Dysplasia of the hip joints. Hip dysplasia in newborns and children under one year old: signs, treatment and consequences

Baby on the tummy. Starting position - the baby lies on his stomach. You grab the child's feet and try to bring the heels to the buttocks. It should look like a frog. In this case, you can slightly press the buttocks to the table. The number of times a day is about 100-150.

Stroking and rubbing. A light massage of the buttocks and thighs in the form of stroking and rubbing for 10 minutes a day can also be done by a mother, but it is better to entrust a more intense massage with kneading to a professional children's masseur when the baby is already more than 2 months old. Naturally, the orthopedist must be seen at the age of 1, 3 and 6 months.

Sources: spine5.com, deti.health-ua.org, orthoped.in.ua, www.mif-ua.com, doctorignatyev.com, asclepion.ru, www.medplus24.ru, 5gdp.by, www.moirebenok. ua

megan92 () 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the effect, and not with the cause ...

Daria () 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. So it goes

megan92 () 13 days ago

Daria () 12 days ago

megan92, so I wrote in my first comment) I will duplicate it just in case - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why sell online?

Yulek26 (Tver) 10 days ago

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

Editorial response 10 days ago

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

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then everything is in order for sure, if the payment is upon receipt. Thanks!!

Margo (Ulyanovsk) 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman suffers from pain ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped ...

Ekaterina a week ago

I tried to drink a decoction of bay leaves, to no avail, only ruined my stomach !! I no longer believe in these folk methods ...

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this Federal program for the fight against diseases of the joints spoke. It is also headed by some well-known Chinese professor. They say that they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient.

Do not ignore such a pathology as "Hip Dysplasia". If treatment is not started before the child's bones are strong, then most likely he will remain an invalid with a "duck walk".

From this article you will learn about what kind of disease it is, what this ailment can cause, how to recognize dysplasia, and most importantly, get acquainted with the methods of treating a disease that can cost a child a happy childhood, adaptation in society and many happy moments.

This article will be useful primarily to parents who are planning or who have completely infants. In most cases, dysplasia affects girls and can be caused by both heredity and trauma at such a fragile age.

Hip dysplasia in children - a description of the disease

When a pediatrician makes a diagnosis of "hip dysplasia", it is understood that the infant has a congenital pathology in the development of the elements of the hip joint.

Subsequently, if adequate treatment is not applied, this can lead to gait disturbance, constant back and joint pain, spinal curvature, pelvic displacement and, in the end, to a wheelchair. Hip dysplasia in newborns indicates the underdevelopment of all elements of the joint, as well as their incorrect comparison.

Dysplasia is a congenital inferiority of the hip joint, associated with the abnormal development of its constituent structures: the muscular-ligamentous apparatus, the articular surfaces of the pelvis and the head of the femur. Due to a violation of the growth of joint structures, the femoral head is displaced relative to the articular surface of the pelvis (subluxation, dislocation).

Surgeons and orthopedists under the concept of "hip dysplasia" combine several diseases:

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

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

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

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

Pathogenesis - the course of a disease

There are several theories of the occurrence of hip dysplasia, but the most reasonable are genetic (in 25-30% there is heredity through the female line) and hormonal (impact on the ligaments of sex hormones before childbirth).

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

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

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

In the last months of pregnancy, the mobility of the hip joint can be significantly limited if there is a threat of abortion more often in primiparas, in the case of breech presentation, oligohydramnios and a large fetus.

To date, the following risk factors for hip dysplasia are distinguished:

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

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

Classification of hip dysplasia

1. preluxation;
2. subluxation;
3. hip dislocation.

• Pre-luxation and subluxation occurs in every 2-3rd child, it is unilateral and bilateral and occurs almost painlessly in childhood, while the child can freely walk, run and even jump, while parents do not notice almost any deviations, with the exception of clubfoot, valgus feet, scoliotic posture. With pre-dislocation - the femoral head can be freely moved inside the joint, while the ligaments surrounding the joint are weakened, instability is formed.
• Subluxation - the head of the femur can pop out and return to its place in the joint, while, as a rule, a dull click is heard.
• Dislocation is an extremely rare occurrence, one in 1000 children born has such a pathology. In a dislocation, the head of the femur lies outside the joint.

It is on these three types in modern medicine that it is customary to divide hip dysplasia.

Causes of dysplasia in newborns

Here, the opinions of doctors differ: some experts insist on a genetic factor, while gynecologists and obstetricians talk about malformations of the child’s joints even in the early stages of the mother’s pregnancy, which, according to doctors, is promoted by addictions, poor ecology, malnutrition, as well as infectious diseases.

In this case, terminology is indispensable. Let us describe one of the mechanisms of the origin of dysplasia in children. With functional blocking in the cervical spine (which occurs during childbirth and after), the upper lobe of the trapezius muscle is tense, while tension occurs in the lower lobe, in the thoracic spine, blocking subsequently occurs in the lumbosacral and ilio-sacral joints.

As a result of this, the iliac crest rises higher on one side, the pelvis is distorted (twisted pelvis). What kind of stirrups in this case can we talk about if on one side the leg looks shorter than the other. Accordingly, the femoral head, in relation to the other, is located asymmetrically.

Any dynamic load in this case is painful. And no massage, and no orthopedic devices will correct this situation. Lost every hour, every day, not to mention weeks and months.

