits. Firstly, it does not cause discomfort to children (and adults). Secondly, to do an ultrasound, you don’t need to pay a lot of money; the procedure is quite affordable.

An ultrasound is performed on infants starting at 4 months and ending at 6. The study will reveal the extent of the disease and 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 carried out?

The success of 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, immediate treatment will have to wait: 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 all his might and dysplasia of a subsequent degree is diagnosed, the result of treatment is unpredictable. To be honest, it is unlikely that treatment will bring complete recovery. Parents are required to follow the following rules:

1. Do not put the baby on his feet until the doctor writes the appropriate permission;
2. It is required to help the baby do special preventive exercises. For example, lie on your back, spread your legs and rotate your hip joint. Exercise helps 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 grow together correctly.

Fortunately, treatment is available and feasible with positive results. The main thing is to visit the doctor on time, without starting the disease.

How to help your child before diagnosis

If the baby is born healthy, hip dysplasia is not a problem.

For newborn children, a monthly examination by a pediatrician becomes mandatory. Three times a year, parents bring their child to an orthopedist. If doctors don't notice any warning signs, there's no need to worry.

There is an interesting preventive method known -. You cannot swaddle a child so that the legs of the wrapped baby remain straight, like those of a tin soldier. Recent studies show that there is a relationship between the two methods - swaddling with a “tin soldier” and pathology of the hip joint. Such swaddling was adopted in the time of great-grandmothers; do not allow representatives of the older generation to swaddle the baby in the wrong way.

It is better if the little one is wrapped up in the likeness of the children of ancient tribes: the baby simply “sits” in a diaper 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 his back, the method is correct, the child clasps his mother’s back with his legs, the femurs are constantly in an apart, fixed state. The Japanese noticed that when the swaddling method became widely used in families with newborn children, the percentage of dysplasia decreased significantly!

Hip dysplasia, type 2a, most often appears in newborns. It is better for expectant mothers to closely monitor their health during pregnancy, without stopping caring for the baby after his birth.

It is easier to stop any disease at the very beginning. Hip dysplasia today is diagnosed in the womb. The main thing is to treat this responsibly, and you will avoid bad consequences in adulthood.

Informed means armed. In the article you will get acquainted with the role of preventive actions and why early diagnosis is important for preventing the disease.

What modern capabilities does medicine have today to reduce the incidence of hip dysplasia? Where to look for answers to pressing questions. How to professionally help your child. Get acquainted with the information prepared for you, and you will receive answers to these questions.

Hip dysplasia: main characteristics

Hip dysplasia is a pathology that is characterized by underdevelopment of all its elements (acetabulum, head and neck of the femur, as well as the surrounding capsule, ligaments, muscles). Since hip dysplasia is quite common, having an idea about it is useful not only for mothers, fathers, grandparents, but also for people who are just planning to add to their family.

Hip dysplasia is the most common congenital orthopedic pathology and occurs on average in every 7 newborns. Congenital hip dislocation is much less common - approximately 1 case per thousand newborns.

The word dysplasia in literal translation, means immaturity, underdevelopment of the hip joint. Dysplasia can be “mild” or “severe”, which is why treatment tactics differ significantly. Also, the treatment of dysplasia differs depending on the patient’s age.

Surgeons and orthopedists use the term “hip dysplasia” to combine several diseases:

• congenital preluxation - a violation of the formation of the joint without displacement of the femoral head;
• congenital subluxation – partial displacement of the femoral head;
• congenital dislocation is an extreme degree of dysplasia, when the femoral head does not come into contact with the articular surface of the acetabulum of the pelvic bone;
• X-ray immaturity of the hip joint is a borderline condition characterized by delayed development of the bone structures of the joint.

In newborns and children in the first months of life, preluxation is most often observed - a clinically and radiologically determined disorder in the development of the hip joint without displacement of the femoral head. Without proper treatment, as the child grows, it can transform into subluxation and dislocation of the hip.

Due to a violation of the ratio of articular surfaces, cartilage is destroyed, inflammatory and destructive processes occur, which leads to the occurrence of a severe disabling disease - dysplastic coxarthrosis.

Unilateral dysplasia occurs 7 times more often than bilateral, and left-sided - 1.5-2 times more often than right-sided. In girls, disorders of the formation of the hip joints occur 5 times more often than in boys.

There are several theories for the occurrence of hip dysplasia, but the most substantiated are genetic (25-30% have female inheritance) and hormonal (the effect of sex hormones on the ligaments before childbirth).

The hormonal theory is confirmed by the fact that dysplasia is much more common in girls than in boys. During pregnancy, progesterone prepares the birth canal for childbirth by softening the ligaments and cartilage of the woman's pelvis.

Once in the fetal blood, this hormone finds the same application points in girls, causing relaxation of the ligaments that stabilize the hip joint. In most cases, if the process is not interfered with by tight swaddling, restoration of the ligament structure occurs within 2-3 weeks after birth.

It has also been noted that the occurrence of dysplasia is facilitated by limited mobility of the hip joints of the fetus during intrauterine development. In this connection, left-sided dysplasia is more common, since it is the left joint that is usually pressed against the wall of the uterus.

In the last months of pregnancy, the mobility of the hip joint can be significantly limited with the threat of miscarriage, more often in first-time mothers, in the case of breech presentation, oligohydramnios and a large fetus.

Today, the following risk factors for hip dysplasia are identified:

1. presence of hip dysplasia in parents,
2. abnormalities of the uterus,
3. unfavorable course of pregnancy (threat of miscarriage, infectious diseases, taking medications),
4. breech presentation of the fetus,
5. transverse position of the fetus,
6. multiple pregnancy,
7. oligohydramnios,
8. natural birth with breech presentation of the fetus,
9. pathological course of childbirth,
10. first birth,
11. female,
12. large fruit

The presence of these risk factors should be a reason for observation by an orthopedist and preventive measures (wide swaddling, massage and gymnastics).

Causes of dysplasia

There are many reasons for the occurrence of hip dysplasia. The main ones are hereditary predisposition, breech presentation of the fetus during pregnancy, pathology of the 1st trimester of pregnancy, oligohydramnios and many others.

Sometimes, a congenitally normal hip joint may lag behind further development and not correspond to age - then this dysplasia is no longer congenital, but “acquired”. Let us highlight the causes of hip dysplasia:

• Hereditary disorder of its formation;
• Breech presentation, oligohydramnios, increased uterine tone during pregnancy.
• Pathology of pregnancy;
• Prematurity
• Hereditary (family) relaxation of the bursa-ligamentous apparatus;
• Factors that act after childbirth are also important:
• Pathology nervous system newborn (mainly hypertonicity).
• Rickets
• Dysbacteriosis.
• Improper feeding and tight swaddling.
• Gynecological problems in the mother Low weight of the newborn (less than 2500g)

Disorders appear in children as a result of one or more factors. Speaking about disorders of the musculoskeletal system in adulthood, we need to make a reservation: they appeared in infancy. They just didn’t receive proper treatment then.

