Consequences of joint dysplasia in children. Fixing orthopedic devices. Degree of disease development

After birth, hip dysplasia is common in newborns. Diagnosis of such diseases is quite difficult. Parents will be able to suspect the first signs in children under one year old. This disease is dangerous due to the development of adverse complications that can significantly worsen the baby’s quality of life.

What it is?

This pathology of the musculoskeletal system arises from the influence of numerous causes that lead to disruption of the intrauterine anlage of organs. These factors contribute to underdevelopment of the hip joints, as well as all the articular elements that form the hip joints.

With severe pathology, the articulation between the head of the femur and the acetabulum, which form the joint, is disrupted. Such violations lead to the appearance of unfavorable symptoms of the disease and even complications.

Congenital underdevelopment of the hip joints is quite common. Almost every third of a hundred children born is diagnosed with this disease. It is important to note that susceptibility to this disease is higher in girls, and boys get sick somewhat less frequently.

In European countries, dysplasia of large joints is more common than in African countries.

Pathology is usually found on the left side; right-sided processes are recorded much less frequently, as are cases of bilateral processes.

Causes

There are several dozen provoking factors that can lead to the development of physiological immaturity of large joints. Most of the impacts that lead to immaturity and disruption of the structure of large joints occur in the first 2 months of pregnancy from the moment the baby is conceived. It is at this time that the intrauterine structure of all elements of the child’s musculoskeletal system takes place.

The most common causes of the disease include:

• Genetics. Typically, in families where cases of this disease have occurred, the likelihood of having a baby with pathologies of large joints increases by 40%. At the same time, girls have a higher risk of getting sick.
• Exposure to toxic chemicals during pregnancy. This situation is most dangerous in the first trimester, when intrauterine development of the musculoskeletal system occurs.
• Unfavorable environmental situation. Harmful environmental factors have a negative effect on the development of the unborn child. An insufficient amount of incoming oxygen and a high concentration of carbon dioxide can cause intrauterine hypoxia of the fetus and lead to disruption of the structure of the joints.
• The expectant mother is over 35 years old.
• The baby weighs more than 4 kilograms at birth.
• The birth of a baby ahead of schedule.
• Breech presentation.

• Carrying a large fetus with an initially small uterus. In this case, the baby physically does not have enough space for active movements. This forced passivity during fetal development can lead to limited mobility or congenital dislocations after birth.
• Infection with various infections of the expectant mother. During pregnancy, any viruses or bacteria easily pass through the placenta. Such infection in the early stages of a baby’s development can lead to birth defects in the structure of large joints and ligaments.
• Poor quality nutrition, lack of vital vitamins, which are necessary for the full development of cartilage and ossification - the formation of bone tissue.
• Excessive and very tight swaddling. Excessive pressing of the child's legs to the body can lead to the development of various types of dysplasia.

Kinds

Doctors classify various forms of the disease according to several main characteristics. For dysplasia, such criteria are combined into two large groups: according to the anatomical level of the lesion and according to the severity of the disease.

According to the anatomical level of the lesion:

• Acetabular. There is a violation in the structure of the main large elements that make up the hip joint. Basically, with this option, damage to the limbus and marginal surface occurs. At the same time, the architecture and structure of the joint changes greatly. These injuries lead to disruption of movements that should be performed by the hip joint normally.
• Epiphyseal. A pronounced impairment of mobility in the joint is characteristic. In this case, the norm of the angles that are measured to assess the work of large joints is noticeably distorted.
• Rotary. With this variant of the disease, a violation of the anatomical structure of the joints may occur. This is manifested by the deviation of the main structures that form the hip joint from the median plane. Most often, this form is manifested by gait disturbance.

By severity:

• Mild degree. Doctors also call this form preluxation. Severe disorders that arise with this option and lead to disability, as a rule, do not occur.
• Medium heavy. It may also be called a subluxation. With this option, the head of the femur usually extends beyond the articulation during active movements. This form of the disease leads to the development of adverse symptoms and even long-term negative consequences of the disease, which require more active treatment.
• Heavy current. Such a congenital dislocation can lead to adduction contracture. With this form, a pronounced violation and deformation of the hip joint occurs.

Symptoms

Identification of the first symptoms of anatomical defects of large joints is carried out already in the first months after the birth of the baby. The disease can already be suspected in an infant. When the first signs of illness appear, the baby should be shown to an orthopedic doctor. The doctor will conduct all additional examinations that will clarify the diagnosis.

The most characteristic manifestations and signs of the disease include:

• Asymmetry in the location of skin folds. They are usually quite well identified in newborns and infants. Every mother can evaluate this symptom. All skin folds should be approximately at the same level. Pronounced asymmetry should alert parents and suggest that the child has signs of dysplasia.
• The appearance of a characteristic sound resembling a click, during adduction of the hip joints. This symptom can also be detected with any movements in the joint in which abduction or adduction occurs. This sound occurs due to active movements of the femoral head along the articular surfaces.
• Shortening of the lower limbs. It can occur on one side or on both. With a bilateral process, the baby often experiences growth retardation. If the pathology occurs only on one side, then the child may develop lameness and gait disturbance. However, this symptom is detected somewhat less frequently when the baby tries to stand on his feet.
• Pain in large joints. This sign intensifies when the child tries to stand on his feet. Increased pain occurs when performing various movements at a faster pace or with a wide amplitude.
• Secondary signs of the disease: slight muscle atrophy in the lower extremities, as a compensatory reaction. When trying to determine the pulse in the femoral arteries, a slightly reduced impulse may be observed.

Consequences

Dysplasia is dangerous due to the development of unfavorable complications, which can occur with a long course of the disease, as well as with insufficiently effective and well-chosen treatment of the disease in the initial stages.

With a long course of the disease, persistent gait disturbances may develop. In this case, surgical treatment is required. After such therapy, the baby may limp slightly. However, later this unfavorable symptom completely disappears.

Also, if signs of the disease have been observed for a long time, muscle atrophy may occur in the injured lower limb. On the contrary, the muscles on a healthy leg may be excessively hypertrophied.

Severe shortening also quite often leads to gait disturbances and severe lameness. In severe cases, this situation can even lead to the development of scoliosis and various posture disorders. This occurs due to a shift in the supporting function of damaged joints.

Large joint dysplasia can lead to various adverse consequences in adulthood. Quite often, such people have cases of osteochondrosis, flat feet or dysplastic coxarthrosis.

Diagnostics

As a rule, this pathology begins quite mildly. Only a specialist can identify the first symptoms; it is quite difficult for parents to do this on their own at home.

The first step in establishing a diagnosis is a consultation with an orthopedic doctor. Already in the first year of a child’s life, the doctor determines the presence of predisposing factors, as well as primary symptoms of the disease. Usually, the first orthopedic signs of the disease can be recognized during the first six months of a child’s life. To accurately verify the diagnosis, various types of additional examinations are prescribed.

The safest and most informative method that can be used in infants is ultrasound. Interpretation of ultrasound allows you to establish various signs characteristic of the disease. This method also helps to establish the transient form of the disease and describe the specific changes that occur in the joint characteristic of this variant. Using ultrasound, you can accurately determine the timing of ossification of the nuclei of the hip joints.

Ultrasound diagnostics is also a highly informative method that clearly describes all anatomical defects observed in various types of dysplasia. This study is absolutely safe and is performed from the very first months after the birth of the baby. There is no significant radiation exposure to the joints during this examination.

X-ray diagnostics is used only in the most complex cases of the disease. X-rays should not be performed on children under one year of age. The study makes it possible to fairly accurately describe various anatomical defects that arose after birth. This diagnosis is also used in complex clinical cases in which it is necessary to exclude concomitant diseases.

All surgical methods for examining large joints in newborns are not used. During arthroscopy, doctors use instrumental instruments to examine all the elements that make up the hip joint. During such studies, the risk of secondary infection increases several times.

Typically, magnetic resonance and computed tomography of large joints are performed before planning various surgical interventions. In complex cases, orthopedic doctors can prescribe examination data to exclude various diseases that may occur with similar symptoms.

Treatment

Diseases of the musculoskeletal system need to be treated for a long time and with strict adherence to the recommendations. Only such therapy makes it possible to eliminate as much as possible all the unfavorable symptoms that arise with this pathology. A complex of orthopedic therapy is prescribed by an orthopedic doctor after examining and examining the baby.

Among the most effective and commonly used treatment methods are the following:

• Using wide swaddling. This option allows you to maintain the most comfortable position for the hip joints - they are in a slightly apart state. This type of swaddling can be used even for babies from the first days after birth. Becker's pants are one of the wide swaddling options.
• The use of various technical means. The most commonly used are various tires and spacers. They can be of different rigidity and fixation. The selection of such technical means is carried out only on the recommendation of an orthopedic doctor.
• Physical exercises and exercise therapy should be performed regularly. Typically, such exercises are recommended to be done daily. The complexes should be performed under the guidance of the medical staff of the clinic, and subsequently independently.
• Massage. It is prescribed from the first days after the birth of the baby. Courses are conducted several times a year. With this massage, the specialist works well on the baby’s legs and back. This method of treatment is well accepted by the child and, when carried out correctly, does not cause any pain.
• Gymnastics. A special set of exercises must be performed daily. Abduction and adduction of the legs in a certain sequence allows you to improve movement in the hip joints and reduce the manifestations of stiffness in the joints.
• Physiotherapeutic methods of treatment. The baby can undergo ozokerite and electrophoresis. Various types of thermal treatment and inductotherapy are also actively used for children. Physiotherapeutic procedures for the treatment of dysplasia can be performed in a clinic or specialized children's hospitals.