And if we also recall the displacement in the cervical region, which leads to impaired cerebral circulation and recall the hypothalamus, which regulates the production of hormones by other glands, including the production of hormones responsible for normal growth and full development, then it becomes scary.

As you can see, the treatment should be comprehensive, thanks to the use of manual diagnostics and therapy methods, many problems can be successfully corrected without expecting an aggravation of the process.

Common causes of dysplasia include:

• Difficult delivery and breech presentation of the child in the womb (occurs 10 times more often than in the normal course of the birth process and the position of the baby). In 80% of cases it occurs in girls.
• Tight swaddling. Pediatricians almost unanimously argue that young parents should give up tight swaddling, which constrains the movements of the child. The fact is that the fragile joints of the crumbs will constantly be in an immobilized position, which can lead to their deformation - displacement of the joint from the acetabulum. Even statistics speak of the need to abandon "cocoonization": in southern countries, where mothers do not swaddle babies, hip dysplasia is 80% less common than in northern ones. After tight swaddling was banned in Japan, the percentage of dysplasia dropped from 3 to 0.2.
• Hormonal disorders. In the third trimester of pregnancy in the mother's body, the hormone progesterone begins to be produced in excess, which is necessary to relax the ligaments of the articular apparatus - a kind of preparation for the birth of a child. Having a positive effect on the mother, the high level of the hormone can harm the baby, provoking the underdevelopment of the joints. A high level of oxytocin also has a very negative effect, which increases the tone of the muscles of the fetus, which leads to a dislocation of the joint. Experts insist on the hormonal factor in the development of dysplasia, because it is more common in girls who are physiologically very sensitive to changes in the mother's hormonal background.

Other causes of dysplasia include: insufficient consumption of pregnant foods containing phosphorus, calcium, iodine and iron, as well as vitamins E and B; oligohydramnios, increased uterine tone and large fetal size.

Symptoms of the disease

That should alert parents. Up to 1 month. Increased tone of the back muscles, visually one leg is shorter than the other, an additional fold on the buttock, asymmetry of the gluteal folds and buttocks, incomplete dilution of the legs, with bent knees. The position of the body of the child is C-shaped, the head is held on one side, often the child holds a clenched fist on one hand.

3 - 4 months. When bending the legs in the knee and hip joints, a click is often heard, a flat-valgus foot (the heel is not in line with the lower leg). One leg is visually shorter than the other.
6 months and older.

The habit of getting up and walking on toes, when walking, the toes of one or two legs are turned in or out, clubfoot. Excessive curvature of the spine in the lumbar region - horizontal pelvis, gait, "like a duck." Visual slight curvature of the spine, stoop. One leg is shorter than the other due to the sloping pelvis.

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

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

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

Diagnosis of pathology

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

The most difficult is the diagnosis of predislocation. On examination, in this case, asymmetry of the folds and a click symptom can be detected. Sometimes there are no external symptoms.
With subluxations, asymmetry of the folds, a click symptom and limitation of hip abduction are detected.

In some cases, there is a slight shortening of the limb. The dislocation has a more pronounced clinic, and even parents can notice the symptoms of the pathology. To confirm the diagnosis, additional examination methods are carried out - ultrasound and radiography of the hip joints.

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

An indication for ultrasound of the hip joints up to 4 months of age is the identification of one or more symptoms of dysplasia (click, limitation of hip abduction, asymmetry of the folds), aggravated family history, childbirth in breech presentation (even in the absence of clinical manifestations).

X-ray of the hip joints is an affordable and relatively cheap diagnostic method, however, to date, its use is limited due to the danger of radiation, and the inability to image the cartilaginous head of the femur. During the first 3 months of life, when the heads of the femurs are made of cartilage, the radiograph is not an accurate diagnostic method.

From 4 to 6 months of age, when ossification nuclei appear in the femoral head, radiographs become a more reliable way to detect dysplasia. X-rays are prescribed to assess the condition of the joints in children with a clinical diagnosis of hip dysplasia, to monitor the development of the joint after treatment, and to assess its long-term results.

It is not worth refusing to undergo this examination, fearing the harmful effects of x-ray exposure, since undiagnosed dysplasia has much more serious consequences than x-rays.

The difficulty of identifying the disease in infants in the early stages lies in the lack of expression of key symptoms, which is why, at the birth of a baby, a pediatrician carefully examines him to identify any pathologies. If there is a suspicion of a pathology of the hip joint, a referral for ultrasound diagnostics is issued. According to the plan, such diagnostics are carried out at 1, 3, 6 and 12 months.

In addition, you can determine the presence of pathology in a child yourself:

• Lay the baby on the back, bend the legs at a right angle at the knees and hip joints and gently spread them apart. If there is some discomfort and restriction in movement, if the legs do not touch the surface asymmetrically, the child should be urgently shown to the orthopedist.
• Asymmetric folds on the baby's ass and hips. To check, put the baby on his tummy and straighten his legs. Also, this symptom should be attributed to the unequal length of the legs.
• Clicking sounds when turning the hip. The “slip symptom” is defined as follows: put the child on the back, bend the legs at the right angle at the knees and hip joints, place the thumb on the inner surface of the thigh, index and middle on the outer: carefully move the thigh, if you hear a click, then the femoral head stays in an unstable position.