Symptoms in adult patients are usually similar:

• Limitation of hip extension (or excessive hip extension)
• Clicking (crunching sensation) when hips move apart
• Asymmetry of the femoral folds

However, these signs, determined by eye, do not prove dysplasia 100%, and are so-called probable signs that can also occur normally. Unfortunately, there are asymptomatic cases of dysplasia (there are many of them, about 18%), so only objective methods - ultrasound or X-ray examination - can accurately establish the diagnosis.

There are five classic signs that help you suspect hip dysplasia in babies. Any mother can notice the presence of these symptoms, but only a doctor can interpret them and draw conclusions about the presence or absence of dysplasia.

1. Asymmetry of skin folds. The symptom can be checked by placing the child on his back and straightening the legs brought together as much as possible: symmetrical folds should be visible on the inner surface of the thighs. With unilateral dislocation, the folds on the affected side are located higher. In the prone position, pay attention to the symmetry of the gluteal folds: on the side of the dislocation, the gluteal fold will be located higher. It should be borne in mind that asymmetry of skin folds can also be observed in healthy infants, so this symptom is given significance only in conjunction with others.
2. The symptom of slippage (click, Marx-Ortolani) is almost always detected in the presence of hip dysplasia in newborns. The diagnostic value of this symptom is limited by the age of the baby: it can be detected, as a rule, up to 7-10 days of life, rarely it persists up to 3 months. When the legs are bent at the knee and hip joints, a click is heard (the sound of the femoral head being reduced). When the legs are brought together, the head comes out of the joint with the same sound. The clicking symptom indicates joint instability and is detected already in the initial stages of dysplasia, therefore it is considered the main sign of this pathology in newborns.
3. Limited hip abduction is the second most reliable symptom of dysplasia. When the legs are bent at the knee and hip joints, resistance is felt (normally they are moved apart without effort to a horizontal plane of 85-90º). This symptom is of particular value in the case of unilateral damage. Limitation of abduction indicates pronounced changes in the joint and is not detected in mild dysplasia.
4. Relative shortening of the lower limb is found with unilateral lesions. For a child lying on his back, his legs are bent and his feet are placed on the table. The shortening of the thigh is determined by the different heights of the knees. In newborns, this symptom is detected only with high dislocations with upward displacement of the femoral head and is not detected in the initial stages of dysplasia. It has great diagnostic value after 1 year.
5. External rotation of the hip. As a rule, parents notice this symptom while the baby is sleeping. It is a sign of hip dislocation, and is rarely detected in subluxations.

Diagnostics

None of the above signs are considered decisive for making a diagnosis of “congenital dysplasia of the hip joint”. To clarify it, it is necessary to conduct an ultrasound and x-ray of the hip joints, which make it possible to determine the severity of dysplasia.

Ultrasound can also reveal signs of immaturity of the hip joint. In many countries, to exclude hip dysplasia, ultrasound is performed on all children before discharge from the hospital.

It does not produce an x-ray load, and is possible in a child from the age of one week, while an informative x-ray can be obtained only from the age of three to four months, when ossification points appear, which can be seen on an x-ray. However, X-ray control in case of dislocation is mandatory.

Historically, until the mid-80s, the only objective research method was x-ray examination, which has not lost its importance even now and is indispensable for diagnosing the condition of the joints of children over one year old.

For newborns and children under 1 year of age, the world's gold standard for diagnosis is ultrasound. In countries such as Austria, Germany, Switzerland, ultrasound examination of the hip joints is performed on absolutely all children in the maternity hospital.

There are still many questions: how reliable is ultrasound as a diagnostic method? The answer is clear - the method is absolutely reliable, and discrepancies in the diagnosis arise not because of the shortcomings of the method, but because of errors in its execution, or rather because of the unprofessionalism of the specialist who performs the research.

After all, the resulting image of the joint depends on how correctly the doctor installed the sensor. Incorrect, just a couple of degrees, tilt of the sensor leads to an incorrectly taken image, and accordingly to an incorrect diagnosis. In order to avoid such errors, there is a clearly defined research technique and the necessary “identification points” developed by the founder of the ultrasound diagnostic method of the hip joint, Professor R. Graf from Austria.

In the case when the ultrasound image is correct, and only such an image can be analyzed - ultrasound examination for children under one year of age is a more accurate method than x-rays, because it shows the cartilaginous components of the joint that are not visible on x-rays, and in children the hip joint largely cartilaginous.

The first to examine the child for the presence of dysplasia is a neonatologist in the maternity hospital and, if symptoms indicating a violation of the formation of the hip joint are detected, he refers him for consultation to a pediatric orthopedist. An examination by a pediatric orthopedist or surgeon is recommended at 1, 3, and 6 months of age.

The most difficult thing is to diagnose preluxation. Upon examination, in this case, asymmetry of the folds and a clicking symptom may be detected. Sometimes there are no external symptoms. With subluxations, asymmetry of the folds, a clicking symptom and limitation of hip abduction are detected. In some cases there is slight shortening of the limb.

Dislocation has a more pronounced clinical picture, and even parents can notice the symptoms of the pathology. To confirm the diagnosis, additional examination methods are performed - ultrasound and radiography of the hip joints.

Ultrasound examination of the hip joint is the main method for diagnosing dysplasia up to 3 months. The method is most informative at the age of 4 to 6 weeks. Ultrasound is a safe method of examination and therefore can be prescribed as screening at the slightest suspicion of dysplasia.

Indications for undergoing an ultrasound of the hip joints before 4 months of age are the identification of one or more symptoms of dysplasia (clicking, limited hip abduction, asymmetry of the folds), a family history, and breech birth (even in the absence of clinical manifestations).

X-ray of the hip joints is an accessible and relatively cheap diagnostic method, however, today its use is limited due to the danger of radiation and the inability to image the cartilaginous head of the femur. During the first 3 months of life, when the heads of the femurs consist of cartilage, x-rays are not an accurate enough diagnostic method. From 4 to 6 months of age, when ossification nuclei appear in the femoral head, radiographs become a more reliable way to detect dysplasia.

X-rays are used to assess the condition of the joints in children with a clinical diagnosis of hip dysplasia, to monitor the development of the joint after treatment, and to evaluate its long-term results. You should not refuse to undergo this examination for fear of the harmful effects of x-ray radiation, since undiagnosed dysplasia has much more serious consequences than x-rays.

