Dysplasia of the Hip Joint: Diagnosis and Treatment

Hip dysplasia

Signs & Symptoms of the Hip Dysplasia in Baby

Sometimes it happens that a mother looking at her newborn baby notices strange signs: one leg is clearly shorter than the other, hips and buttocks are not symmetrical. If place a child on the table and try to bend his knees and then spread them in opposite directions – they will not touch the table. The first thing to do in this situation – is to show the baby to pediatric orthopedics. Most likely, the child has dysplasia or hypoplasia of one or both hip joints. According to the severity of the disease, the dysplasia may be accompanied with pre-dislocation, incomplete dislocation or dislocation of the joint (s) which differentiates according to the degree of displacement of the femoral head (hip joint component) from the acetabulum (“pelvic” joint component). An extreme manifestation of hip dysplasia is an inborn hip dislocation.

Dysplasia Diagnosing

Dysplasia DiagnosingIn the hospital, pediatricians have to carefully examine the child for inborn disorders of the hip joint. In addition, the pediatrician should be monitoring the state of child’s joints since birth. If a doctor has any suspicions the child should be sent to additional examination, such as ultrasound diagnostics of hip joints or to the pediatric orthopedics. Scheduled visit to the orthopedist should be performed at the age of one month and later at 3, 6, and 12 months (or when a child starts walking) Orthopedist conducts clinical examination and if necessary directs the child to ultrasonography (US) of the hip joints.  It is a harmless method of examination, but it does not give a complete picture of the pathological changes in the joint.

Ultrasound is more suitable for screening ( examining of all new-born children on the subject of hip joints diseases. Also, ultrasound may be used to control the treatment efficiency. In cases of dysplasia (or if there is a suspicion), the doctor may send the child to X-ray of the hip joints. The results will give the possibility to more objectively figure out the state of the joints. If the pediatric orthopedist confirmed the diagnosis of dislocation (incomplete dislocation or pre-dislocation) of the hip, the treatment should be prescribed immediately. If the treatment measures are not enough the transition of mild dysplasia into the sub dislocation and later to the dislocation may happen.

It should be remembered that the treatment of inborn hip dislocation is long (usually from one month to one year) and complex. Parents should be patient: hip dysplasia therapy prolonged, continuous and at first the child will have difficulties with getting used to it. During the first month after the birth, the wide swaddling of the child is widely spread. The principle of the method is based on providing a spreading of the legs so that the hip and the core of the baby make the angle of 60-80 ° in the horizontal plane. The child quickly becomes accustomed to a wide swaddling, tolerates it easily and during the re-swaddling  holds the legs in the position of abduction. It is also necessary to do the therapeutic exercises – spreading hips at each change of diapers. Tummy time with spreading legs is also good.Therapeutic exercises for a baby with dysplasia

In case the exercises and wide swaddling don’t help the orthopedist will appoint one of the orthopedic devices:  Pavlik’s harness  is the most gentle to the hip joint and the most suitable for child and parents handbook. It is usually for children from the third week to 9 months. Perinki Frejka – plastic pants that support legs in the “frog” position. Prescribed for children since 1 up to 9 months old (changing of the manual with time is necessary) Hip spacers are used for walking. Treatment is aimed at fixing the hip joints in functionally favorable position – flexion and abduction. However, Pavlik stirrups are still considered the most suitable device for children from 1 month to 6-8 months old.

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Physical therapy, calcium electrophoresis of the hip joint. Massage and physiotherapy exercises should be carried out under the supervision of the specialist. The most important thing is not to interrupt the treatment. It sometimes happens that parents remove the tires and other assistive devices without consulting an orthopedist. It should not be done under any circumstances as the disposition of the hip may lead to the dysplastic coxarthrosis.  It’s a severely disabling disease of the hip joints, characterized by pain, gait disorder, a decrease in range motion in the joint. In that case, only surgery may help.  During the conservational (non-surgery) treatment of the inborn hip dislocation, the child might not be able to walk for a long time.

The desire to see the child walking and running is understandable. But it is forbidden to put the child on his feet without orthopedists permission. It may eliminate all the success achieved during the treatment of the inborn hip dislocation. In cases when the conservative treatment is not successful, the surgery is required. The idea of the surgery is the reduction of the femoral head and the restoration of the anatomic matching of the   hip items. The procedure of the surgery is performed according to individual features (sometimes a few surgeries may be required).

After the surgery, the long-term fixation is necessary and then the recovery through physical exercises, massage, and physiotherapy. It is important to carefully follow all the doctors’ recommendations in order to prevent complications and, in most cases at the age of 1-2 years eliminate the disease.

Preventing measures

For the purpose of child joints to develop normally, doctors recommend performing the wide-swaddling (or hip-healthy swaddling) or no swaddling at all.

The so-called tight diapering (when the baby’s legs are straightened and tightly pulled together) should be performed in no case. Inborn hip dislocation is not common in the countries where the children are rarely swaddled (African countries, Vietnam, Korea). For the proper joints development, the adequate range of motion is necessary. The risks of the hip dysplasia lower significantly at the physiological (natural or provided by nature) position of joints when the baby’s legs are bent at the knees and spread.

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