At an older age, another symptom of dysplasia manifests itself - lameness when walking, as well as the so-called. duck walk.

Treatment

To date, the main principles of conservative treatment of hip dysplasia are:

1. Early start of treatment;
2. Giving the limb a position conducive to reduction (flexion and abduction of the hip);
3. Preservation of the possibility of active movements;
4. Long-term and continuous treatment;
5. The use of additional methods - therapeutic exercises, massage, physiotherapy.

The effectiveness of conservative treatment is assessed using ultrasound and radiography of the hip joints. The standard scheme for the treatment of hip dysplasia includes: wide swaddling, massage and exercise therapy for up to three months, Pavlik's stirrups (Gnevkovsky's apparatus) for up to 6 months, and further - abduction splints in the presence of residual defects. When diagnosing a dislocation after 6 months, sometimes they first resort to adhesive traction with subsequent fixation of the joint in the outlet splint.

The duration of treatment and the choice of orthopedic devices depends on the severity of dysplasia (pre-luxation, subluxation, dislocation) and the age of the patient.

When prescribing Pavlik stirrups or other devices, it is important to follow the recommendations of the attending physician and observe the mode of wearing them. As a rule, in the first two weeks, it is necessary to wear stirrups constantly, removing them only during the evening bath.

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

Physiotherapy treatment includes electrophoresis with calcium chloride, cocarboxylase and vitamin C, paraffin applications on the hip joint area, ultraviolet irradiation and vitamin D preparations.

It should be borne in mind that massage, exercise therapy and physiotherapy procedures at each stage of treatment have their own characteristics. Therefore, they should be used only under the supervision of the attending physician.
Surgical treatment is used after the child reaches the age of 1 year.

Indications for surgery are true congenital hip dislocation in the absence of the possibility of conservative reduction, re-dislocation after closed reduction, and late diagnosis (after 2 years).

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

To prevent the severe consequences of dysplasia, you just need to follow the doctor's recommendations. One of the most effective methods of treatment is fixing the legs in a divorced position. As a preventive measure, the use of wide swaddling can be used, when the baby's legs are bent at a right angle at the knees and in the TBS, widely separated to the sides. With this method, a multilayer diaper is placed between the legs.

This allows you to fix the limbs in the desired position. As therapeutic exercises, it is possible to carry out extension-flexion of the legs to and from the stomach with the hips abducted one hundred and eighty degrees, as well as rotational movements along the femoral axis with the legs. Gymnastics should be continued for up to four months.

Dysplasia of t / b joints can be treated with physiotherapy and massage. It makes sense to use soft devices, for example, a Vilensky splint or Pavlik stirrups, this will help in fixing the joints in the correct position at the age of up to 3 months. If a child at the age of two years has been diagnosed with dysplasia of the hip joints, then surgical intervention is indispensable.

The disadvantage of the operation is expressed in a long and difficult recovery period. If your baby has hip dysplasia, do not despair. The earlier a problem is discovered, the easier it can be dealt with.

Treatment of dysplasia corresponds to the severity. If a child has mild hip dysplasia, then you can follow simple rules to normalize the development of joints.

Children are assigned a massage, then gymnastics. In more complex cases, the child is given abduction splints to fix the legs. Tires are prescribed by an orthopedist, who carefully examines the type of dysplasia using ultrasound, x-rays and orthopedic methods. If it is not possible to achieve a result using conservative methods, they resort to surgical treatment.

Parents can independently massage with rotation of the leg along the femoral axis with pressure on the limb, but the child may experience pain. At an older age, cycling, physical exercises in warm water, and therapeutic exercises are recommended. Most importantly, do not forget about the preventive examination of babies, because timely diagnosis and treatment can avoid many problems.

Modern treatment of dysplasia in children with manual medicine methods

In order to go to an appointment with a doctor, you must take with you photocopies of an extract from the maternity hospital, the conclusions and conclusions of an orthopedist, an x-ray or ultrasound, and a photocopy of their description. If we approach the problem of dysplasia in infants in a new way, then it should be recognized that traditional treatment often only torments babies. In order to establish the root cause, whether it is a dislocation, subluxation or preluxation.

At a very early stage, you should not torment the baby with orthopedic devices. Every day a child must learn the world, experience dynamic loads on the hip joints, in which blood circulation improves, all functions are restored, normal physiological development of the hip joints and tissues surrounding it occurs.

They approach this problem one-sidedly only from orthopedics, considering only disorders in the hip joints, forgetting about the integrity of the whole organism, as a single functional system is impossible. Most narrow specialists are very critical of treatment innovations - the use of manual medicine, I believe that if the technique works, then it must be applied.

I was pleasantly surprised when I attended the 2002 International Conference on Manual Therapy that I was not alone in my opposition to outdated dysplasia treatments. There are already orthopedists who are learning manual therapy techniques, but in Ukraine this is still a matter of the future.

Manual therapy in the hands of a "non-specialist" can cause irreparable harm to the patient's health. There is a choice - massage and "orthopedic devices". For example, various stirrups, insoles for flat feet, devices - corsets for scoliosis, a "chance" collar, corset belts for sciatica, crutches, a wheelchair. Or manual medicine, but at the same time we must remember that every lost day in childhood is irreplaceable.