Degrees of dysplasia

There are 3 degrees of dysplasia: preluxation (occurs in more than 1.6% of newborns), subluxation (0.5%) and hip dislocation (less than 0.01%)

An early clinical symptom of the first degree of dysplasia: preluxation in newborns and infants is the limitation of passive extension of the legs bent at right angles at the hip and knee joints in a child lying on the table.

Because of increased tone in the muscles of the limbs in newborns, complete abduction of the hips is impossible, however, the difference in abduction angles indicates decentration of the head of the femur in the acetabulum, which indirectly indicates underdevelopment of the joint. Other signs are asymmetry of skin folds on the thigh, asymmetry of the gluteal-femoral folds

Subluxation of the hip (second degree of dysplasia) is clinically manifested by the Ortolani-Marx symptom: when the hip is adducted, the head slides off it (dislocates), when the hip is abducted, the head is reduced into the socket (“jumping” of the head of the femur over the edge of the acetabulum), which is felt as “ click" under the examiner's hand.

This is due to underdevelopment of the posterior edge of the acetabulum. Relative shortening and outward rotation of the limb are also a symptom of hip subluxation. Shortening of the lower limb can be detected by examining a child lying on his back, with the legs flexed at the hip and knee joints.

With hip dislocation (third degree of dysplasia), the previously described symptoms are more pronounced. The appearance of late symptoms is associated with the onset of walking: significant limitation of hip abduction, tension of the adductor muscles, greater trochanter above the Roser-Nelaton line. When the hip is abducted in flexion in the hip joint, the depth of the femoral triangle, in which the head of the femur is absent, increases.

For unilateral dysplasia, grade 3. a significant weakening of the function of the gluteal muscles is detected - Trendelenburg's symptom (when leaning on a leg that is in a position of dislocation or subluxation, the buttock of the opposite side drops). Shortening and outward rotation of the limb disrupts the gait, limping with deviation of the torso towards the dislocation, tilt of the pelvis towards the painful side and functional scoliosis as a consequence of dysplasia.

With bilateral dislocation of the hips, the gait is like a duck's, the pelvis tilts forward with the formation of lordosis. When examining a newborn, when not all of these symptoms are detected, it is better to suspect the presence of pre-dislocation of the joint and begin early non-operative treatment than to wait for an early X-ray examination only at 3 months of age.

Treatment of hip dysplasia

Today, the main principles of conservative treatment of hip dysplasia are:

• Giving the limb a position conducive to reduction (flexion and abduction of the hip);
• Maintaining the possibility of active movements;
• Long-term and continuous treatment;
• Application of additional methods - therapeutic exercises, massage, physiotherapy.
• The effectiveness of conservative treatment is assessed using ultrasound and radiography of the hip joints.

The standard treatment regimen for hip dysplasia includes: wide swaddling, massage and exercise therapy for up to three months, Pavlik stirrups (Gnevkovsky apparatus) for up to 6 months, and subsequently, abduction splints in the presence of residual defects. When diagnosing a dislocation after 6 months, sometimes they first resort to adhesive traction, followed by fixation of the joint in an abduction splint.

The duration of treatment and the choice of orthopedic devices depend on the severity of dysplasia (preluxation, subluxation, dislocation) and the age of the patient. When prescribing Pavlik stirrups or other devices, it is important to adhere to the recommendations of the attending physician and observe the regime for wearing them. As a rule, stirrups must be worn constantly during the first two weeks, removing them only for evening swimming.

Exercise therapy for hip dysplasia is used from the first days of life. It strengthens the muscles of the affected joint and promotes the full physical development of the child. Massage begins at the age of 7-10 days, it prevents muscle dystrophy and improves blood supply to the affected joint, thus helping to speed up recovery.

Physiotherapeutic treatment includes electrophoresis with calcium chloride, cocarboxylase and vitamin C, paraffin applications on the hip joints, ultraviolet irradiation and vitamin D preparations. It should be borne in mind that massage, exercise therapy and physiotherapeutic procedures at each stage of treatment have their own characteristics. Therefore, they should only be used under the supervision of a physician.

Surgical treatment is used after the child reaches the age of 1 year. Indications for surgery are true congenital dislocation of the hip in the absence of the possibility of conservative reduction, repeated dislocation after closed reduction and late diagnosis (after 2 years).

A child with a congenital dislocation of the hip should be monitored by an orthopedist until the age of 16. It is important to understand that hip dysplasia in infancy can be corrected in a few months, but if it is not cured in time, correction of disorders in older age will take much more time and effort.

To prevent the serious consequences of dysplasia, you just need to follow your doctor’s recommendations. The result of untreated dysplasia primarily depends on the degree of underdevelopment of the joint (how sloping the roof of the hip joint is, how underdeveloped the femoral head is), as well as on accompanying conditions that inhibit further development (hypertonicity, dysbiosis, rickets, etc.).

If hip dysplasia is minimally expressed, and there are no aggravating factors, in 50% it can be eliminated spontaneously. Think! 50% is every second child, because it is unknown which of them will be yours.

With severe dysplasia of the hip joints, subluxation and dislocation of the hips, spontaneous normalization does not occur. With untreated dysplasia, if its complications do not occur and, due to the sloping roof of the hip joint, subluxation or dislocation of the hip does not occur, your child will complain of rapid fatigue, pain in the legs at the end of the day and after physical activity, and a gentle lameness will appear.

In case of dislocation of the hips, which can be complicated by untreated hip dysplasia, in addition to the above complaints, a diving-type lameness, the so-called “duck gait,” will be striking.

Sometimes parents hope that the dysplasia will be “corrected” by the chiropractor, but this cannot happen. The grandmother, if she really has some skills, can correct a traumatic dislocation, but then she will still need a plaster cast, and in the case of congenital dysplasia (underdevelopment) of the joint, no manipulations by her can lead to immediate development of the joint.

Massage is useful for the treatment of hip dysplasia; it accelerates development, but it must be used in conjunction with other measures prescribed by the orthopedist. One should not take for granted the statements of a massage therapist like “I cured 150 children with dysplasia without using stirrups”: either these were cases when dysplasia simply did not exist, or it was so minimal that it could go away spontaneously, without any treatment at all, including massage.

The timing of treatment for dysplasia is individual and depends on the degree of joint underdevelopment. With moderate underdevelopment, the period from the start of treatment to complete recovery is about 3 months.

Hip dysplasia in children

Disorders of the musculoskeletal system in this form are considered the most common among infants. For every 1000 children there are 2-3 cases with this diagnosis. What’s interesting is that it occurs 5 times more often in girls than in boys. The group of hip dysplasia in young children includes diseases such as:

1. congenital preluxation (minimal severity of the dysplastic process - changes affect only the roof of the acetabulum);
2. congenital subluxation (the head of the femur is partially in the socket, partially outside it);
3. congenital dislocation (the most severe form of hip dysplasia, in which, in addition to irregular shape elements of the joint there is a complete disconnection of the articular surfaces, the femoral head leaves the articular cavity and moves to the side and upward);
4. immature hip joint (can be detected by ultrasound).