• Spa treatment. Helps effectively cope with adverse symptoms that arise from dysplasia. Staying in a sanatorium can significantly affect the course of the disease and even improve the baby’s well-being. For children with hip dysplasia, it is recommended to undergo sanatorium treatment annually.
• Adequate nutrition with the obligatory inclusion of all necessary vitamins and microelements. Children with disorders of the musculoskeletal system must eat a sufficient amount of fermented milk products. The calcium they contain has a beneficial effect on the structure of bone tissue and improves the growth and physical development of the child.
• Surgical treatment in newborns is usually not performed. Such therapy is possible only in older children. Usually, before reaching 3-5 years of age, doctors try to carry out all the necessary treatment methods that do not require surgery.
• The use of painkillers, non-steroidal anti-inflammatory drugs to eliminate severe pain. Such drugs are prescribed mainly for severe variants of the disease. An orthopedic doctor or pediatrician prescribes painkillers after examining the child and identifying contraindications to such medications.
• Plaster application. It is used quite rarely. In this case, the affected leg is fixed quite tightly with a plaster cast. After some time, the cast is usually removed. The use of this method is quite limited and has a number of contraindications.

In order to reduce the risk of possible development of dysplasia, use the following tips:

1. Try to choose a looser or wider swaddle if the child has several risk factors for the development of dysplasia of large joints. This method of swaddling can reduce the risk of developing disorders in the hip joints.
2. Monitoring a healthy pregnancy. Try to limit the impact of various toxic substances on the body of the expectant mother. Severe stress and various infections can cause various intrauterine malformations. The expectant mother must ensure that she protects her body from contact with any sick or feverish acquaintances.
3. Using special car seats. In this case, the child's legs are in an anatomically correct position throughout the entire journey in the car.
4. Try to hold your baby correctly. Do not press the baby's legs tightly to the body. An anatomically more advantageous position is considered to be a more abducted position of the hip joints. Also remember this rule while breastfeeding.
5. Preventive complex of gymnastic exercises. Such gymnastics can be performed from the first months after the birth of the child. The combination of exercises and massage significantly improves the prognosis of the disease.
6. Choose the right diapers. A smaller size can cause a forced adducted state of the child’s legs. Avoid overfilling your diaper and change them frequently.
7. Get regular check-ups with an orthopedic surgeon. Every baby must attend such consultations before the age of six months. The doctor will be able to identify the first signs of the disease and prescribe the appropriate treatment package.

With high-quality treatment, most negative manifestations of dysplasia can be eliminated almost completely. Medical supervision of a child diagnosed with dysplasia should be carried out over a long period of time. Such babies undergo regular examinations by a neurologist and orthopedist. Controlling the course of the disease helps prevent the development of dangerous and unfavorable complications.

To learn about what hip dysplasia is, how it is treated and at what age it is best to start treatment, watch the following video.

One of the fundamental important questions that all orthopedists in the world pose is hip dysplasia, which is quite common today. This is a pathological deformation of the joints, which is congenital and, if you carefully examine the baby, is diagnosed immediately after birth.

Hip dysplasia (HJ) today refers to the defective development of the articular joint itself or its various elements, which include the acetabulum with the area around it, the cartilaginous tissue surrounding the articular surface, muscle elements and ligaments. Without proper support from these structures, the femur cannot stay in its intended place, which is why a condition called dysplasia develops.

Dysplasia is not always diagnosed from the very birth of the child. Sometimes the problem can only be identified when the baby takes his first steps. If parents have any doubts, they are advised to consult a doctor. Today, hip dysplasia can be successfully treated if therapy is started early.
Content:

• What is the reason
• Types of disease
• Signs. How to determine?
• Symptoms
• Treatment of hip dysplasia in children
• Pavlik stirrups
• Variety of tires
• Freyka tire
• Vilensky tire
• Tübinger tire
• Tire Volkov
• Surgery
• Massage for hip dysplasia in children
• Gymnastics and exercises
• Swaddling for dysplasia
• Electrophoresis
• Dr. Komarovsky about hip dysplasia
• Possible consequences

What is the reason

Today, not a single doctor can say with certainty what is the main reason for the development of dysplasia and associated changes in the hip joint. There is more and more talk about a hereditary predisposition, which must be combined with a number of conditions that contribute to the manifestation of pathology.

For example, it has been found that female infants suffer from dysplasia much more often than male infants. Some doctors attribute such statistics to the fact that girls usually have more flexible connective tissue, which affects the joints.

The course of pregnancy is of great importance. Many women suffering from excess progesterone during pregnancy subsequently observed hip dysplasia in their children to varying degrees. The number of births also matters. For first-born children, the risk of developing dysplasia is always higher than for children who are born second or third in the family.

The characteristics of the fetus and its development are also important in the development of dysplasia. For example, large children more often suffer from dysplasia not only because they have a higher load on the hip joint. The point is also that in the uterus a large fetus is significantly limited in movement, which prevents the normal development of joints.

Naturally, none of the doctors excludes the influence of external factors, be it a bad environment, the mother’s bad habits, working in a hazardous industry, or taking medications that have a negative effect on the fetus.

Interestingly, the disease is often associated with the culture of swaddling babies in various parts of the world. For example, in countries with the accepted method of rigid direct swaddling, dysplasia in children is diagnosed more often. This is due to limited joint mobility, which prevents their full development.

On the other hand, doctors cite the example of Asian countries, where many women carry children on their backs or in special devices on their chests. This approach helps to ensure the separation of the legs (formation of the correct configuration of the joint) and sufficient mobility so that the joint is formed correctly and fully.

Types of disease

There are three main types of hip dysplasia.

Acetabular dysplasia

Involves pathological changes in the acetabulum, which is the site of attachment of the head of the femur and one of the main elements of the joint. With this type of pathology, the cartilage around the acetabulum is mainly affected. Due to the incorrect location of the bone head, the cartilage tissue can wear out and become deformed, which leads to gradual wear and tear of the joint and stretching of its capsule.

Epiphyseal dysplasia

Usually characterized by the fact that cartilage tissue becomes bone. Such changes make it very difficult to carry out movements in the joint, since the bone tissue is not flexible and cannot serve as a spacer between the two structures. In addition to difficulty moving, there are complaints of pain. Over time, deforming changes in the legs develop.

Rotational dysplasia

Accompanied by slow development of articular elements, as well as incorrect location of the components of the joint relative to each other. Doctors are still arguing about whether rotational dysplasia is classified specifically as a dysplasia, or whether it is still considered a borderline condition.

Dividing dysplasia into types is necessary for doctors to understand the mechanism of development of pathology. This helps to choose the optimal way to combat the disease, to stop this or that pathological process, making the effect of therapy targeted, and not just general.

In addition to different types of dysplasia, there are three stages of this disease.

• Grade I is usually characterized by mild subluxation. In this case, the head of the femur does not leave its place in the acetabulum, but is only slightly mixed in it.
• Grade II is characterized by complete subluxation, in which the head of the bone continues to be only half located in the acetabulum.
• Grade III is characterized by complete displacement of the head from the acetabulum, and full dislocation develops.

Dividing dysplasia into three different stages is necessary in order to choose the right treatment methods. So, for example, in the first stage of pathology, you can only get by with massage and proper swaddling of the child, but in the third stage, most likely, you will have to resort to the help of special structures or surgery.

Signs. How to determine?

The hip joint is one of the strongest joints in the human body. It develops in such a way as to withstand high loads. It is the hip joint that experiences the main pressure during running, walking or simply being in a sitting position, and it must withstand these loads.

The normal hip joint consists of the ball-shaped head of the femur and the crescent-shaped acetabulum. Tendons, muscles and ligaments provide support for the joint in an adequate configuration, as well as normal reproduction of movements in all planes. A joint can function correctly and fully only if all its elements are fully developed, which is not the case with dysplasia.

In the early stages of life, a baby suffering from hip dysplasia, especially if it is mild, may be no different from a completely healthy child. The first signs of pathology in this case will attract attention only when the child begins to take his first steps.

Among the signs that every attentive parent can pay attention to, there are only two main ones: asymmetry of skin folds on the legs and a difference in the length of the legs.

The signs are interconnected. Asymmetry of folds essentially develops due to the fact that one of the limbs is slightly shorter than the other. Because of this, the knee bend area on the shortening side will be slightly higher than on the healthy leg. The position of the inguinal and gluteal folds is also of diagnostic importance. Differences may consist not only in the level of position of the folds, but also in their depth and shape.

It is important to remember that if the pathology affects the hip joints on both sides, both of these signs lose their informativeness. You can focus on skin folds and leg length only if dysplasia has developed on only one side. It is also interesting that some doctors believe that on the side where the subluxation or dislocation is located, skin folds are observed in greater numbers, but this is not true. With dysplasia, this opinion is incorrect, since in half of the babies the sign may be present, but there will be no dislocation or subluxation.

Many parents pay attention to the asymmetry of the femoral skin folds, but it has no diagnostic value for dysplasia. This sign is also characteristic of healthy children without pathologies.

When assessing limb length differences, it is important to conduct a proper diagnostic examination of the infant. The child is assessed when he is in a supine position, with his legs slightly bent not only at the knees, but also at the hip area. Dysplasia will be accompanied by a distinct phenomenon of shortening of the femur, which is formed if the bony head is displaced posteriorly in relation to the acetabulum in which it should be located. As a result, the knee on the affected side will be lower than the knee on the healthy side. The presence of this phenomenon indicates that the baby has a pathological change in the hip joint area of ​​the most severe form, called congenital hip dislocation.

Symptoms

In addition to the signs that can be assessed by any attentive parent, hip dysplasia in a baby can be detected during a medical examination. In this case, the doctor pays attention to specific symptoms that not every parent can assess without appropriate knowledge.