At each stage of the development of the child, the formation of both organs and tissues is constantly taking place. Do not let the body adapt to problems - look for ways to solve them. "A tablet under the tongue is the simplest." Movement is life. And if something in biomechanics is wrong, then it must be eliminated, and not anesthetized and delay time. The body will tell you at the first stage with acute pain, which the baby cannot tell about, but this can be determined by tonic muscle tension.

Look for the reason why this pain comes from, and do not suppress this pain. In severe cases - a true dislocation of the hip - I am for the treatment to be carried out in a complex way, using manual therapy and orthopedics together, and in extreme cases, surgery.

Everyone chooses the way to solve the problem, i.e. treatment, myself. And what was laid down in childhood will grow. In this particular case, we are talking about children, parents choose, since no one takes into account the opinion of the baby. He can scream for some time, arrange sleepless nights, making it clear that he does not agree with this, but he cannot change anything - the parents decide.

The principle of treatment of joint dysplasia:

1. Manual methods to eliminate subluxation / dislocation.
2. Relax the tense muscles of the pelvis and spine, to prevent displacements in the joints.
3. Assign therapeutic exercises to strengthen the ligaments.
4. Give time for the formation of joints, without limiting the movements of the baby.

If you are told that a child with dysplasia will not walk or will limp, then this is not true. The likelihood of lameness is only with an extreme form of dysplasia - with a true dislocation of the hip. The rest of the children walk normally and outwardly practically do not differ from their peers up to a certain age.

But these children are guaranteed no less terrible disease - scoliosis, osteochondrosis with all associated diseases. Unfortunately, scoliosis also awaits those children who were tormented by wearing stirrups, various devices in childhood, did massages, ultraphoresis, went in for swimming and did not really have the right treatment, i.e. did not eliminate initially the reason because of what it all happened.

Alternative treatment of hip dysplasia

Even among orthopedists, traumatologists, surgeons there is no consensus and mutual understanding about dysplasia. Dysplasia manifests itself differently in all children and is not always detected immediately after birth. Joints may be normal at birth and in the first few months of development, but later diagnosed as abnormal by 6-12 months of age.

During the initial examination immediately after birth, even a very experienced orthopedist cannot give an accurate diagnosis, although redisposition to hip dysplasia can be predicted from the first day. If you pay attention to torticollis, in which the child constantly keeps his head in one direction.

Each child is individual and develops according to the genetic characteristics of the parents. Parents are not afraid of the fact that a child at 7-8 months old does not yet have teeth and, for example, a large fontanel has not “closed” in time. Parents are sure that the teeth will grow and the fontanel will harden, although these two conditions can be compared with "mouth dysplasia" and "skull dysplasia."

But the signs of hip dysplasia must be constantly monitored, because in fact, dysplasia in children is a weak, incomplete development of the joint, in most cases it is a natural feature of the body of a small child, and much less often a sign of the disease - true dislocation.

Over the past 30-40 years, nothing has changed in the treatment of hip dysplasia, with the exception of various orthopedic devices and testing them on children. Pavlik's stirrups, Freik's splint, CITO, Rosen, Volkov, Schneiderov, Gnevkovsky's apparatus, etc. - these orthopedic devices are needed only with a true dislocation of the hip.

And they are prescribed to almost every child from one month to one year of constant wear, with the exception of bathing. Often, at the same time, the child's psyche is disturbed - at first he is whiny, restless, and then depressed, oppressed, withdrawn, indifferent to everything.

Children were repeatedly brought to me in apparatuses at the age of 2.5 years, they differ sharply in physical and mental development. Although there were those who adapted and jumped and ran in the apparatus in a race with their peers.

Dangerous consequences of the disease

Why is dysplasia dangerous? The answer is simple: lameness. It turns out that the hip joint, due to neglect, begins to form in its own way, the muscular-ligamentous apparatus is fixed in this position. The child will walk, but the gait will be "duck".

Further, due to violation of the axis and fulcrum, problems with the spine begin: lordosis, kyphosis, osteochondrosis, and so on. And it will only get worse with age. A new false joint is formed, but it will not be able to perform its function. Here, only surgical treatment will be needed, although it all depends on the neglect of the process.

If treated during infancy, it will take an average of six months, and if later, the result can be only after a few years. In order not to miss the pathology, it is enough to visit the pediatrician every month.

If he has any suspicions, he will refer you to an orthopedist. And then it will be determined whether parents should worry or not. The result of untreated dysplasia primarily depends on the degree of underdevelopment of the joint (how much the roof of the hip joint is beveled, the femoral head is underdeveloped), as well as on the accompanying conditions that inhibit further development (hypertonicity, dysbacteriosis, rickets, etc.).

If hip dysplasia is minimally expressed, and there are no aggravating factors in 50%, it can be eliminated spontaneously. Think! 50% is every second child, because it is not known which of them will be yours.

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

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

Sources: www.sbornet.ru, miralady.com, doctorignatyev.com, orthoped.in.ua, deti.health-ua.org, mama.ua, medicalexclusive.com.ua, tvoymalysh.com, www.ivetta.ua, www.moideti.com

megan92 () 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the effect, and not with the cause ...

Daria () 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. So it goes

megan92 () 13 days ago

Daria () 12 days ago

megan92, so I wrote in my first comment) I will duplicate it just in case - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why sell online?