The causes of dysplasia in an infant may be:

• diseases of the mother in the first trimester of pregnancy (the joint is formed from 4 to 12 weeks of pregnancy),
• endocrine factors,
• taking medications,
• influence of environmental factors,
• hereditary predisposition,
• breech presentation and female gender of the baby

Most often, hip dysplasia is diagnosed in the first days after the birth of a child. However, this depends on the clinical picture, the severity of dysplasia, the maturity of the child and the presence of symptoms of damage to the nervous system. It is very important to begin treatment of the child immediately after dysplasia is detected, observing the principle of continuity of treatment.

Even in the maternity hospital, wide swaddling is prescribed - to form a normal joint, a constant position with spread, bent legs (“frog pose”) is recommended. In this case, under the pressure of the femoral head, the acetabulum gradually forms. Daily physical therapy is also recommended.

1. Bicycle (alternately bending and straightening the legs).
2. Rotational movements in the hip joint, the leg is bent at the knee joint (some authors recommend only inward rotation).
3. Leg abduction and adduction.
4. The exercises are repeated either with each diaper change (each exercise 10-15 times), or 2-3 times a day (each exercise 25-30 times).
5. Physical therapy for hip dysplasia should be carried out on a hard, flat surface, and not on a bed. If structures for spreading the legs are used, you need to check with your doctor how and when to carry out the exercises.
6. In addition, a child suffering from hip dysplasia receives a daily massage of the back, buttocks, hips and lumbar region (stroking, rubbing, light kneading of the muscles).
7. In more severe cases, special splints are used to hold the child’s hips in abduction position, which promotes proper development of the hip joint. Attention! With hip dysplasia, the child should be in the hip abduction position around the clock. Therefore, designs are used that do not interfere with the movements of the limbs, so as not to disrupt blood circulation and the normal development of delicate articular surfaces and muscles.

In the presence of a dislocation (severe form of hip dysplasia), reduction and fixation are performed, for which Pavlik stirrups or similar structures are used. If reduction does not occur, then treatment in Pavlik's stirrups is stopped and alternative treatment is started. Usually this is a closed, one-stage reduction under anesthesia, followed by fixation with a plaster cast.

If reduction is achieved, then flexion is reduced to 90 0 and treatment is continued in stirrups for 5-6 months. The duration of treatment for congenital dislocation of the hip, which accompanies hip dysplasia, is individual (from 2 to 10 months), and depends on the severity of the pathology and on how parents follow the doctor’s recommendations.

The prognosis for treating children in the first 3 months of life is favorable. Treatment of children after 3 months presents significant difficulties and requires the use of combined techniques. At the beginning of treatment, a splint-spacer is applied to relax the muscles for 2-4 weeks, then a lightweight plaster cast is applied in the position of flexion in the knee and hip joints.

After treatment, a control x-ray is prescribed; if treatment is successful, the fixing structures are removed. It is necessary to avoid vertical loads - until the orthopedist gives permission, the child should not be placed on his legs and allowed to walk. The child is also prescribed physical therapy, 2-3 courses of massage (once a day, 10-15 sessions every 1-2 months), swimming, and physiotherapy.

Calcium supplements are prescribed and a dose of vitamin D is selected. To treat dysplasia in young children, doctors have developed specialized abduction splints that help keep the baby’s legs in an extended position. This is done to allow the roof of the joint to form.

For newborn babies up to 3 months of life, the same treatment methods are used:

• regular execution of abductor-circular movements in the joints,
• spreading the legs using a Freik pillow or Pavlik stirrups,
• massage aimed at maintaining and strengthening the gluteal muscles.

If it is not possible to achieve results using conservative methods, surgical treatment is prescribed. After the operation, long-term fixation of the legs is also carried out.

Prevention of dysplasia

Hip dysplasia is not “ birth defect", because all the anatomical elements of the joint are present in the child. During pregnancy, the mother's body produces hormones that help the ligaments stretch better during childbirth. Certain fetal positions can also cause hip sprains.

Fortunately, most unstable hip joints in infants are stabilized naturally and the joints develop normally. Tight swaddling, genetic predisposition and other factors can disrupt the natural recovery process.

Prevention and early diagnosis are key to the effectiveness of simple techniques to prevent dislocation or malformation of the joint. How to diagnose hip dysplasia? The diagnosis of hip dysplasia and hip dislocation can be made during a routine examination of the child.

A hip ultrasound may be recommended for a child who has risk factors or if the doctor has any suspicions about hip dysplasia. Ultrasound examination is a harmless and painless method, and allows the doctor to obtain a reliable picture of the hip joint.

The American Academy of Pediatrics recommends an ultrasound examination at six weeks of age for all female newborns who are breech or breech. In children with other risk factors, it is also advisable to have an ultrasound scan, especially if the doctor suspects hip dysplasia.

X-rays are recommended if necessary at four months of age and older. What can you do to protect your child's joints? Improper swaddling of babies can cause serious problems in the hip joint. It is important that the hips can move freely and are not tightly fixed in an extended position and pressed against each other.

Allow your baby to keep his hips flexed, in the position they were when the baby was born, and leave room for his legs to move freely. About 40 years ago, before the advent of modern medical technology, some doctors recommended the use of large diapers, or so-called “abductor pants” to protect the baby’s joints in the first few months of life, when they form very quickly.

When healthy babies are born, their hips are flexed and do not straighten to the adult position. If you leave your hips in a flexed position during this time, the mother's hormones have time to leave the baby's body, and the ligaments of the hip joint have time to become stronger. The child will still have plenty of time for the hip joint to get into the desired position before the child begins to walk.

This simple and physiological method has been used in Serbia, Japan and other countries around the world to help prevent hip dysplasia. In countries where it is traditional to carry children in the “ridden” position, strapped to the mother’s back, the incidence of hip dysplasia is very low. On the contrary, in those countries where it is customary to tightly swaddle the legs, tying them to a crib or board in an extended position, the incidence of hip dysplasia is high.

Which children are at high risk for hip dysplasia? The risk group for hip dysplasia includes children who have had:

• Hip dysplasia in relatives
• Breech presentation
• Congenital torticollis or congenital foot deformities
• Birth weight more than 4 kilograms
• Mother's age is more than 35 years
• Clicking in the joint

You can help your baby have healthy joints by identifying risk factors early, following your doctor's orders, and protecting your baby's joints by avoiding swaddling his feet too tightly in the first few months of life.