In diagnosing dysplasia in infants under one year of age, the gold standard is the assessment of the presence of the Marx-Ortolani symptom or, as it is otherwise called, the “click” or slipping symptom. It is best to entrust checking a child for the presence of a symptom to a pediatrician, so as not to injure the baby, but any parent should still know the essence of the procedure.

The test begins with the child being placed on his back. Babies in this position lose the ability to resist, so the diagnosis can be carried out without interference. The baby's legs are flexed at the knees and hip joints and they begin to gently, without making sudden movements, move them in different directions. Normally, without discomfort, the baby’s shins can almost touch the surface of the table on which the examination is taking place.

If the child has dysplasia, the head of the femur will pop out of the acetabulum during abduction, which will be accompanied by a push. The shock will be felt by the doctor who conducts the diagnosis. After this, the child is left with his legs apart, watching as the affected leg slowly returns to its normal position. Returning to the anatomically correct position ends with a slight jerking movement, which indicates dislocation of the femoral head.

The Marx-Ortolani symptom is, of course, considered the gold standard in diagnosing hip dysplasia, but its presence does not always mean that the baby is sick if we are talking about a child in the first two weeks of life. Many children in the first weeks of life demonstrate the presence of a positive symptom, recovering within a few weeks without outside influence.

Because of this, it is necessary to carefully interpret the results of the test for the presence of the Marx-Ortolani sign and have only a professional perform the test. An experienced doctor will be able to understand when the presence of a positive symptom indicates dysplasia, and when it is only a temporary anatomical feature.

If the Marx-Ortolani symptom is no longer informative, the baby’s ability to abduct the legs is first assessed. With the first degree of dysplasia, the abduction will be free, the child will not feel discomfort, as normal. However, with the disease of the second or third stage, attempts to abduct the leg will cause discomfort to the baby. Hip dysplasia does not allow the baby's legs to spread more than 60-65 degrees. This symptom is used to diagnose dysplasia in older children.

It is important to understand at what age which test has the greatest diagnostic value and to apply them correctly and interpret the results obtained.

Additional symptoms that indicate that a child has hip dysplasia include the following:

• pain that appears when trying to spread the baby’s legs in different directions or in response to movements (the child will let you know about this by crying during the examination, increased anxiety);
• excessive elasticity of the joint, in which the bone head easily jumps out of the acetabulum and falls into place at the slightest load;
• joint mobility, allowing the baby to twist the limb at an unnatural angle, taking unusual poses.

Often, dysplasia is diagnosed only when the child stands on his feet and takes his first steps. At this time, the attention of responsible parents is drawn to a swaying, duck-like gait if both joints are affected. If the pathology is observed on one side, then the child often walks on tiptoes without touching the floor with his heels, and may also have a pronounced limp, which is explained by the different lengths of the legs.

Hip dysplasia in newborns is not always diagnosed without the use of additional techniques. For example, if a diagnosis needs to be made at the very beginning of a baby’s life, and conventional tests do not give results, ultrasound and radiography techniques are used.

Among all methods, preference is mainly given to ultrasound, since this method is the safest and is suitable for frequent use. With its help, not only a diagnosis is made, but also the treatment process is monitored.

During an ultrasound or x-ray, the doctor pays attention to the following symptoms of dysplasia:

• the acetabulum in the image may have deformations or flattening, while the bone head will also be deformed, and the cartilaginous plates surrounding it may be underdeveloped;
• The ligamentous apparatus and joint capsule are assessed, which may be too stretched;
• the incorrect position of the bone attracts attention (the angle between the head and the acetabulum is assessed);
• you can also see the exit of the head of the bone from the cavity (the exit can be either partial or complete).

Other diagnostic techniques are used if the issue of joint surgery is being decided. Additional diagnostic techniques include CT or arthrography. The first method allows you to get a more complete picture of the condition of the joint, and the second makes it possible to evaluate the joint if the doctor is faced with a very advanced process of dysplasia.

Treatment of hip dysplasia in children

The basis of the treatment of dysplasia is the early diagnosis of the pathology, and the same earlier initiation of its therapy. It is important to remember that if a child is diagnosed with mild dysplasia, no special measures are taken to treat it. All that parents need to do in this case is to create conditions for the joint under which it will return to its normal state and become fixed in it.

The situation with the treatment of children with severe dysplasia is much more complicated. In this case, various orthopedic techniques are used to help correct the situation. Orthopedic treatment is also indicated for children with mild dysplasia if the effect of preventive measures is not achieved within six months.

The use of various orthopedic structures to help place the joint in the correct position is widely used in treatment.

Pavlik stirrups

Pavlik stirrups are a design that replaced rigid orthopedic devices, the use of which often led to the development of necrotic changes in the head of the femur.

Today's Pavlik stirrups are made of soft fabric and allow you to spread the child's legs to the sides without injury in order to return the head of the bone to its natural position.

Variety of tires

In today's orthopedics, there are many options for splints that are used if a child is diagnosed with hip dysplasia. A suitable splint is selected by an orthopedic doctor, taking into account the child’s developmental characteristics and the severity of dysplasia.

Freyka tire

The Freika splint or Freika panties is an orthopedic device that allows you to spread your baby’s legs up to 90 degrees and, if necessary, increase this angle a little more. The splint is made of dense material, but is designed in such a way as not to injure the child.

Its use is relevant not only in the case of dysplasia without dislocation, but also in case of hip subluxation.

Vilensky tire

The Vilensky splint is an orthopedic device consisting of a pair of belts (mostly leather is used as the material) and a metal spacer that connects them. Parents should definitely visit a doctor before putting on the splint for the first time, so that he can show you the technique to follow when putting the device on the baby.

The Vilensky splint requires compliance with a number of requirements, without which its wearing will not be effective. These include:

• the need to carefully and tightly lace the belts to prevent them from slipping;
• The splint is worn constantly for 4-6 months of the baby’s life; removal of the splint is allowed only for the bathing period;
• selection of the length of the spacer from an orthopedic doctor (the length is adjusted using a small wheel, which is sealed so that the child cannot move it while playing);
• The splint is not removed even when the baby is sleeping or changing clothes, and for the convenience of these manipulations, clothes with buttons are used.

Tübinger tire

It is a cross between Vilensky's stirrups and Pavlik's stirrups. It is also equipped with a leg spacer and special threads that allow you to adjust the width of the leg abduction.

Tire Volkov

Today, this orthopedic design is used very rarely in the treatment of dysplasia. Its use is limited by a number of serious disadvantages. For example, the Volkov splint is quite expensive, it is difficult to choose correctly, it limits the child’s mobility, causing him significant inconvenience.

The variations listed are only the most common. Every day the modern market offers more and more new means to combat dysplasia, but it is impossible to definitely choose one that will be ideal in all respects.

Surgery

Surgery is not used very often in the treatment of hip dysplasia, but in some cases it is impossible to correct the situation without intervention. This, for example, happens when conservative therapy is ineffective or when the pathology was discovered in the baby after the first year of life.

There are several different techniques that are used to reduce dislocation in dysplasia. One of the most common is open reduction, which is used if it was not possible to restore the normal configuration of the joint conservatively.

Another treatment option is osteotomy. In this case, one of the components of the joint is divided in two and fused again. This approach can reduce pain and make the joint more functional.

You can quickly align your baby’s legs of different lengths, making walking easier. The last surgical treatment option is joint replacement. It is used actively mainly in cases where the deformation has greatly changed the configuration of the joint.

Surgical treatment is effective in most cases, but after it a long and sometimes difficult rehabilitation is required, which is not always well tolerated by children. Because of this, doctors try to delay surgical resolution of the issue for as long as possible.

Massage for hip dysplasia in children

Massage techniques are quite widely used if the baby’s hip dysplasia is very severe. All manipulations are carried out in agreement with an orthopedic doctor and only a professional massage therapist. It is recommended to adhere to the following rules:

• massage is done on a hard surface without distortion;
• It is recommended to use a client, as massage sometimes provokes urination;
• a minimum of 10 sessions are required;
• one session is done once a day;
• The massage is done in courses with a break of a month.

Basically, during the massage, the techniques of stroking, light pinching and clapping are used. No force is used during the massage; all movements of the massage therapist should be smooth and careful. Particular attention is paid to the area of ​​the hip joint, where rubbing and kneading is carried out.

The massage therapist can perform passive gymnastics by performing the “hovering” exercise with the baby (the child is picked up and raised above the changing table), carefully making circular movements in the hip joint, bending and spreading the child’s limbs in different directions.

Passive gymnastics is included in massage when it comes to treating children who are not yet one year old.

Gymnastics and exercises

Therapeutic gymnastic exercises are used during the entire period of treatment for hip dysplasia. For this disease, doctors, when prescribing exercises, try to achieve the following goals:

• promote the formation of the joint, returning it to its correct position and configuration;
• carry out strengthening measures in relation to the femoral muscles, which should provide support for the bone in the acetabulum;
• monitor and compensate for the baby’s lack of physical activity;
• ensure the full development of the physical condition of a child with dysplasia;
• provide the hip joint area with as much oxygen as possible to prevent necrotic changes.

It is important to remember that there are no age contraindications for gymnastics. This means that even very young children are given gymnastics, but for them it will be done in a passive form and interspersed with massage.

The selection of a set of exercises is made individually each time. When choosing the optimal exercises, the doctor is guided by the general condition of the child and his physical characteristics. As the baby grows and his body strengthens, the load may increase proportionally.

Swaddling for dysplasia

Hip dysplasia in infants requires not only treatment with physical education, but also proper swaddling of the child. The wide swaddling technique is widely used, which can be not only therapeutic, but also diagnostic.

Wide swaddling is performed for a number of indications:

• the baby is at risk for developing hip dysplasia;
• Ultrasound of the hip joint showed immaturity of the joint or one of its components;
• The child cannot be treated with methods other than swaddling for any reason.