Yulek26 (Tver) 10 days ago

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

Editorial response 10 days ago

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

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then everything is in order for sure, if the payment is upon receipt. Thanks!!

Margo (Ulyanovsk) 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman suffers from pain ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped ...

Ekaterina a week ago

I tried to drink a decoction of bay leaves, to no avail, only ruined my stomach !! I no longer believe in these folk methods ...

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this Federal program for the fight against diseases of the joints spoke. It is also headed by some well-known Chinese professor. They say that they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient.

One of the fundamental important issues that all orthopedists of the world put before themselves is hip dysplasia, which is quite common today. This is a pathological deformity of the joints, which is congenital in nature and, if you carefully examine the baby, is diagnosed immediately after birth.

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

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

• What is the reason
• Varieties of the disease
• Signs. How to determine?
• Symptoms
• Treatment of hip dysplasia in children
• Stirrups Pavlik
• Various tires
• Sheena Freika
• Tire Vilensky
• Tubinger tire
• Sheena Volkova
• 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, no doctor can say with certainty what is the main reason for the development of dysplasia and related changes in the hip joint. Increasingly, they talk about hereditary predisposition, which should 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 these statistics to the fact that girls usually have more flexible connective tissues, which affects the joints.

Of great importance is the course of pregnancy. Many women who suffer from excess progesterone during the period of bearing a baby subsequently observed hip dysplasia in their children to one degree or another. The number of births also matters. First-born children are always at higher risk of developing dysplasia than children who appear 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 are more likely to 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 the joints.

Naturally, none of the doctors excludes the influence of external factors, whether it be bad ecology, the presence of bad habits in the mother, work in hazardous production, taking medications that have a negative effect on the fetus.

Interestingly, the disease is often associated with the culture of baby swaddling in various parts of the world. So, for example, in countries with an accepted method of hard direct swaddling, dysplasia in children is diagnosed more often. This is due to the limitation of joint mobility, which prevents their full development.

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

Varieties of the disease

There are three main types of hip dysplasia.

Acetabular dysplasia

It implies pathological changes on the part of the acetabulum, which is the site of application of the femoral head 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 deform, which leads to gradual wear of the joint, stretching of its capsule.

epiphyseal dysplasia

It is usually characterized by the fact that cartilage tissue becomes bone. Such changes greatly complicate the implementation of movements in the joint, since the bone tissue does not have flexibility and cannot serve as a gasket between the two structures. In addition to difficulty in movement, there are complaints of pain. Over time, deforming changes in the legs develop.

Rotational dysplasia

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

The division of dysplasia into types is necessary for doctors to understand the mechanism for the development of pathology. This helps to choose the best way to fight the disease, to stop a particular pathological process, making the effect of therapy directed, and not just general.

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

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

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

Signs. How to determine?

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

Normally, the hip joint consists of the head of the femur, which resembles a ball in shape, and the acetabulum, which has a crescent shape. Support of the articulation in an adequate configuration, as well as normal reproduction of movements in all planes, is provided by tendons, muscles and ligaments. The joint can work correctly and fully only if all its elements are fully developed, which is not observed 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: the asymmetry of the skin folds on the legs and the difference in the length of the legs.

The signs are interconnected. The asymmetry of the folds, in fact, develops due to the fact that one of the limbs is somewhat shorter than the other. Because of this, the area of ​​​​the knee bend on the shortening side will be slightly higher than on a healthy leg. The position of the inguinal and gluteal folds is also of diagnostic value. Differences can consist not only in the level of the position of the folds, but also in their depth, 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 the skin folds and the length of the legs only if dysplasia has developed on only one side. It is also interesting that some doctors believe that there are more skin folds on the side where the subluxation or dislocation is located, but this is not true. With dysplasia, this opinion is incorrect, since half of the babies may have a sign, 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 symptom is also characteristic of healthy children without pathologies.

When assessing the difference in the length of the limbs, it is important to correctly conduct a diagnostic examination of the infant. The child is evaluated when he is in the supine position, with his legs slightly bent not only in the knee area, but also in the hip area. Dysplasia will be accompanied by a distinct phenomenon of shortening of the hip, which is formed if the bone head is displaced back 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 region of the hip joint of the most severe form, called congenital hip dislocation.

Symptoms

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

In the diagnosis of dysplasia in infants under one year old, the gold standard is the assessment of the presence of the Marx-Ortolani symptom, or, as it is otherwise called, the “click”, slip symptom. It is best to entrust the check of the 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 reception.

The test begins with the child being placed on their back. Infants in this position lose their ability to resist, so diagnosis can be made without interference. The baby is bending the legs in the area of ​​​​the knees and in the hip joint, and they begin to carefully, without making sudden movements, spread them in different directions. Normally, without inconvenience, the baby's shins can almost touch the surface of the table on which the study is taking place.

If the child has dysplasia, the femoral head will pop out of the acetabulum during abduction, which will be accompanied by a push. The shock will be felt by the doctor who diagnoses. After this, the child is left with the legs apart, watching how the sore leg slowly returns to its normal position. The return to the anatomically correct position ends with a slight jerky movement, which indicates a dislocation of the femoral head.