Sources: zdravoe.com, orthoped.in.ua, deti.health-ua.org, tvoymalysh.com.ua, yod.ua/articles, spine5.com, lib.komarovskiy.net

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Okay then! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried it? traditional methods joint treatment? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Ekaterina A week ago

I tried drinking a decoction from bay leaf, no use, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and back, and the state fully finances the treatment for each patient

Hip dysplasia is a congenital defect of the joint that can lead to joint damage. Dysplasia in newborns is the direct cause of congenital hip dislocation. This pathology, in turn, can lead to changes in gait, chronic pain syndrome and significantly limit mobility in the future.

The newborn itself (a newborn is a child in the first 28 days of life) is not bothered by dysplasia; Parents and doctors identify the disease by external symptoms, and not based on the baby’s crying or restlessness. If the pathology is not treated on time, it leads to deformation of the musculoskeletal system, disruption of the formation of the musculoskeletal system and disability. The disease can affect one leg (usually) or both. Boys suffer from hip dysplasia 7 times less often than girls.

What is it?

Today, hip dysplasia is considered the most common pathology of the musculoskeletal system in newborns and infants. “Dysplasia” translated means “improper growth,” in this case of one or both hip joints.

The development of the disease is associated with disruption of the formation of the main joint structures in the prenatal period:

• ligamentous apparatus;
• bone structures and cartilage;
• muscles;
• change in the innervation of the joint.

Most often, hip dysplasia in newborns and the treatment of this pathology is associated with a change in the location of the femoral head in relation to the bony pelvic ring. Therefore, in medicine this disease is called congenital hip dislocation.

Treatment must begin from the moment the pathology is diagnosed, the earlier the better, and before the baby begins to walk - from this moment irreversible complications appear. They are associated with an increasing load on the joint and the exit of the bone head completely from the acetabulum with an upward or sideways displacement.

The child develops changes when walking: a “duck” gait, significant shortening of the limb, compensatory curvature of the spine. These disorders can only be corrected through surgery. With pronounced changes in the joint, the baby may remain disabled for life.

Statistics

Hip dysplasia is common in all countries (2 - 3%), but there are racial and ethnic characteristics of its distribution. For example, the incidence of congenital underdevelopment of the hip joints in newborn children in Scandinavian countries reaches 4%, in Germany - 2%, in the USA it is higher among the white population than African Americans, and is 1 - 2%, among American Indians, hip dislocation occurs in 25- 50 per 1000, while congenital hip dislocation almost never occurs among South American Indians, southern Chinese and Africans.

A connection between morbidity and environmental problems has been noted. The incidence in the Russian Federation is approximately 2 - 3%, and in environmentally unfavorable regions up to 12%. Statistics on dysplasia are contradictory. Thus, in Ukraine (2004), congenital dysplasia, subluxation and dislocation of the hip occur from 50 to 200 cases per 1000 (5 - 20%) newborns, that is, significantly (5-10 times) higher than in the same territory during the Soviet period.

A direct connection has been noted between the increased incidence and the tradition of tightly swaddling the baby's straightened legs. Among peoples living in the tropics, newborns are not swaddled, their freedom of movement is not limited, they are carried on their backs (while the child’s legs are in a state of flexion and abduction), the incidence is lower. For example, in Japan, as part of a national project in 1975, the national tradition of tightly swaddling the straightened legs of infants was changed. The training program was aimed at grandmothers to prevent traditional swaddling of babies. As a result, there was a decrease in congenital hip dislocation from 1.1-3.5 to 0.2%.

This pathology occurs more often in girls (80% of identified cases); family cases of the disease make up about a third. Hip dysplasia is 10 times more common in children whose parents had signs of congenital hip dislocation. Congenital dislocation of the hip is detected 10 times more often in those born with a breech presentation of the fetus, more often during the first birth. Dysplasia is often detected during drug correction of pregnancy, or during pregnancy complicated by toxicosis. Most often the left hip joint is affected (60%), less often the right (20%) or both (20%).

Until the first half of the last century, only the severe form of dysplasia, congenital hip dislocation (3-4 cases per 1000 births) was taken into account. In those years, “mild forms” of dysplasia were not detected or treated. From the 70s - 90s. The term “hip dysplasia” is used, meaning not only dislocation, but also preluxation and subluxation of the hip joint. The incidence numbers have increased tenfold.

It should be noted that the lack of clear standards and the fear of missing severe orthopedic pathology is the reason for overdiagnosis (20-30% at the pre-dislocation stage). The dilemma of “immature hip joint and preluxation” is usually resolved in favor of dysplasia, which increases morbidity figures.

Causes of dysplasia

Underdevelopment and improper formation of the hip joint occur when the intrauterine development of the child is disrupted due to disturbances in the formation, development and differentiation of the baby’s musculoskeletal system (from 4-5 weeks of intrauterine development until the formation of full walking).

Reasons that negatively affect the fetus and disrupt organogenesis:

• gene mutations, resulting in the development of orthopedic deviations with disturbances of the primary anlage and the formation of defects in the hip joints of the embryo;
• exposure to negative physical and chemical agents directly on the fetus ( ionizing radiation, pesticides, drug use);
• a large fetus or breech presentation, causing displacement in the joints due to a violation of the anatomical norms of the location of the child in the uterus;
• disturbance of water-salt metabolism in the fetus due to kidney pathology and intrauterine infections.

Factors that negatively affect the development of the fetus and cause the formation of dysplasia on the mother’s side are:

• severe somatic diseases during pregnancy - cardiac dysfunction and vascular pathology, severe kidney and liver diseases, heart defects;
• vitamin deficiency, anemia;
• violation of metabolic processes;
• suffered severe infectious and viral diseases during pregnancy;
• unhealthy lifestyle, unhealthy diet and bad habits (smoking, drug addiction, drinking alcohol);
• early or late toxicosis.

In the risk group for the development of this pathology, contributing to the early diagnosis of dysplasia in infants. At the same time, even in the maternity hospital, the neonatologist and pediatrician at the site observe the baby more actively.

This group primarily includes premature babies, large children, with a breech presentation of the fetus, a pathological pregnancy and with a family history. It should be noted that this pathology occurs more often in girls than in boys.

Also, in addition to true dysplasia, infants (impaired development of the joint) may exhibit immaturity of the joint (slow development), which is considered a borderline state for the development of dislocation of the hip joint.

Symptoms of dysplasia

When examining a baby, pay attention to following signs(see photo):

• position and size of the lower extremities;
• position of skin folds in the thigh area (symmetrical or asymmetrical);
• muscle tone;
• volume of active and passive movements.

Hip dysplasia in infants manifests itself with characteristic symptoms.