The wide swaddling technique is not difficult, and therefore even parents can easily perform it without the intervention of a doctor. Swaddling begins with the baby being placed on his back. Two strips of diapers are placed between the baby's legs, which are secured in the waist area with the help of a third strip. This swaddling technique allows you to easily hold his limbs at an angle of at least 60 degrees without much discomfort for the child.

Exercise therapy

Exercise therapy is a technique used for the rehabilitation of children after the joint has been operated on or brought back to its normal configuration using conservative methods. Therapeutic physical education allows you to provide the child with the necessary amount of physical activity. For children under three years of age, you can perform the following set of exercises:

• flexion and extension of the hips from a supine position;
• rolling from a sitting position to a lying position and back, preferably without support from the hands;
• active crawling, which should be maximally stimulated by parents;
• transitions from a standing position to a sitting position, also preferably without using hands as support;
• walking at different paces and types;
• development of the skill of throwing objects;
• complex exercises aimed at strengthening the muscular system of the legs;
• complex exercises aimed at developing the abdominal muscular systems;
• breathing exercises to help saturate the circulatory system with oxygen.

As in the case of gymnastics, a set of exercises for physical therapy should be selected strictly individually in each individual case. This is due to the fact that certain types of exercise or physical activity may be contraindicated for some children.

Electrophoresis

Electrophoresis is another technique widely used in the treatment of children with hip dysplasia. When performing procedures on a child, electrodes are applied to the area of ​​the affected joints, which are moistened in medicinal solutions. The most commonly used solutions are iodine, calcium or phosphorus.

Calcium and phosphorus entering the joint through the skin have a strengthening effect on its elements, promoting the correct formation of its elements and the formation of the configuration.

Electrophoresis as a physical procedure is popular due to the fact that it can be carried out not only in a hospital setting, but also at home. The procedures are carried out in a course, which includes 10-11 sessions of electrophoresis.

In addition to electrophoresis, doctors can recommend other physical procedures that will have a beneficial effect on the joint affected by dysplasia. For example, applications with ozokerite are often used, which successfully improves blood flow at the site of contact with the skin and promotes restoration processes in tissues.

Another technique is the use of warm baths with fresh water. The baby is placed in such a bath for 8-9 minutes a day. Warm water helps improve blood flow, providing the joint with oxygen.

Dr. Komarovsky about hip dysplasia

Dr. Komarovsky, discussing the topic of hip dysplasia, pays special attention to the erroneous opinion that in order to prevent the development of this disease, a child must be swaddled so that his legs are straight. On the contrary, he says, such swaddling will only contribute to the development of pathology.

The doctor says that the correct configuration of the joint can only be achieved if the baby’s legs are spread apart. In this case, the head of the femur is ideally in the acetabulum, where it should be.

The doctor draws the attention of parents to the fact that dysplasia cannot always be diagnosed at an early age. Moreover, many parents, faced with a diagnosis, ignore it outright, encountering serious problems by the time the baby begins to walk. One of the most dangerous problems is congenital hip dislocation, which must be diagnosed and corrected in a timely manner so that the child can move safely in the future.

Dr. Komarovsky also draws the attention of parents to the fact that there are no clear criteria for diagnosing hip dysplasia. Today, when faced with dysplasia in practice, the doctor himself takes responsibility, selecting a treatment regimen for the child. At the same time, a large number of factors are assessed in parallel, among which are the child’s weight, his gender, general condition at birth and much more.

Komarovsky draws special attention to parents to the fact that not all children need treatment with Pavlik stirrups or various splints, but not in every case simply doing gymnastics will be effective. In each individual case, the decision on treatment for dysplasia is made individually, based not only on the presence of the disease, but also on many other criteria.

If the doctor is unsure about the optimal treatment, he may suggest observing the child for several weeks. There is no need to be afraid of such a decision. Yes, hip dysplasia in children under one year of age should be treated as early as possible, but several weeks in practice do not play a big role, but significantly help in the diagnostic search and reduce the risk of error when choosing treatment.

Possible consequences

Many parents have come across the concept of dysplasia, but few of them know what this disease threatens their child in the future, even if its signs are completely absent in childhood. Of course, there is no need to fear that a child with dysplasia is doomed to a recumbent lifestyle, because this is far from the case.

However, according to doctors' observations, children suffering from hip dysplasia begin to walk much later, and learning this simple skill is more difficult for them. If dysplasia is very severe, the child may completely refuse to try to walk due to severe pain attacks that accompany each step.

An abnormal gait in a child with this disease will contribute to the development of spinal diseases such as kyphosis or scoliosis. This happens due to incorrect distribution of the load on the spinal column during movement.

The most dangerous complication of dysplasia is cosarthrosis. This pathology is accompanied by severe deformation and almost complete destruction of the affected joint. As a result, problems with walking appear; a person may become disabled, as he will be forced to move, at best, with the help of a cane. For coxarthrosis, the only treatment method that will be available to a person is to replace the joint with an artificial one. Of course, arthrosis does not develop in one year, but it is impossible to prevent its development in dysplasia, which no one has ever treated.

It is important to remember that with hip dysplasia, timely diagnosis and medical care play a huge role. If parents turn a blind eye to the child’s condition, believing that the absence of complaints is a sign of health, with age they will almost certainly encounter the development of complications of this disease. It is important to remember that the more advanced the case of dysplasia, the more difficult, dangerous and expensive its treatment will be. Also, treatment of dysplasia becomes more complicated as the child grows and the load on the joints increases.

To avoid problems in the future, dysplasia should be treated immediately after it is diagnosed, and the doctor will select the optimal method of therapeutic intervention.

Hip dysplasia is a congenital disorder that can occur for a variety of reasons. Pregnancy rarely goes perfectly. Dirty air, unhealthy food, unfavorable heredity - all this can affect the development of the fetus.

It is best to identify this disease in newborns in order to create the necessary conditions for correction from the very first days. Otherwise, there is a high risk of complications.

Symptoms

Hip dysplasia is usually called underdevelopment of the acetabulum, ligaments with muscles, cartilage tissue, or the joint itself. This disease is not so dangerous if it is diagnosed in a timely manner in children.

Girls suffer from hip dysplasia more often than boys, so they need to be examined more carefully. Even an experienced pediatrician can miss warning signs due to fatigue or inattention. Parents can independently recognize dysplasia in newborns and infants by the following signs:

1. One of the baby's legs is noticeably shorter than the other.
2. The gluteal folds are asymmetrical.
3. There is an unusual fold on the thigh
4. Bent knees are at different heights.

Quite often, with this pathology, the hip joint moves too freely, making a loud click when moving to the extreme position. This sound indicates that the femur is popping out of the acetabulum. The pelvis develops unevenly, the structure of the hip is unstable. If your child shows these signs, take him to the doctor as soon as possible.

It also happens that dysplasia is not noticed in children older than one year. This is possible if the child missed examinations by an orthopedist. The following signs should alert parents:

1. The child does not walk normally unless corrected. Prefers to walk on tiptoes.
2. Doesn't keep balance. When walking, his body sways from side to side.
3. Does not allow legs to spread, bent at the knees, screams or cries in pain.
4. Legs easily twist into an unnatural position.

The pathology will not develop until the baby gets back on his feet. Nine out of ten children completely get rid of all symptoms of the disease after undergoing a year of treatment.

Treatment

Like other pathologies, it is necessary to treat this disease, especially if it was diagnosed too late. After all, the child can still be restored to the ability to walk normally. True, the chances of a full recovery are getting smaller every week after the baby starts.

If you are not sure whether your baby is suffering from a deformed hip joint, but do not have the opportunity to consult with a specialist, try not to aggravate the course of the disease. For this:

• Do not swaddle newborns tightly: such fixation forces the joint to constantly remain in an inverted position.
• It is better to use a wide swaddling: spread the baby’s legs so that they look in different directions, and place two folded diapers between them. This way the bone will be in the right place, and the development of the hip joint will proceed normally.

1. Orthopedic products. The most famous today are Pavlik's stirrups.
2. Exercise therapy, swimming on the tummy. There are different exercises for each age.
3. Physiotherapy: ozokerite application, electrophoresis with calcium and chlorine, mud therapy.
4. Massage.

In rare cases, surgery is required. It is mainly given to older children.

It is much more difficult to cure hip dysplasia if the deformity is discovered after six months. In this case, the recovery period can last five years or more.

Consequences

Congenital subluxation of the hip leads to pathological changes in the development of the entire hip system. Newborns have virtually no discomfort from dysplasia. But the older the child gets, the more pain and suffering the disease will cause him.

In newborns

In the absence of experience, it is difficult to determine whether the strange position of the leg is a sign of dysplasia. The thigh may look unusual due to a lack of muscle tone. But the consequences of the disease are specific and cannot be confused with other ailments.

What complications are typical for dysplasia:

1. Gradual loss of function of the hip joint. Subluxation gets worse over time because the joint does not have the opportunity to develop normally. Abduction of the leg bent at the knees causes pain.
2. Shortening of the injured limb. Asymmetry increases with each week of the baby's life, especially if swaddling is incorrect.
3. Deformation of the glenoid cavity. Over time, the bone will no longer fall into place even when brought into the correct position.
4. Development of pelvic asymmetry. Lack of nutrition of the bones leads to their atrophy; on the side of the deformity, the pelvis decreases in size.
5. Increased neck-shaft angle. The legs are positioned even more asymmetrically.

Rare complications are also possible. Displacement of the head of the bone in newborns can provoke the formation of a new acetabulum. This leads to the development of a new joint, which subsequently becomes the cause of deforming arthrosis.

All these negative consequences can be avoided if you start correcting the position of the bone from the first months.