The Marx-Ortolani symptom is, of course, considered the gold standard in the diagnosis of hip dysplasia, but its presence does not always mean that the baby is sick when it comes to a child in the first two weeks of life. Many children in the first weeks of life show a positive symptom, being cured within a few weeks without external influence.

Because of this, it is necessary to carefully interpret the results of the test for the presence of the Marx-Ortolani symptom and trust the test only to a professional. 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 already uninformative, the baby’s ability to abduct the legs is first evaluated. With the first degree of dysplasia, the abduction will be free, the child will not feel discomfort, as is normal. However, with a disease of the second or third stage, attempts to take the leg away 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 of the tests 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:

• soreness 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 pops out of the acetabulum and falls into place at the slightest load;
• joint mobility, which allows the baby to twist the limb at an unnatural angle, taking unusual poses.

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

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

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

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 flattenings, while the bone head will also be deformed, the cartilaginous plates surrounding it may be underdeveloped;
• the ligamentous apparatus and joint capsule are evaluated, which may be too stretched;
• attention is drawn to the incorrect position of the bone (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 methods are used if the issue of operating the joint is being decided. Additional diagnostic methods are CT or arthrography. The first technique allows you to get a more complete picture of the state 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 pathology, and the same earlier start of its therapy. It is important to remember that if a child is diagnosed with mild dysplasia, special measures for its treatment are not carried out. 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 gain a foothold 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 in the event that the effect of preventive measures will not be within six months.

The use of various orthopedic structures is widely used in the treatment, helping to establish the joint in the correct position.

Stirrups Pavlik

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

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

Various tires

In today's orthopedics, there are many splint options that are used if a child is diagnosed with hip dysplasia. The warrant of a suitable tire is selected by an orthopedic doctor, taking into account the developmental features of the child, the severity of dysplasia.

Sheena Freika

The Frejka tire or Frejka 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 tire is made of dense material, but thought out 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.

Tire Vilensky

The Vilensky tire is an orthopedic type 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 shows the technique to be followed when the device is put on the baby.

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

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

Tubinger tire

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

Sheena Volkova

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

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

Surgery

Surgery is not often used in the treatment of hip dysplasia, but in some cases it is impossible to correct the situation without intervention. This, for example, occurs when conservative therapy is ineffective or when a pathology was detected in a 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 the joint has not been conservatively restored to its normal configuration.

Another treatment option is osteotomy. In this case, one of the components of the joint is divided in two and spliced ​​again. This approach allows you to reduce pain and make the joint more functional.

You can quickly level the baby's legs of different lengths, facilitating the process of walking. The last option for surgical treatment is joint prosthetics. 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 the surgical resolution of the issue as long as possible.

Massage for hip dysplasia in children

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

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

Basically, during the massage, techniques of stroking, light pinching and clapping are used. Force during the massage is not applied, 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 “floating” exercise with the baby (the child is taken in his arms and rises above the changing table), gently making circular movements in the TBS, bending and spreading the child’s limbs in different directions.

Passive gymnastics is included in the 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 of hip dysplasia. With this disease, doctors, prescribing exercises, try to achieve the following goals:

• contribute to the formation of the joint, returning it to its correct position and configuration;
• carry out strengthening measures for the femoral muscles, which should provide support for the bone in the acetabulum;
• control and compensate for the lack of physical activity of the baby;
• ensure the full development of the physical condition of a child with dysplasia;
• maximally provide the area of ​​the hip joint with an influx of oxygen 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, just for them it will go in a passive form and interspersed with massage.

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

Swaddling for dysplasia

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

Wide swaddling is carried out for a number of indications:

• the baby is at risk for the development of hip dysplasia;
• Ultrasound of the hip joint showed the immaturity of the joint or one of its components;
• it is impossible to treat a child with other methods, except for 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 fact that the child is laid on his back. Two strips of diapers are placed between the baby's legs, which are fixed in the belt area with the help of the third strip. Such a swaddling technique allows, without much discomfort for the child, to easily hold his limbs at an angle of at least 60 degrees.

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 by conservative methods. Physiotherapy allows you to provide the child with the necessary amount of physical activity. With children under three years old, you can perform the following set of exercises:

• flexion and extension of the hips from a supine position;
• rolls from a sitting position to a lying position and back, preferably without relying on hands;
• active crawling, which should be maximally stimulated by parents;
• transitions from a standing to a sitting position, also preferably without the use of hands as a support;
• walking of 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 muscular systems of the abdominal press;
• breathing exercises that help saturate the circulatory system with oxygen.

As in the case of gymnastics, a set of exercises for physiotherapy exercises 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 carrying out procedures for a child, electrodes are applied to the area of ​​\u200b\u200bthe affected joints, which are wetted in therapeutic solutions. The most commonly used solutions are iodine, calcium or phosphorus.

Calcium and phosphorus, which enter the joint through the skin, have a strengthening effect on its elements, contributing to the correct formation of its elements and the formation of a configuration.

Electrophoresis as a physiotherapy 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 may recommend other physiotherapy procedures that will have a beneficial effect on the joint affected by dysplasia. So, for example, applications with ozocerite are often used, which successfully improves blood flow at the site of contact with the skin, and promotes regenerative processes in tissues.

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

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 even. On the contrary, he says, such swaddling will only contribute to the development of pathology.