1. Limitation of hip abduction. Childhood hip dysplasia is manifested by limited abduction to 80 degrees or less. The symptom is most typical for unilateral lesions.
2. Slipping symptom (synonym: clicking symptom). The child is placed on his back, bending his legs at both the knee and hip joints at an angle of 90 degrees (the examiner's thumbs are placed on the inner surface of the thighs, the remaining fingers are on the outer surface). When the hips are abducted, pressure is applied to the greater trochanter, resulting in the reduction of the femoral head. The process is accompanied by a characteristic click.
3. External rotation of the lower limb is a sign characterized by outward rotation of the hip on the affected side. It can also occur in healthy children.
4. Relative shortening of the limb. The symptom is rare in newborns and is observed with high dislocations.
5. The asymmetrical position of the femoral and gluteal folds is revealed during an external examination.

Secondary (auxiliary) signs of hip dysplasia in a newborn:

• atrophy of soft tissues (muscles) on the affected side;
• pulsation of the femoral artery is reduced on the side of the dysplastic joint.

Asymptomatic cases of congenital hip dislocation are rare.

Severity of traffic accidents

1. I degree – pre-dislocation. A developmental deviation in which the muscles and ligaments are not changed, the head is located inside the beveled cavity of the joint.
2. II degree – subluxation. Only part of the femoral head is located inside the articulation cavity, as it moves upward. The ligaments are stretched and lose tension.
3. III degree – dislocation. The head of the femur comes completely out of the socket and is located higher. The ligaments are tense and stretched, and the cartilaginous rim fits inside the joint.

Diagnostics

In a baby, signs of hip dysplasia in the form of dislocation can be diagnosed as early as maternity hospital. The neonatologist should carefully examine the child for the presence of such abnormalities in certain pregnancy complications.

The risk group includes children who belong to the category of large children, children with deformed feet and those with heredity burdened by this characteristic. In addition, attention is paid to toxicosis of pregnancy in the mother and the gender of the child. Newborn girls are subject to mandatory examination.

Examination methods:

1. Ultrasound diagnostics is effective method identifying abnormalities in the structure of joints in children in the first three months of life. Ultrasound can be performed multiple times and is acceptable when examining newborns. The specialist pays attention to the condition of the cartilage, bones, joints, and calculates the angle of the hip joint.
2. Arthroscopy and arthrography are performed in severe, advanced cases of dysplasia. These invasive techniques require general anesthesia to obtain detailed information about the joint.
3. CT and MRI provide a complete picture of pathological changes in the joints in various projections. The need for such an examination appears when planning surgical intervention.
4. The X-ray image is not inferior in reliability to ultrasound diagnostics, but has a number of significant limitations. The hip joint in children under seven months of age is poorly visible due to the low level of ossification of these tissues. Radiation is not recommended for children in their first year of life. In addition, placing an active baby under the device while maintaining symmetry is problematic.
5. External examination and palpation are carried out to identify characteristic symptoms of the disease. In infants, hip dysplasia has signs of both dislocation and subluxation, which are difficult to identify clinically. Any symptoms of abnormalities require a more detailed instrumental examination.

Consequences

If there is no treatment, then early age this can put the child in serious trouble. Children develop a limp when walking; it can be either subtle or pronounced. Also, the baby will not be able to move his leg to the side, or will do it with great difficulty. The child will be bothered by constant pain in the knees and pelvis with possible bone distortion. Depending on the severity of the symptoms of dysplasia, children experience muscle atrophy of varying severity.

Gradually, as the child grows, the consequences of untreated dysplasia will worsen and be expressed in the development of the so-called “duck walk,” when the baby rolls from one leg to the other, with the pelvis protruding backward. Motor activity such a child will be limited, which will entail underdevelopment not only of other joints, but will also affect the functioning of all organs and overall physical development. In the future, the leg muscles can completely atrophy, and the person will begin to be haunted by constant, incessant pain. In adult patients, hyperlordosis of the spine in the lumbar region is observed. All organs located in the pelvic area are also affected.

All this can be avoided if you start treatment on time and follow preventive measures.

Treatment of hip dysplasia in newborns

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

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

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

1. Without adequate treatment, hip dysplasia in adolescents and adults leads to early disability, and the result of therapy directly depends on the timing of the start of treatment. Therefore, primary diagnosis is carried out in the maternity hospital in the first days of the baby’s life.
2. Today, scientists and clinicians have come to the conclusion that it is inadmissible to use rigid fixing orthopedic structures that limit movement in 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 ultrasound and x-ray control.

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

Wide swaddling technique:

• the child is placed 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 with the third one.

Loose swaddling allows you to keep the baby's legs apart at approximately 60 - 80°.

Massage and exercise therapy

Exercises and massage are performed before feeding: these procedures stimulate blood circulation and improve nutrition of the structures of the hip joint. As a result, the growth processes of cartilage and bone tissue are stimulated, nerve conduction is enhanced - and the joint is formed correctly.

Massage movements are performed smoothly and gently. Apply stroking, rubbing and kneading the muscles of the thighs, buttocks, and lower back. The newborn is laid out on both his back and stomach. The duration of the massage is about 5 minutes. After the procedure, you can leave him to lie on his stomach for a while so that his legs hang down to the sides. This hardens and further strengthens the body.

A set of exercises is selected by a physical therapy doctor or pediatrician according to the degree of development of the disease. Most often this is: abduction of bent legs to the sides (contraindicated in slip syndrome), flexion and extension in the hip and knee joints. The movements are performed very smoothly. At first, they are recommended to be done in water, while swimming. The duration of the gymnastics is also about 5 minutes.

To work with a newborn at home, parents need to attend massage and exercise therapy courses at the clinic.

Wearing various orthopedic devices

Freik's pillow, Pavlik's stirrups and others. All this also helps to keep the baby's legs spread and bent. It is this method of treating hip dysplasia in infants that seems blasphemous to many parents, since they have to constantly see their baby “shackled” in orthopedic spacers.

It is worth remembering that this measure is necessary, but temporary, and should be treated with patience and understanding. The child's initial discomfort goes away within about a week, then he gets used to it and no longer feels any discomfort from wearing the splint. The duration of use of such devices is determined by the doctor based on periodic examinations and ultrasound diagnostics.

Physiotherapy

Many physiotherapeutic procedures are used that eliminate the inflammatory reaction, improve joint trophism and reduce joint pain. The most commonly used procedures are:

Features of caring for newborns with dysplasia

With the right approach to treatment and care, dysplasia in newborns can be overcome. If your baby has disorders in the development of the hip joints, then he needs daily care and constant observance of special rules when carrying, feeding, and putting to bed.

1. Hip dysplasia in newborns eliminates vertical loads on the legs.
2. If the child is in a lying position, then his feet should hang slightly, this way better relieves tension from the thigh muscles.
3. Transportation by car in a special child seat that does not interfere with the wide spread of the legs.
4. The correct position when carrying in your arms: hold the baby in front of you by the back, while his legs should tightly grasp you from behind.
5. Make sure that when feeding and sitting down, the hips are separated as far as possible.