If you start treatment before three months, by the age of one and a half years the child will completely get rid of the subluxation. In this case, the disease will not affect his gait or the development of his hip joints.

Children from one to two years old

The consequences of dysplasia in children examined after six months are more severe than in infants. The older the baby gets, the stronger his bones are, which means it is more difficult to carry out corrections. If it is enough to fix the baby in the correct position to correct the position of the hip joint, then older children need a whole range of procedures to cure all the deformities that have occurred.

With dysplasia, the head of the femur does not have support and constantly suffers from overload. As a result, the entire femur bone cannot grow normally. This leads to the following complications:

1. Decreased neck-shaft angle.
2. Stretching, atrophy of the femoral ligament, up to its complete disappearance by the age of four.
3. Shortening of the muscles of the injured hip and the entire limb.

These deformities cause a lot of discomfort to the child and interfere with normal crawling and walking. Children suffering from dysplasia often prefer to sit in bizarre, strange positions. They try to avoid pain caused by involuntary prolapse of the femur.

Older children

Over time, many small changes lead to serious consequences. Cases of late diagnosis of hip dysplasia are extremely rare, so doctors have not yet had time to study all the deformities caused by the disease. Here are the main problems that develop as a result of delayed treatment or its absence:

1. The pelvis tilts forward, shifting to the painful side. Constant uneven load on the spinal column leads to scoliosis.
2. The child experiences pain when walking and limps on an underdeveloped leg. Over the years, the limp gets worse.
3. Pathological dislocation of the hip develops in both directions.
4. Movement of the knee joint becomes painful due to the atrophy process.
5. The child cannot keep the pelvis in balance and rolls over when walking from one foot to the other. A “duck walk” is formed, which is practically impossible to correct when the pathology develops.
6. Chronic pain occurs in the lower back, which is forced to cope with colossal overloads. Hyperlordosis develops in the lumbar region.
7. The pelvic organs are subject to constant unnatural mechanical stress. This leads to pain, chronic diseases, damage to the pelvic organs and a general deterioration in their functioning.

It is also possible to completely block the movement of the damaged hip in older age due to further overload of the weakened joint and hormonal changes. This is the most unpleasant option possible, occurring only in advanced cases. In adulthood, this can lead to the development of dysplastic coxarthrosis. This disease requires joint replacement surgery. Otherwise, the person loses his ability to work.

Other consequences

Children with dysplasia always stand on their feet later than their healthy peers. Even the most favorable progression of the disease hopelessly disfigures the gait of children, depriving it of stability. In the absence of timely treatment, the child may list sideways, clubfoot, limp, and awkwardly roll from side to side at the same time.

It is impossible to correct your gait while the bone is popping out of the joint. You can begin to instill new habits only when the treatment procedures begin to bear fruit.

Often children can walk normally only after surgery.

Lack of timely treatment and constant stress on a deformed hip can turn a healthy child into a small disabled person. What you can expect:

1. From the thoracic segment, curvature of the upper spinal column (kyphosis) almost inevitably develops, “balancing” the forward bend of the spine in the lumbar region. Over the years, kyphosis in children progresses, compensating for the increasing lordosis.
2. Children with dysplasia cannot bear prolonged stress because their bodies are constantly forced to cope with the difficult task of maintaining balance.
3. The musculoskeletal system is in constant motion due to hip hypermobility.

Occasionally, a child's body may try to correct the situation on its own by changing the outline of the joint, and the bone will begin to fall into place. The result can be considered self-healing, but such a joint will not allow the deformed limb to move as freely as a healthy one.

Over the years, even children who have not received treatment get used to their situation and learn to live with a disability. But the growing body creates more and more stress on the underdeveloped half. This leads to the development of new diseases in children, including osteochondrosis, and further progression of the pathology. Therefore, it is important to devote all efforts to healing children as quickly as possible, regardless of at what stage the subluxation of the hip joint was discovered.

As children age, the number of available, pain-free treatment options decreases as children's bones grow and become stronger. But there is no age threshold after which dysplasia stops causing pain and deforming the skeleton. Surgical intervention helps even in advanced cases, returning the opportunity to live a full life.

The hip joint takes the main load, as it is the support from the neck to the spine, which is why this formation is the strongest and most powerful.

Due to this, a person maintains balance in any state, in motion or at rest. And if pain occurs in the hip joint, then this is not just discomfort, but a limitation of a person’s mobility.

When visiting the clinic when the leg hurts in the hip joint, the patient can undoubtedly count on professional help and receive orthopedic, osteopathic diagnostics, doctor’s recommendations and a treatment algorithm.

If necessary, the patient receives kinesiotherapeutic treatment. The topic of pain in the hip joint is relevant today; more and more people come to medical institutions with such a complaint.

What can be confused with pain in the hip joint?

The first advice we always give is, of course, to consult a specialist, but you are probably interested in finding out what is happening to you and why, in general, your hip joints may hurt, and what to do.

Many people think that if the hip hurts, then the problem is in the hip joint. They decide to undergo expensive examinations, which ultimately show nothing.

This situation occurs when ailments are caused by problems in a completely different place, for example, in the lumbar spine or in the junction of the pelvis and sacrum and are not associated with pain in the hip joint on the left or right.

Often patients come with such a problem as “a clicking sound in the groin area” when moving. The problem here is not in the bone tissue, but in the tendons and muscles. In a hospital setting, the click can be eliminated by:

• pelvic correction;
• correction;
• lumbar region;
• relaxation of the iliopsoas muscle.

Causes of pain

The most obvious injury is a bruise or fracture. The femoral neck is often fractured because it is the narrowest part of the joint. The risk group includes older people whose bones become thinner and more fragile, as well as patients suffering from osteoporosis. Non-traumatic injuries include the development of diseases:

• arthritis;
• osteoarthritis;
• infectious processes;
• tendon inflammation.

At a certain point, degradative changes in tissue will begin, both in the joint itself and near it, which will lead to severe painful sensations. Pain in the hip joint can be sharp, aching, pulling or throbbing. The area becomes numb or, conversely, a strong burning sensation is felt.

Major diseases causing pain

There may be no obvious signs of damage, but the person feels unbearable pain in the hip joint, the cause of which cannot be explained. However, with load and weather changes, the problem only worsens. The main pathologies that manifest themselves through acute pain in the hip joint:

• Arthritis. It is more common in older people, but recently the younger generation has also been suffering from it. The hip joint is the first to suffer from arthritis; its structure changes. The person feels pain in the groin, legs, lateral thighs and knees;
• Tendinitis. Tendon inflammation. The pain syndrome intensifies with loads, and in their absence a person may not be bothered by anything at all. There is a pulsation and burning sensation;
• Inflammation of the joint capsule. The pain is felt on the lateral surface of the thigh, closer to the buttocks. Inflammation is caused by infectious diseases, destruction of the joint when cartilage enters the liquid environment;
• Infections. It can be caused by influenza virus, streptococcus, or staphylococcus, which quickly attack the compound. The person feels hot and the thighs become swollen. It is impossible to touch the source; a person feels acute pain in the hip joint and pelvic bones, which turns into aching pain when walking. The hip joints may be affected by tuberculosis;
• Perthes disease is hereditary. It mainly affects young boys. Although the pain is mainly located under the kneecap, the hip is also affected.

The presented list is not a guide to self-medication, but only makes it clear what causes acute, aching pain in the hip joint and the reasons for their occurrence.

Based on the symptoms and general condition of a person, only a specialist can make an accurate diagnosis and prescribe effective treatment.

Among the natural factors that cause pain in the hip joint are:

• Pregnancy. It is natural that increased body weight affects the supporting system, which may cause discomfort;
• Postpartum period. The unnatural position of the pelvic bones after childbirth increases pain. This goes away with time.

Destruction of cartilage tissue during coxarthrosis

This disease belongs to the class of degenerative diseases; there are several reasons for its occurrence:

• joint overload;
• impaired blood supply after injury or with age-related changes;
• spine pathologies;
• flat feet and other foot diseases;
• genetic predisposition;
• physical inactivity.

The severity of signs of the disease in coxarthrosis depends on the stage of development, but is always accompanied by restriction in movement.

Often pain in the hip joint radiating to the leg is combined with unpleasant sensations in the knee. It occurs under heavy loads, then under light loads, and at rest.

Muscle atrophy occurs, the leg gradually becomes shorter and the person begins to limp. The thigh muscles gradually atrophy.

A joint problem will not resolve on its own; just because the pain has subsided does not mean it will not return again. And cartilage tends to wear out.

How to remove

When a sudden onset occurs, the first thing that worries a suffering person is how to relieve pain in the hip joint in order to be able to continue to move and feel normal. My patients use a proven remedy that allows them to get rid of pain in 2 weeks without much effort.

You can relieve pain in the hip joint with treatment for a while in several ways, but you should understand that all these are temporary measures. The success of using one method or another depends on the severity of the disease and the cause of pain. Consultation with a doctor is required.

• Medicines. For arthritis, painkillers, anti-inflammatory drugs, sedatives and medications to improve sleep are prescribed;
• Short exercises. To increase joint strength and flexibility, physical activity is necessary, but moderate. After them, the pain subsides, fatigue is reduced and motor function is activated;
• Cold or hot compresses can provide short-term relief and relieve stiffness of movement. For swelling and inflammation, cold baths are used. To relax and increase blood circulation, apply hot compresses;
• Physiotherapy. An individual program is drawn up in the physiotherapy room using massage and thermal treatments;
• Weight control. Weight control will help to significantly reduce the load; in obese people, a colossal load falls on the hip joint;
• Fixing systems. Bandages help reduce pain and improve mobility and stability;
• Assistive devices. The use of canes and orthopedic insoles support motor function and alleviate the human condition;
• Avoid intense exercise. Frequent climbing stairs, skiing, running and other active sports with excessive physical exertion aggravate the fate of diseased joints and aggravate pain. Such activities should be excluded.

