Hip dysplasia and congenital hip dislocation

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


The word dysplasia literally means immaturity, underdevelopment of the hip joint. Dysplasia can be "mild" and "severe", which is why the treatment tactics differ significantly. The treatment of dysplasia also differs depending on the age of the patient.

What causes hip dysplasia?

There are many reasons for the occurrence of hip dysplasia. The main ones are hereditary predisposition, pelvic presentation of the fetus during pregnancy, pathology of the 1st trimester of pregnancy, lack of water and many others. Sometimes the innately normal hip joint may lag behind in further development and not correspond to age – then this dysplasia is no longer congenital, but "acquired".

Symptoms of hip dysplasia:

restriction of hip dilution (or excessive hip dilution);
click (crunch sensation) when spreading the thighs;
asymmetry of the femoral folds. 

However, these signs, which are determined "by eye", do not prove dysplasia by 100% and are so-called probable signs that can occur in the norm.
Absolute proof of the norm or pathology can only serve as objective methods of research - X-ray examination and ultrasound diagnostics.

Diagnosis of hip dysplasia

Historically, until the mid-80s, the only objective method of research was X-ray examination, which has not lost its significance 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, ultrasound is the world's gold standard for diagnosis. In countries such as Austria, Germany, Switzerland, ultrasound examination of the hip joints is performed for absolutely all children in the hospital.
In Ukraine, ultrasound examination of the hip joints of newborns has been carried out for more than 20 years, but there are still many questions about how reliable this method of diagnosis is. The answer is unambiguous – 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 study. After all, the resulting image of the joint depends on how correctly the doctor installed the sensor. The wrong angle of the sensor by just a couple of degrees leads to an incorrectly made image, and, accordingly, to an incorrect diagnosis. To avoid such mistakes, there is a clearly prescribed research technique and the necessary "identification points" developed by the founder of the method of ultrasound diagnosis of the hip joint, Professor R. Graf from Austria.
In the case when the ultrasound image is correct, and only such a picture can be analyzed, ultrasound for children under the age of one year is a more accurate method than X – rays because it shows the cartilaginous components of the joint that are not visible on the X-ray, and in babies the hip joint is more cartilaginous.
We have the most extensive experience in ultrasound diagnostics of hip dysplasia in Ukraine.
In our Medical Center, ultrasound diagnostics is performed by Anna Yakovlevna Vovchenko – a leading specialist of Ukraine in the field of ultrasound research of joints, a student of the founder of the method, Professor R. Graf. In 1993, Anna Yakovlevna was trained by him in Austria and since then has trained more than 200 doctors in Ukraine. The topic of her PhD thesis, defended in 1996, is also devoted to dysplasia - "Early diagnosis of hip dysplasia".
Our Medical Center provides both diagnosis and treatment of hip dysplasia. Experienced orthopedists advise and select an individual course of treatment aimed at a speedy recovery and prevention of undesirable consequences of dysplasia.

THE MOST FREQUENT QUESTIONS OF PARENTS & nbsp;

What is hip dysplasia, what is the cause of its occurrence, is it not related to the wrong management of childbirth or an injury inflicted on the child in the maternity hospital?

Hip dysplasia in translation into Russian means immaturity (underdevelopment) of the hip joints. This condition of the joints is not associated with birth trauma and refers to congenital diseases.
The main causes of hip dysplasia:

• inherited disorder of its formation;
• breech presentation, oligohydramnios, increased tone of the uterus during pregnancy;
• pathology of pregnancy;
• prematurity;
• hereditary (family) relaxation supplier ligaments; 

Factors that act after childbirth are also important: 

pathology of the nervous system of the newborn (mainly hypertension);
rickets;
dysbacteriosis;
improper feeding and tight swaddling. 

What symptoms allow you to suspect dysplasia? My child has asymmetrical folds – does this necessarily indicate hip dysplasia?

The main symptoms of hip dysplasia (here we do not consider cases with congenital hip dislocation):

• symptom of restriction or asymmetry of hip abduction (or looseness of hip symptoms);
• symptom of "click" - when the child's thighs are separated, the doctor feels a characteristic crunching in the hip joint; 
• assimmetry of the skin folds (gluteal, femoral, popliteal). This symptom does not necessarily indicate dysplasia, it can also be observed in healthy children. 

Attention!!!!! 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.

Can dysplasia resolve itself?

The result of untreated dysplasia depends primarily on the degree of underdevelopment of the joint (as the sloping roof of the hip joint, the immature femoral head) and related conditions, hindering the full development (hypertonicity, goiter, rickets, etc.).
If hip dysplasia is expressed minimally, and there are no any aggravating factors in 50%, it can be eliminated spontaneously. Think about it! 50% - this is every second child, because it is not known which of them will be yours.
With severe hip dysplasia, subluxation and dislocation of the hips, spontaneous normalization does not occur. With untreated dysplasia, if there are no complications and due to the sloping roof of the hip joint there is no subluxation or dislocation of the hip, your child will complain of rapid fatigue, pain in the legs at the end of the day and after physical exertion, there will be a gentle limp.
With a dislocation of the hips, which can be complicated by untreated hip dysplasia, in addition to the above complaints, a diving type of limp, the so-called "duck gait", will catch the eye.
                  
What happens if dysplasia is not treated? Can a masseur, a grandmother, a psychic cure dysplasia ...

Sometimes parents hope that the dysplasia will" correct " the grandmother-chiropractor, but this can not be. The grandmother, if she really has some skills, can set a traumatic dislocation, but then you will still need a plaster cast, and in the case of congenital dysplasia (underdevelopment) of the joint, no manipulations of her can lead to instantaneous development of the joint.
Massage is useful for the treatment of hip dysplasia, it accelerates further development, but it must be used in combination with other manipulations prescribed by an orthopedist. You should not take for granted the statements of a masseur like: "I cured 150 children with dysplasia without using stirrups", or these were cases when dysplasia simply did not exist, or it was so minimal that it could pass spontaneously, without treatment at all, including massage.

How long to treat dysplasia?

The terms of treatment of dysplasia are individual and depend on the degree of underdevelopment of the joints. With moderate underdevelopment, the period from the beginning of treatment to complete recovery is about 3 months.
                  
They say (neurologist, masseuse...) that stirrups harm the treatment of tone, what to do?

The opinion that Pavlik's stirrups interfere with the treatment of increased tone is erroneous, although even if it were so, the presence of one disease does not exclude the need to treat another. During the massage in patients with hip dysplasia (this does not apply to patients with congenital hip dislocation), the stirrups can be removed.
                  
Is X-ray examination harmful for hip dysplasia?