The hip joint is an important supporting element of the human skeleton. He is constantly exposed to heavy loads when carrying heavy loads, running, and long walks. It is necessary to monitor the correct full development of this joint from infancy, otherwise in adult life the disease will still make itself felt, but it will be much more difficult to cure than dysplasia in newborns.

Reduction of congenital hip dislocation

Indications for reduction of congenital hip dislocation:

1. The child is over 1 year old. Before this, the dislocation is relatively easily reduced using functional techniques (splints and orthoses, see above). But there is no single unambiguous algorithm. Sometimes a dislocation after 3 months of age cannot be corrected by any means other than surgery.
2. The child's age is no more than 5 years. At an older age, it is usually necessary to resort to surgery.
3. The presence of a mature hip dislocation, which is determined by radiography and/or ultrasound.

Contraindications to closed reduction of congenital hip dislocation:

1. Severe underdevelopment of the acetabulum;
2. Strong displacement of the head of the femur, inversion of the articular capsule into the joint cavity.

Closed reduction for congenital hip dislocation is performed under anesthesia. The doctor, guided by X-ray and ultrasound data, performs a reduction - returning the femoral head to the correct position. Then a coxitis is applied for 6 months (on the pelvis and lower limbs) a plaster cast that fixes the child’s legs in an extended position. After removing the bandage, massage, therapeutic exercises, and physiotherapy are performed.

However, some children develop a relapse after closed reduction of congenital hip dislocation. How older child, the more likely it is that you will eventually have to resort to surgery.

Prevention of pathology

If you do not want dysplasia to appear in your baby, you must take certain precautions:

1. Taking vitamins, proper nutrition, light physical activity during pregnancy.
2. Constantly following your doctor's recommendations during pregnancy. In this case, an important element of the examination is ultrasound, which can show health problems at an early stage of fetal development.
3. Postpartum examination by an orthopedist, as well as an ultrasound of the hip joint.
4. It is necessary to eliminate the causes that can lead to the appearance of pathology and provoke dislocation.
5. The use of therapeutic exercises and regular physical activity, which will help place and fix the bone in place.
6. Carrying a baby in a sling, as well as using wide swaddling.
7. If the diagnosis of “dysplasia” is nevertheless made, then the baby cannot be put on his feet until the doctor allows it.

Modern methods of diagnosing and treating hip dysplasia are still far from perfect. In outpatient settings (clinics), cases of underdiagnosis (the diagnosis is not made in time for existing pathology) and overdiagnosis (the diagnosis is made in healthy children) are still common.

Many orthopedic structures 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 conducted.

Hip dysplasia is a congenital disorder of the development of all elements that make up its composition, which can lead to hip dislocation and disability. The disease appears in the prenatal or postnatal periods under the influence of unfavorable factors. The principle of treatment is long-term (several months) fixation of the hip joint in the optimal position. The earlier this disease is detected in a child, the more successful the treatment will be and the shorter the recovery period. In severe and advanced cases, surgery is performed.

Description

Hip dysplasia is a congenital pathology in which there is an incorrect orientation of the elements of the joints and a decrease in the area of ​​their contact with each other. Anatomically, this manifests itself in underdeveloped supporting areas of the femoral head and acetabulum. Orthopedists make this diagnosis in more than 10% of newborns. Babies with congenital hip dislocation account for 0.4% of the total, and with subluxation – 4%. Left-sided lesions are more common than right-sided ones, and bilateral dysplasia is observed in a quarter of cases.

The formation of the joint begins in the 9th to 15th weeks of pregnancy. The influence of external or internal unfavorable factors leads to joint dysfunction (dysplasia) and the appearance of congenital pathology.

Risk factors for this disease in children are:

• breech presentation, which promotes hip dislocation, tight intrauterine position and oligohydramnios;
• female (estrogens help relax ligaments - girls get sick 5 times more often than boys);
• mother's first pregnancy;
• hereditary predisposition (noted in the family history in 13% of cases);
• hormonal disorders in a pregnant mother;
• race (pathology is most common in Europe, and least common in Asian countries);
• tight swaddling with straightened legs.

In an adult healthy person The head of the femur fits completely into the acetabulum, forming a ball-and-socket joint. In a newborn baby, even in the absence of pathology, the head is only half in the socket, since during the prenatal period it is formed larger in size than the socket. The baby's cartilage plate and ligaments protect the head from displacement and excessive movements. By the age of one year, with normal development, 80% of the head already enters the socket, the capsule and surrounding muscles become denser, and the hip joint becomes ready to absorb loads when walking.

Sometimes at birth, anatomical disorders of the articular joint are slightly expressed; a more pronounced manifestation occurs gradually, after several years. In other cases, newborns develop a dislocation in utero due to defects in the formation of the joint.

Dysplastic syndrome in children is often accompanied by other disorders of the musculoskeletal system, such as:

• flatvalgus feet;
• chest deformation;
• (“X-shaped” limbs);
• weak ligaments and excessive joint mobility;
• scoliosis.

There is a relationship with pathologies in other systems and organs:

• myopia of varying degrees;
• irregularities in the shape of the lens (or its subluxation), cornea or eye;
• tendency to form scars on the skin;
• congenital heart defects.

The development of dysplasia leads to changes of varying degrees in the hip joint. Before walking and in the absence of treatment, the femoral head moves upward, forming an acetabular dislocation. Due to constant friction When the head hits the cartilaginous disc, it becomes deformed, and bumps, grooves, and foci of necrosis appear on the surface of the disc, which subsequently lead to arthritis. As the child begins to walk, the hip displacement increases. Its limiting position is one in which the support of the head becomes gluteal muscles(iliac dislocation). The outcome of dysplasia depends on the timeliness of diagnosis and treatment of the infant.

Symptoms and diagnosis

In children under one year old, several symptoms of dysplasia are noted:

• Incomplete abduction in the hip joints. To determine this sign, the child is placed on his back, his legs are bent at the knees and hip joints, and spread apart. In newborn babies 1-3 months old proper development the hips should be in contact with the surface of the couch (in older children, the abduction angle is normally at least 60 degrees). If a child has a congenital dislocation, then the head of the femur rests on the ilium, and there is no complete abduction. Restriction of hip extension is also observed in neurological disorders (increased muscle tone, spastic paralysis), therefore, in addition to consulting an orthopedist, you need to be examined by a pediatric neurologist.
• When spreading the legs using the above method, a click is felt (but not heard) in the joint, which occurs due to the fact that the head jumps over the rear edge of the cavity. When moving back, the head is set and the click occurs again. This symptom is typical for children aged 2-3 weeks after birth; muscle resistance subsequently increases.
• Unilateral dislocation is determined by abducting the legs, bent at the hip joint at a right angle. On the affected side, the femoral axis is visualized higher than on the healthy leg. Also, on a dislocated leg, tissue retraction is observed in the area of ​​the femoral triangle.
• Varying depth and asymmetry of the inguinal and gluteal folds on the legs indicates a unilateral dislocation of the hip in a child and is detected in half of the patients. With bilateral joint damage, this symptom is not indicative.
• Shortening of one of the limbs (manifests itself with a low dislocation of the hip). This sign can be determined by the different level of the kneecaps when the legs are bent at the knees (the child’s position is lying on his back).
• When crossing a child's legs while lying on his back, their intersection occurs in the upper part of the thigh (normally in the middle or lower part).