How to treat?

To cure a patient, specialists set several tasks that improve his condition:

• pain relief;
• improving the nutrition of bone tissue so that it recovers faster;
• strengthening of periarticular muscles;
• increased blood flow;
• decreased pressure on the femoral head;
• return of mobility.

Complex treatment includes several types and stages; this is the only way to achieve the best result in eliminating hip joint disease and symptoms. Rather than temporarily relieve pain, it is better to deal with the cause of its occurrence.

Medication assistance

Doctor prescribing painkillers, for example, ketoprofen, indomethacin, diclofenac, butadione. You should not prescribe therapy on your own, since incorrect or excessively long-term use contributes to the destruction of bone tissue.

Therefore, instead of self-medication, you need to choose professional help in order not only to relieve discomfort for a while, but also what causes pain in the hip joints and the reasons. And the treatment must also be special.

To restore the structure of bone tissue and its nutrition, chondroprotectors are prescribed. These drugs are considered the most effective in the treatment of arthrosis. They fight the cause of the disease and eliminate pain syndromes, improving fluid production in the joints.

Manual therapy and exercise therapy

Therapy is not used as a separate type of treatment; its effectiveness will be negligible, but in combination with other methods, patients experience visible improvements in their condition. Methods of influence:

• Manipulation. Sharp, short movements;
• Mobilization. Gentle traction of the hip joint.

There are a number of contraindications for the use of exercise therapy. Electrophoresis and laser therapy are also used as anti-inflammatory, analgesic and therapeutic agents. Physiotherapy is prescribed after the exacerbation of the disease has passed.

Surgery

Some diseases that cause pain in the hip joint, such as arthrosis, require surgery. When the decrease in mobility reaches the “critical” stage and there is a threat of complete loss of functionality of the joint.

In this case, the hyaline cartilage is destroyed and the structure of the bone tissue changes. The hip joint may be completely replaced with an artificial mechanism, or measures may be taken to stabilize it.

Night pain

Sleep becomes impossible and the psychological state is unbalanced when pain in the hip joint occurs at night. This entails such unpleasant consequences as:

• chronic fatigue;
• depression;
• anxiety;
• aggressiveness;
• inattention.

Due to daytime worries, pain in the leg in the hip joint area may not be felt as strongly as at night, when a person’s activity has stopped and all feelings are focused on one’s own physical condition.

However, pain syndromes are a sign of an oncoming illness. Another reason why the hip joint hurts at night is osteochondrosis - pinching of the sciatic nerve.

Aseptic necrosis

Necrosis of the head is a consequence of improper metabolic processes and blood circulation. As a result, the bone substance of the femur begins to die in the places where it is adjacent to the acetabulum.

Pain in the area of ​​the hip joint on the left or right side can appear at any time and at any age, due to damage to the joint itself or to the bone tissue, cartilage, and ligaments located next to it.

Often the symptoms are accompanied by numbness and limited movement of the entire support, as well as severe pain in the leg in the hip joint. Only a doctor can tell you what to do in this case, so delaying going to see him can be dangerous to your health.

Pain in the hip joint on the left or right can also occur in infants. Pathology of the pelvic bones develops in the womb. The diagnosis is called “congenital dislocation of the hip joint.”

In the first weeks after birth, infants must be carefully examined to identify all possible problems and developmental abnormalities. The sooner doctors detect possible “problems” in the baby’s body, the faster they can be dealt with and the number of dangerous health consequences can be reduced to a minimum.

Along with such important specialists for the baby as a neurologist and an ophthalmologist, the child must be examined by an orthopedist. The first visit to an orthopedist is usually made when the baby is 1 month old.

When, after the examination, the specialist writes a soothing “healthy” on the card, parents can calm down a little. But it happens that a mother’s legs give way when she hears in the orthopedist’s office: “Suspected hip dysplasia.” Such a diagnosis sounds menacing, but before you panic, you should understand the essence of the disease, the causes that cause it, and also learn about treatment methods.

What is the pathology of joint development?

Dysplasia is the incorrect development of the hip joint, in which the articular structures are not formed or are formed late, which leads to its inferiority. What does it look like?

The mobility and proper functioning of the hip joint depends on the interaction of the head of the femur and the socket of the joint, as well as the articular ligaments. In a newborn, the hip joint is an immature structure. It is characterized by a flat acetabulum with a vertical orientation and excessive elasticity of the articular ligaments. The head of the femur is able to be held in the socket only by its own capsule. To prevent displacement, the joint is also held in place by a cartilaginous plate of the socket called the limbus. As the child grows and the joints develop, the socket becomes rounded, the ligaments become stronger, and all joint structures begin to function normally.

But with slow or insufficient tissue development, the hip joint begins to form with deviations, if the articular cavity is very sloping or too flat, the ligaments and limbus are not able to hold the head of the femur in the correct position. When moving, the head may partially or completely come out of the socket, everting the limbus. The acetabulum may be partially closed by connective or fatty tissue.

In addition to abnormal development of the acetabulum or ligaments, there may be abnormal development of the joint bone, in which the position of the joint and the socket relative to each other is incorrect. Because of this, the load on the joint is distributed incorrectly, and the joint develops abnormally.

Doctors tend to combine all disorders of the hip joint caused by improper development of its components (acetabulum, ligaments, bones of the joint) into a general group called “hip dysplasia.” Previously, due to imperfect diagnostic methods, doctors could only determine hip dislocation, in which the head of the hip joint lost contact with the acetabulum. Currently, dysplasia refers to changes in the hip joints that precede dislocation.

Symptoms and causes of dysplasia

Recently, cases of hip dysplasia in children, unfortunately, have become more frequent. If earlier cases of dysplasia were observed in 2-3 newborns out of a thousand, now in some countries the number of babies with disorders of the hip joints reaches two hundred per thousand. Some are inclined to associate this with the deterioration of the environmental situation, but there are a number of other factors that can affect the occurrence and development of hip dysplasia in a child. Let's take a closer look at them.

1. Hip dysplasia in newborns is one of the diseases where influence of hereditary factor quite significant. So, if there have been cases of dysplasia in the family, then the probability of its manifestation in children in subsequent generations is very high. Moreover, disorders of the hip joints are transmitted mainly through the female line. In girls, dysplasia is observed much more often than in boys, in approximately 70% of cases.
2. Another common cause of dysplasia is intrauterine disorders in fetal development . If the expectant mother suffered from severe toxicosis, did not eat properly or adequately, then the child does not receive enough nutrients. This negatively affects the formation of the baby’s bone and connective tissues, and as a result, the potential for the proper development of children’s joints is not laid.
3. Wish give birth to a child in adulthood – a decision that requires real courage. However, future children of mothers over 40 years of age are more likely to suffer from various abnormalities, among which hip dysplasia is not uncommon.
4. Disturbances in the formation of the hip joints can occur in children who are in the prenatal period. breech . Particularly risky is the presentation of the child, in which the legs at the hip joints are bent and raised high.

However, you should not worry too much: even if one of the risk factors is present during pregnancy, this does not mean that the baby will certainly be born with dysplasia. It is not uncommon for a mother to pass on hip dysplasia to her daughter, but her children turned out to be completely healthy. However, the presence of a history of such a disease in the mother and her relatives requires close attention to the child, since such children are at risk.

It is extremely difficult to notice dysplasia in a newborn, so in the earliest period of the baby’s life, doctors do not take upon themselves the opportunity to make an accurate diagnosis. But by the eighth week of life, pathology in children can be identified or suspected based on the following classic signs:

• asymmetry of folds on the child’s legs. Previously, this was one of the most obvious clinical symptoms of dysplasia. In a child with articular disorders, the folds on the legs brought together do not coincide; their depth and length are also different. This is why many mothers begin to sound the alarm, studying the child’s legs on their own. However, you should pay attention to the following: only the asymmetry of the inguinal and popliteal folds, as well as the folds under the butt, will be informative. The folds on the hips may not coincide even in absolutely healthy babies. So it is appropriate to leave the assessment of the fold pattern to the orthopedist;
• difficulty abducting the hip to the side. The legs of a healthy baby can be easily bent at the knees and spread at the hip joints so that they touch the surface of the table, while the angle between the body and the joint will normally be 80–90 degrees. If one leg (in rare cases, both) cannot be moved to the side, there is every reason to assume that the baby has dysplasia or even a dislocated hip. However, this sign is not always reliable. If the baby is excited, nervous or scared, he will resist any manipulation of his legs, and it will not be easy to move them apart;
• Another symptom of hip dysplasia in children is the so-called short hip syndrome. If the child's legs are bent at the knees and hip joints, then in case of violations one knee will be lower. This is a symptom of a severe form of dysplasia - hip dislocation;
• An informative indicator that guides orthopedists when making a diagnosis is the sliding (clicking) symptom, also known as Marx-Ortolani syndrome. It manifests itself as follows: when the child’s bent legs are moved to the sides and brought back to their original state in case of hip dysplasia, a slight click is heard. It is a sign that the head of the joint, which has lost contact with the acetabulum, has returned to it and moved away again. This sign disappears when the baby turns one month old, so it is informative only for the first few weeks of the child’s life.

In any case, you should never diagnose hip disorders in a child yourself. Only an orthopedist can interpret the symptoms of dysplasia and accurately determine the presence of disorders.

Degrees of dysplasia

Based on the disruption of the interaction between the femoral head and the acetabulum, the following degrees of development of pathology are distinguished:

1st degree– the head of the joint is excessively mobile, but does not extend beyond the acetabulum (the so-called pre-dislocation of the hip).

2nd degree– significant displacement of the joint head within the glenoid cavity (hip subluxation).