To achieve the correct configuration of the joint, the doctor says, is possible only if the baby's legs are in a divorced state. In this case, the femoral head is ideally located in the acetabulum, where it should be.

The doctor draws the attention of parents to the fact that dysplasia is not always possible to diagnose at an early age. Moreover, many parents, faced with a diagnosis, ignore it point-blank, facing serious problems by the time the baby begins to walk. One of the most dangerous problems is congenital dislocation of the hip, which must be diagnosed and eliminated in a timely manner so that in the future the child can move freely.

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

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

If the doctor has doubts about the choice of optimal therapy, he may offer to observe the child for several weeks. Do not be afraid of such a decision. Yes, hip dysplasia in children under one year of age should be treated as early as possible, but at the same time, a few weeks in practice do not play a big role, but they significantly help in the diagnostic search and reduce the risk of error in choosing a treatment.

Possible consequences

Many parents have come across the concept of dysplasia, but few of them know what this disease threatens the child in the future, even if its signs are completely absent in childhood. Of course, you should not be afraid that a child with dysplasia is doomed to a recumbent lifestyle, because this is far from the case.

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

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

The most dangerous complication of dysplasia is coarthrosis. This pathology is accompanied by severe deformity, almost complete destruction of the affected joint. As a result, there are problems with walking, a person can get a disability, as he will be forced to move at best with a cane. With coxarthrosis, the only treatment method that will be available to a person is the replacement of a joint with an artificial one. Of course, as arthrosis does not develop in one year, however, 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 condition of the child, believing that the absence of complaints is a sign of health, with age they will almost certainly face 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 it will be to treat. Also, the treatment of dysplasia becomes more complicated as the child grows and the load on the joints increases.

To avoid problems in the future, treatment of dysplasia must be dealt with immediately after it is diagnosed, and the doctor will select the best method of therapeutic action.

Hip dysplasia is a congenital disease 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 commonly referred to as underdevelopment of the acetabulum, ligaments with muscles, cartilage, or the joint itself. This disease is not so dangerous if 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 leg of the baby 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 thigh is unstable. If your child has these signs, take him to the doctor as soon as possible.

It also happens that dysplasia is not noticed in children older than a 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 toes.
2. Doesn't keep balance. When walking, his body sways from side to side.
3. Does not allow to spread legs bent at the knees, screams or cries in pain.
4. The legs are easily twisted into an unnatural position.

Pathology will not develop until the baby gets 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 return the opportunity to walk normally. True, the chances of a full recovery are less and less every week after the baby has gone.

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

• Do not swaddle newborns tightly: this fixation causes the joint to constantly stay in an everted position.
• It is better to use wide swaddling: spread the baby's legs so that they look in different directions, and put two folded diapers between them. So the bone will be in the right place, and the development of the hip joint will proceed normally.

1. Orthopedic means. The most famous today are Pavlik's stirrups.
2. Exercise therapy, swimming on the tummy. Exercises for every age.
3. Physiotherapy: ozocerite application, electrophoresis with calcium and chlorine, mud therapy.
4. Massage.

In rare cases, surgery is required. It is mainly carried out for older children.

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

Effects

Congenital hip subluxation leads to pathological changes in the development of the entire hip system. Newborns have practically no discomfort from dysplasia. But the older the child becomes, 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 legs is a sign of dysplasia. The thigh may look unusual due to the lack of muscle tone. But the consequences of the disease are specific, they cannot be confused with other ailments.

What complications are typical for dysplasia:

1. Gradual loss of function of the hip joint. The subluxation worsens over time as the joint is unable 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 a baby's life, especially with improper swaddling.
3. Deformity of the articular cavity. Over time, the bone will stop falling into place even when brought into the correct position.
4. Development of pelvic asymmetry. The lack of nutrition of the bones leads to their atrophy, on the side of the deformation, the pelvis decreases in size.
5. An increase in the cervical-diaphyseal angle. The legs are even more asymmetrical.

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 have time to 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 either his gait or the development of the 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 becomes, the stronger his bones, which means that it is more difficult to carry out a correction. 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 femoral head does not have an emphasis and constantly suffers from overloads. As a result, the entire femur cannot grow normally. This leads to the following complications:

1. Decreased cervical-diaphyseal angle.
2. Stretching, atrophy of the ligament of the femur, up to its complete disappearance by the age of four.
3. Shortening of the muscles of the injured thigh and the entire limb.

These deformations cause the child a lot of inconvenience, interfere with normal crawling and walking. Children with 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 affected side. Constant uneven load on the spinal column leads to scoliosis.
2. The child experiences pain when walking and limps on an underdeveloped leg. As the years go by, the limping gets worse.
3. Pathological dislocation of the hip develops in both directions.
4. Movement of the knee joint becomes painful due to the process of atrophy.
5. The child cannot keep the pelvis in balance and rolls over when walking from foot to foot. A “duck gait” is formed, which is practically not amenable to correction with the development of pathology.
6. There are chronic pains in the lower back, forced to cope with colossal overloads. Hyperlordosis develops in the lumbar region.
7. The pelvic organs are subjected to constant unnatural mechanical stress. This leads to pain, the occurrence of 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 injured hip at an older age due to further overloads 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 condition requires joint replacement surgery. Otherwise, the person loses his ability to work.