Symptoms of dysplasia in newborns

Often in newborn children, these symptoms are not clearly expressed, therefore, as a mandatory routine examination, all infants at the age of 1 month undergo an ultrasound examination of the pelvic joints, which allows an accurate diagnosis of dysplasia or to exclude it. Ultrasound is also used for dynamic monitoring during the treatment of a child. Ultrasound examination visualizes the structure of the hip joint, it is possible to determine the nature of the development of bone and cartilage tissue of the acetabulum, the degree of centering of the femoral head and socket.

In children over 1 year old, the following signs are observed with dysplasia:

• later onset of walking (at 15-16 months);
• lameness;
• pronounced curvature of the spinal column;
• when standing on the affected leg, the other half of the child’s pelvis is lowered;
• “duck” gait with bilateral dysplasia.

For children over 3 months of age, an X-ray examination is used to obtain information about changes in bone structures. In more younger age the joint consists mainly of cartilage, which cannot be visualized using x-rays. To assess cartilage and soft tissues, arthrography of the hip joint is indicated (x-ray examination with preliminary administration of a contrast agent). This diagnostic method is used to predict conservative treatment options and justify surgical intervention.

In complex and unusual cases, after repeated and unsuccessful surgical treatment, for more precise study To determine the geometry of the joint, the doctor prescribes a computer or magnetic resonance imaging scan. In specialized clinics, older children undergo arthroscopy - an examination of the hip joint using an endoscope, which is inserted into it through a small incision.

Treatment

The success of therapy and its duration depend on how early the diagnosis was made. If dysplasia is detected in a child under the age of 3 months, then treatment lasts relatively short time (2-3 months at the initial stage of the disease, 3-4 months in the presence of pre-dislocation, 6-8 months in case of dislocation), and noticeable results are achieved in 97% of cases. After six months of age, these figures drop to 19 months. and 30% respectively. For dysplasia in newborns, conservative and surgical treatment is used.

Freyka's pillow

The main therapeutic measure for dysplasia is to fix the baby’s legs in a spread position, with the hip joints bent to 90 degrees, using various measures:

• wide swaddling, which must be used already in the maternity hospital and up to 3 months of the child’s life (not only as a treatment, but also for prevention purposes);
• outlet tires, gaskets;
• Freik type;
• special stirrups (Pavlik stirrups, used up to 6 months);
• plaster casts for children over 6 months;
• holding the child in your arms with legs apart (one hand on the baby’s back, and the other under the buttocks, the child should press his stomach against the mother).

Wide swaddling

If the child already has a preluxation or dislocation (displacement of the femoral head relative to the acetabulum), then only stirrups with a retractor pad are used, since other devices do not allow the head to be realigned. Orthopedic devices must be worn at all times, even while swimming. The most convenient in this regard are stirrups. They leave the baby's crotch open, which makes caring for him easier. If you remove them several times during the day, the result will be negative, since the head will make excessive movements and stretch the joint capsule. The use of gymnastics and massage as treatment measures in the absence of fixation of the joint is not allowed, as they aggravate the course of the disease.

Stirrups

Plaster fixing bandages are prescribed in the following cases:

• with late detection of dislocation in children 6 months - 1.5 years;
• in the presence of congenital dislocation and failure of previous treatment;
• in children 1.5 -2.5 years old with congenital dislocation that does not require extra-articular surgery.

If the head does not adjust within 2 months of wearing a plaster cast, then surgical correction methods are resorted to. After a period of fixation in the stirrups, the child can walk no earlier than 2-4 months, if an X-ray examination has shown that the parameters of joint development correspond to age. So that the load on the joint increases gradually over the first 2-3 months. the baby must walk with abductor splints (Vilensky, CITO, John-Korn). When wearing them, a side effect may occur - X-shaped deformation of the child's legs. To avoid this, it is recommended to attach the splint to the lower third of the thigh and use orthopedic shoes with shin support and arch support.

Outlet bus

It is necessary to carry out rehabilitation procedures aimed at strengthening muscles and improving blood supply:

• stimulating massage;
• physical therapy that can be done at home;
• electrical stimulation;
• gymnastics in water, with alternating tension and relaxation of the leg muscles (hydrokinesitherapy), which is quite effective in children under 1 year of age;
• salt baths.

Orthopedic devices lead to limitations physical development child, but the lack of timely treatment will lead to more serious consequences in the future (complete hip dislocation, coxarthrosis), which can no longer be eliminated by conservative methods. They require surgery. Congenital dislocations are also difficult to treat conservatively. After all the necessary measures and rehabilitation have been carried out, the child should be under the supervision of an orthopedist until the end of his growth at 15-17 years, since in such children the development of the joint is slowed down, and repeated hip subluxations often form.

Dysplasia in adults

Hip dysplasia in more than 70% of cases is the cause of the development of coxarthrosis in adults - destruction of the hip joint, which damages the cartilage and deforms the bones. Many patients under the age of 50 have to undergo surgery for total joint replacement (prosthetics), since conservative therapy for this disease is not effective, and joint reconstruction helps only in the early stages of the disease.

Prosthetics for complete hip dislocation may require repeated surgical intervention (up to 30% of cases), since in adults, in the absence of adequate treatment in childhood, this pathology is accompanied by significant anatomical disorders:

• smaller pelvic size on the affected side;
• thinning of bones;
• reduction of the acetabulum, which is filled with fatty and fibrous tissue;
• the head of the femur is smaller than it should be normally and is displaced upward and backward;
• the abductor muscles are atrophied and practically do not contract.

As a result of anatomical changes, a difference in leg length is formed, leading to the development of scoliosis. Deformed knee joint, and the head of the hip joint displaced back provokes a constant forward tilt of the torso (hyperlordosis of the spine). Coxarthrosis is characterized by a progressive course of the disease, which ultimately leads to disability. Women of young, working age are most susceptible to this disease. The higher and longer the mechanical load on the joint, the faster its destruction occurs.