3rd degree- congenital dislocation of the hip: the head of the hip joint extends beyond the acetabulum.

Grade 1 hip dysplasia is observed quite often in children during the newborn period. In some cases, it goes away on its own, but such children still constitute a risk group and should be closely monitored by an orthopedist.

Diagnostics

In the first weeks and months of your baby’s life, you should under no circumstances neglect visits to specialist doctors. This is especially true for an orthopedic doctor, because the sooner violations in the formation of the hip joint are identified, the more effective the measures taken will be.

Before six months, a child, even if he seems healthy, should visit an orthopedist three times: at 1, 3 and 6 months. The doctor, examining the baby, will be able to determine the presence or absence of disorders based on the clinical symptoms described above. However, the most reliable diagnosis will be based on all possible examination methods.

In addition to a medical examination, diagnosis of the development of hip joints in children is carried out using two methods: ultrasound and x-ray examination.

Ultrasonography hip joints is carried out in children under 3 months. This is a reliable diagnostic method that allows you to see both direct hip dislocation and predict the possible risk. Ultrasound is an accurate method and safe for the child.

Many mothers are frightened by incomprehensible words and numbers in the ultrasound protocol. Often, specialists conducting ultrasound examinations are not too verbose and refrain from commenting. Before visiting a doctor, especially impressionable mothers may be in a state close to panic. However, the study protocol is quite simple to understand. As a rule, it indicates the following parameters: the shape of the bony roof (the upper part of the glenoid cavity), the angle α (shows the development of the bony roof), the angle β (shows the development of the cartilaginous roof), the change in the limbus and the centering of the femoral head. Based on these parameters, the conclusion could be as follows:

1. Angle α is greater than 60⁰, angle β is less than 55⁰, the bony roof is square, the limbus is not changed, and the head is centered - type 1, a correctly formed joint.
2. Angle α 43–47⁰, angle β 70–77⁰, the bony roof is rounded and short, the limbus is not changed, and the head of the joint is slightly displaced - type 2, mild dysplasia, predislocation of the hip. If the head of the joint is centered, they do not speak of preluxation, but of delayed development of the joint.
3. Angle α is greater than 43⁰, angle β is greater than 77⁰, the bony roof is beveled and slightly concave, the limbus is short and deformed, the head of the joint is displaced - type 3, hip subluxation.
4. Angle α 43⁰, angle β 77⁰, the bony roof is beveled and strongly concave, the limbus is deformed, short and compressed, the femoral head is displaced - type 4, hip dislocation.

X-ray examination Hip joint tests are usually carried out in infants closer to 6 months; in earlier periods it is not entirely reliable, since the joint in the first months consists mainly of cartilage tissue, invisible on x-rays. The doctor determines the presence of dysplasia by measuring the angles between the elements of the joint.

Treatment

Early diagnosis of the disease is very important, because the earlier treatment for dysplasia is started, the more effective the result will be. For example, detection of joint pathology in a child at 6 months can lead to treatment that lasts several years and does not always bring complete recovery. That is why it is necessary to determine the presence of disorders in the first two months of the baby’s life.

Consequences of untreated dysplasia extremely severe: severe gait disturbances, frequent pain, early disability. Treatment of pathology after a year will no longer be effective. Early detection of the problem and active treatment are the principles of combating dysplasia. Only in this case can the consequences of pathology be alleviated or completely reduced to zero.

Treatment should be comprehensive, using special devices that provide extension and flexion of the baby’s legs, massage and therapeutic exercises. The following orthopedic devices are widely used.

• Pavlik stirrups are a device invented by the Czech orthopedist Pavlik at the beginning of the last century. It is made of soft fabric and consists of leg bending straps and a chest bandage. Ensures the correct position of the head of the joint in the socket, and over time the position of the hip joint is corrected. The good thing about the device is that it does not completely limit the child’s movements - he just cannot straighten and close his legs. Depending on the age, Pavlik stirrups are put on differently, so the first time putting them on should be done by a doctor;
• Freika's pillow is a splint that fits between the child's legs and is secured using waist and shoulder belts. The legs are wide apart and bent at the knees. The degree of separation of the legs and the duration of wearing the Freik pillow are determined only by an orthopedist;
• The Vilensky splint (better known as a spacer) has the form of a metal pipe with a spreader width adjuster and leather cuffs with lacing. The width of the spread is regulated by the doctor. You need to wear the splint around the clock for 4–9 months, removing it only when swimming;
• The Volkov splint is a complex plastic structure of several parts, reminiscent of a corset. Provides complete immobility of joints.

At first glance, most of these devices seem barbaric, and looking at the child’s discomfort in the spacers, parents are overcome with pity. But treating hip dysplasia in children is not an easy process. You should be patient: these inconveniences are for the good, because in advanced forms, surgical methods are used, after which the child is forced to spend up to six months in a cast. So tires, stirrups and cushions are not the biggest problem, but for the sake of your health you can endure it. The consequences of hip dysplasia in children bring much more suffering.

Additional measures

Complete treatment of dysplasia is impossible without massage. The complex of massage movements includes rubbing, spiral stroking, kneading, careful bending and spreading of the child’s legs. For a high-quality and effective massage, you need to contact a specialist and undergo a full course of procedures.

Therapeutic exercises are also a necessary measure. The exercises are performed together with massage and include bending and spreading the child’s legs, bending and pressing the legs to the stomach, rotating movements of the joints, kneading and stroking the surface of the joints. Gymnastics stimulates blood circulation, improves joint mobility and normalizes muscle tone. The therapeutic effect will be noticeable only with regular exercise.

Another well-known measure for the treatment and prevention of dysplasia is wide swaddling. There is a version that severe forms of pathology in the last century were provoked by tight swaddling, when the child’s legs were tightly pressed together. In fact, the risk of dysplasia and its mild forms can be corrected in the first weeks of life with the help of wide swaddling. It is simple to do: before swaddling the baby, you need to place two folded diapers between his legs. This will ensure a slight separation of the legs and normalize the position of the joint.

Prevention

As mentioned above, mild dysplasia can be corrected in the first weeks of a child’s life without additional devices. Therefore, it is advisable from the birth of the baby to take care of the proper development of joints with the help of simple preventive measures.

1. There is no need to swaddle the baby by moving his legs tightly. The best option is loose or the wide swaddling mentioned above.
2. It is necessary to carry a child in your arms correctly. The baby should cling to the adult with his whole body, legs spread wide.
3. A restorative massage is a must! In this case, special attention should be paid to the “bicycle” exercise, in which the child’s legs alternately bend and unbend, simulating pedaling.
4. It is advisable to lay the baby in such a way that his feet hang freely. This will help relax your thigh muscles and avoid putting unnecessary strain on your joints.

Obviously, hip dysplasia in a child is not a death sentence. But, unfortunately, only on the condition that she was noticed on time, and the treatment was complete, persistent and comprehensive. Therefore, it is important to closely monitor the child’s development, visit specialists in a timely manner and carefully follow their recommendations. And then the baby’s first steps will become one of the happiest events in life!

We recommend viewing: Dr. Komarovsky about hip dysplasia in children

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Malformations of the skeleton and connective tissues, if not treated in time, can cause many serious problems and cause significant discomfort to their owner. Congenital hip dislocation or hip dysplasia is a common diagnosis. Find out why this disease is dangerous, how to treat congenital pathologies of the pelvic bones and what to do during the rehabilitation period.

What is hip dysplasia

The femur bed consists of the ilium, which is lined with cartilage tissue and is called the acetabulum. The cavity of the bed contains the head of the femur, and ligaments form around it. This is a kind of capsule that helps the head of the femur to be held inside the bed with a standard tilt of the acetabulum. Any violation of biomechanics - joint hypermobility, insufficient ossification of the heads, violation of the femoral axis - is considered dysplasia.

In newborns

Hip dislocation in infants is manifested by a disturbance during the development of one or more of its immature joints. In this case, the elasticity of the cartilage is lost, the acetabulum is leveled, and the femoral head becomes soft. Over time, bones become shorter or begin to grow in the wrong direction. Depending on the displacement of the structures, this pathology is characterized as dislocation or subluxation.

Hip dysplasia in newborns is much more common than a similar problem in adults. At the same time, late ossification appears more often in girls. In almost half of the cases, the left side of the body suffers from underdevelopment of the hip organs, and bilateral disease accounts for only 20%. Scientists believe that the disease is provoked by pregnancy pathologies, pelvic position of the fetus, heredity, and poor fetal mobility.

In children after one year

It is easy to identify the disease in a one-year-old baby, because by this time children begin to sit, walk and crawl on their own. In this case, a limp may appear on the leg on the side of which the pelvic pathology is located. If the hip dislocation is bilateral, the child walks with a duck gait. In addition, in sick children the gluteal muscle decreases in size, and when pressure is applied to the heel in a lying position, mobility of the leg axis from the foot to the thigh is observed.

In adults

The geometry of the joint in adults can be disrupted due to injury or be a continuation of a childhood illness. This occurs due to intrauterine disorders, as a consequence of complications during difficult childbirth, or with pathologies of the body’s endocrine system. Treatment for adults is longer and more complex. Very often standard methods of therapy are not enough, then doctors recommend joint replacement.

Reasons

Doctors believe that congenital hip dislocation can occur for various reasons. For example, scientists have recently found that unfavorable natural conditions, hereditary factors, and frequent stress can contribute to the development of this pathology and aggravate treatment. The main reasons are:

• breech presentation of the fetus;
• the newborn is too heavy;
• maternal infectious diseases;
• tight swaddling;
• joint injuries;
• deviations in the development of the spine;
• foot deformity;
• spinal cord pathologies;
• hormonal disorders;
• restriction of intrauterine movements of the fetus;
• The age of the woman giving birth is over 35 years.

Species

Hip dislocations can be unilateral or bilateral, the latter being very rare. In addition, doctors divide pathology into three main types:

• Acetabular dysplasia. Symptoms: the acetabulum is of non-standard size, usually reduced in diameter, has a flat base and an underdeveloped cartilaginous dome.
• Dislocation of the femur. Normally, the femoral neck connects to the body at an angle of 40 degrees in adults and 60 degrees in newborns. Violation of the angle leads to dislocation.
• Rotational dysplasia. Described as a violation of the anatomical structure and placement of bones. It manifests itself in children in the form of clubfoot, shortening of the limb.

Degrees of dysplasia in children

Doctors distinguish several stages of development of disorders of the geometry of the hip joint, depending on the severity. These include:

• Initial stage. When structural changes have already begun, but have not yet developed to such a point that the doctor can make a diagnosis after a visual examination.
• Pre-dislocation. It is characterized by stretching of the capsule and a slight displacement of the femoral head.
• Subluxation of the hip. The head of the joint is noticeably displaced in relation to the trochanteric cavity. It moves the rim slightly, causing the hip ligaments to become stretched.
• Dislocation. The head is located outside the acetabulum, up and out. The edge of the cartilaginous rim is pressed and bent inward. The supporting elastic ligaments have lost their flexibility.

Why is hip dysplasia dangerous in children?

An undiagnosed dislocation can cause serious disturbances in the structure of the hip organ and many unpleasant symptoms. With unilateral dislocation, children experience gait disturbance, limited mobility, pelvic distortion, pain in the knees and hip, and mild muscle atrophy. If bilateral dysplasia has been diagnosed in a child, you may notice a duck gait, deterioration in the functions of the internal organs of the small pelvis, and the appearance of pain in the lumbar region.

For adults, the consequences of dysplasia are fraught with arthrosis of the hip joint and dysplastic coxarthrosis. The latter pathology of the musculoskeletal system is characterized by a decrease in physical activity, deterioration of muscle condition, pain in the back, legs, and hips. Sometimes, at the place where the femur comes into contact with the pelvic bone, a growth of a false joint is observed - neoarthrosis. Clinical symptoms manifest themselves in the form of acute pain, lameness, and shortening of one leg. Neoarthrosis is often observed in other connective tissues and can lead to disability.

Signs in infants

It is advisable to carry out visual diagnostics up to seven days after birth. At this stage, the baby's muscle ligaments are relaxed, more mobile and elastic. Doctors may suspect hip dislocation in children at risk: girls, breech babies, newborns from mothers with severe toxicosis, or when the child was born with a large weight. At the same time, external signs of hip dysplasia in infants may be absent. The diagnosis is usually made according to three main criteria.

Asymmetry of skin folds

The skin folds under the knee, in the groin, on the back and front of the thigh should be a mirror image of each other: they should be the same size and depth. If, when lying on your stomach, the depressions are located higher than each other, there is a high probability that the symptom indicates instability of the joints. Do not forget that slight asymmetry can occur even in healthy children. The criterion for diagnosing gluteal folds is not objective for bilateral disorders.

Clicking symptom

This sign is considered the most reliable only when the disease is diagnosed no later than 3 weeks after birth. If the head of the femur moves when the hip is abducted or the rotation of the leg is accompanied by a click, this indicates that the head has slipped from the joint capsule. To identify dysplasia in older children, it is advisable to use more informative examination methods.

Hip abduction angle

Another symptom of congenital dislocation is the inability to spread the child’s legs when lying on his back at an angle of 90 degrees. An unhealthy hip of grade 2 or 3 is characterized by an angle of inclination of no more than 60 degrees. This symptom can be found between 3 and 6 weeks of age. When muscle tone is increased, achieving the desired result will be problematic.

How to identify hip dysplasia in newborns

If clinical diagnostic methods do not give a definite answer, the orthopedic doctor will prescribe additional examinations: radiography or ultrasound. Both methods help to detect underdevelopment of the acetabulum, deviations in the structure of the neck, head or bone. In cases where this does not produce results, they resort to magnetic resonance imaging or CT.

X-ray diagnostics

X-ray exposure of the bone skeleton, although it creates a serious radiation load on the child’s body, also helps to obtain a picture of the structure of the acetabulum and head. In newborns and young children, most of the hip joints consist of cartilage, so the study is carried out in a special way. The image is drawn with horizontal and vertical lines to form a cetabular angle. Its size is the basis for making a diagnosis.

Ultrasound diagnostics

The method is considered as safe as possible. Doctors conduct an initial examination up to 7 days after birth for children who are predisposed to developing pathology. Subsequently, using an ultrasound machine of the hip joints, the condition of the bone part, the cartilaginous protrusion is monitored, the position of the femoral head at rest and during movement is studied, and the angle of inclination of the acetabulum is calculated. To interpret the data obtained, fixed norm tables are used.

Treatment of dysplasia in children

Therapy for congenital joint dislocation will be more successful the earlier it is started. Treatment is always carried out comprehensively using therapeutic exercises, physiotherapeutic procedures, special spacers, orthopedic splints and massage. Complete restoration of the anatomical structure of the hip joints will take a long time. On average, doctors give prognoses from two months to a year, but sometimes the treatment regimen is extended.

Wide swaddling of baby

One of the effective treatment methods in the first days of a baby’s life is the fixed swaddling technique. To do this, place a soft diaper, folded several times, on the perineum and secure it with another cloth. Due to this, the baby’s legs remain constantly in the spread position of extension/flexion at the desired angle. If dysplasia in children was detected at a late stage, the legs are additionally secured with a plaster cast.

Pavlik stirrups

The principle of this method is based on fixing the bend of the legs at the knees using stirrups. The Pavlik device is produced ready for use - it is a chest bandage made of soft tissue, with shoulder and popliteal straps for fixing the limbs. You need to wear the bandage for about a month. If the results of the control examination are unsatisfactory, the dislocation is reduced under anesthesia, and stirrups continue to be worn for another 5-6 months. The Pavlik design cannot be used for:

• pronounced displacement of the femoral head;
• infringement of the capsule;
• significant disturbances in the structure of the acetabulum.

Massage

Therapeutic massage helps speed up blood circulation, strengthen the hip muscle groups, and improve the trophism of the ligamentous apparatus. The technique involves the use of gentle stroking, tapping or rubbing movements. Massage is done daily. First, knead the chest, upper and lower parts of the body, and stomach. Then they smoothly move on to massage the inner thighs, bend and move their legs to the sides, and move their limbs in a circle.

Physiotherapy

To improve metabolic processes in tissues and normalize blood circulation in the damaged area, physiotherapy is used. Various techniques help eliminate pain and muscle spasms. For children, as a rule, choose:

• warm baths;
• ultraviolet irradiation;
• paraffin or ozokerite compresses;
• electrophoresis with calcium, phosphorus or iodine.

Reduction of congenital hip dislocation

When conservative treatment of dysplasia does not help, the doctor may suggest a joint correction procedure - closed reduction of the dislocation. As a rule, this method will give the desired effect when treating children under two years of age. Afterwards, bloodless reduction will be technically difficult to perform, so for children over 3 years of age, head reduction is done using skeletal traction. After the procedure, plaster casts will be placed on the legs for rigid fixation, which must be worn for up to 6 months.

Surgery

The operation is indicated for children for whom all of the above methods have not helped. Its essence is to arrange all the components of the hip part in the right direction. There are a lot of surgical treatment methods: open reduction of a dislocation, corrective surgery, derotational osteotomy, joint replacement surgery, etc. The choice of the best method depends on the degree of deformation of the pelvic cavity and the elasticity of the ligaments.

Treatment of dysplasia in adults

To relieve chronic pain and reduce inflammation, drugs from the NSAID group are used, for example, Ketoprofen, Naproxen, Ibuprofen or Diclofenac. To prevent complications or treat osteoarthritis, neoarthrosis, and to prevent the development of coxarthrosis, chondoprotectors are prescribed: Rumalon, Arteparon and other intramuscular injections. Exercise therapy exercises eliminate defects and prevent dysplasia.

Exercises

The goal of gymnastics is to strengthen muscles and improve motor activity. Exercise therapy is used at all stages of treatment, except for surgery (immediately before and after). It is recommended to do the exercises 2-3 times daily; during rest breaks you can stretch your limbs with a massage. An approximate set of exercises:

• Take a “lying on your back” position. Bend your knees. On the count of three, begin to imitate riding a bicycle by moving your legs back and forth. You need to repeat the gymnastics 10-15 times.
• From the same body position, try to bring your feet as close to each other as possible.
• Do alternate flexion and extension of your legs, equally distributing the load on both limbs.

Video

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 (for 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 refers to congenital pathologies 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 lesions, 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 a healthy adult, the head of the femur fits completely in 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 musculoskeletal disorders, such as:

• flatvalgus feet;
• chest deformation;
• valgus curvature of the legs (“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 of the head against the cartilage disc, its deformation occurs; 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 gluteal muscles become the support of the head (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, with 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. An 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 the 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. At a younger age, the joint consists mainly of cartilage, which is not 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, the doctor prescribes computed tomography or magnetic resonance imaging to more accurately study the geometry of the joint. 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.

Diseases of the hip joints - clinical picture and treatment

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;
• Freyka type pillows;
• 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 to 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 shows 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 (hydrokinesotherapy), which is quite effective in children under 1 year of age;
• electrophoresis with solutions of calcium chloride and aminophylline;
• salt baths.

Orthopedic devices lead to limitation of the child’s physical development, but the lack of timely treatment in the future will lead to more serious consequences (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 subluxations of the hip often form.

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. The knee joint is deformed, and the head of the hip joint, displaced back, provokes a constant forward tilt of the body (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.