Other consequences

Babies with dysplasia always get up later than their healthy peers. Even the most favorable variant of the progression of the disease hopelessly disfigures the gait of children, depriving it of stability. In the absence of timely treatment, the child may roll to one side, clubfoot, limp and roll awkwardly from side to side at the same time.

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

Often, children can walk normally only after surgery.

The lack of timely treatment, the constant load on the deformed hip can make a small invalid out of a healthy child. What to expect:

1. From the side of the thoracic segment, a curvature of the upper section of the 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 endure long-term stress, as 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, the child's body may try to correct the situation on its own by changing the shape 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 an increasing burden 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 throw all your efforts into healing children as soon as possible, regardless of the stage at which the subluxation of the hip joint was detected.

As children age, the number of available and pain-free treatment options decreases as children's bones grow and become stronger. But there is no age threshold, upon reaching which dysplasia ceases to cause pain, deform 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 a support from the neck to the spine, which is why this formation is the strongest and most powerful.

Thanks to this, a person maintains balance in any state, in motion or at rest. And if there is pain in the articulation of the thigh, then this is not just discomfort, but a limitation of a person's mobility.

Turning to 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 is given kinesiotherapy treatment. The topic of pain in the hip joint is relevant today, more and more people come to the medical institution with such a complaint.

What can be confused with pain in the hip joint?

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

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

This situation occurs when the ailments are caused by problems in a completely different place, for example, in the lumbar spine or at 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 "like a click in the groin" when moving. The problem here is not in the bone tissue, but in the tendons and muscles. In a hospital, a click is eliminated by:

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

Causes of pain

The most obvious injury is a bruise or fracture. Often the femoral neck is fractured, as it is the narrowest part of the articulation. The risk group is made up of the elderly, 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 tissue changes will begin, both in the joint itself and near it, which will lead to severe pain. 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 not be obvious signs of damage, but the person feels unbearable pain in the hip joint, the cause of which cannot be explained. However, under load and changing weather, the problem only worsens. The main pathologies that manifest themselves through acute pain in the hip joint:

• Arthritis. It is more common in the elderly, but the younger generation has also recently suffered from it. The very first to suffer from arthritis is the hip joint, its structure changes. The person feels pain in the groin, legs, side of the thigh and knees;
• Tendinitis. Tendon inflammation. The pain syndrome intensifies with exertion, and in their absence, a person may, in general, not be bothered by anything. There is a pulsation and burning sensation;
• Inflammation of the articular bag. The pain is felt on the side 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 the influenza virus, streptococcus, staphylococcus, which rapidly infect the compound. The person experiences a fever and the thighs swell. It is impossible to touch the hearth, a person feels a sharp pain in the hip joint and pelvic bones, when walking it turns into aching. The hip joints may be affected by tuberculosis;
• "Perthes' disease" is hereditary. It mostly affects young boys. Despite the fact that the pain is localized mainly under the patella, the thigh is affected.

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

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

Among the natural factors that cause the hip joint to hurt are:

• Pregnancy. It is natural that an increase in body weight affects the support system, which can be caused by discomfort;
• postpartum period. The unnatural position of the pelvic bones after childbirth increase soreness. It goes away with time.

Cartilage destruction in coxarthrosis

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

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

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

Often pain in the hip joint radiating to the leg is combined with discomfort in the knee. It occurs with heavy loads, then with small ones, and at rest.

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

The joint problem will not resolve itself, if the pain has subsided, this does not mean that it will not return again. And cartilage tends to wear out.

How to remove

With a sudden onset, the first thing that worries a suffering person is how to relieve pain in the hip joint in order to be able to move on and feel normal. My patients use a proven remedy, thanks to which you can get rid of pain in 2 weeks without much effort.

It is possible to relieve pain in the hip joint with treatment for some time in several ways, but it should be understood that all these are temporary measures. The success of using one or another method depends on the severity of the disease and the cause of the pain. A doctor's consultation is required.

• Medicines. For arthritis, painkillers, anti-inflammatory drugs, sedatives and drugs to improve sleep are prescribed;
• Short exercise. 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 relieve the condition for a short time, and also relieve stiffness of movements. With edema, inflammation, cold baths are used. To relax and enhance blood circulation, hot compresses are made;
• Physiotherapy. An individual program is compiled in the physiotherapy room using massage and thermal procedures;
• Weight control. Weight control will help to significantly reduce the load; in obese people, a colossal load is placed on the hip joint;
• Fixing systems. Bandages help reduce soreness, they improve mobility and stability;
• Auxiliary devices. The use of canes, orthopedic insoles support the motor function and facilitate the human condition;
• Avoid strenuous exercise. Frequent climbing stairs, skiing, running and other active sports with excessive physical activity aggravate the fate of diseased joints and exacerbate pain. Such activities should be excluded.

What to treat?

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

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

Comprehensive treatment includes several types and stages, the only way to achieve the best result in eliminating hip disease and symptoms. Than to relieve pain for a while, it is better to deal with the cause of its occurrence.

Medical assistance

Appointment by a doctor of painkillers, for example, ketoprofen, indomethacin, diclofenac, butadione. It is not worth prescribing therapy on your own, since improper or excessively prolonged use contributes to the destruction of bone tissue.

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

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

Manual therapy and exercise therapy

As a separate type of treatment, therapy is not used, 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 goes into the stage of "criticality" and there is a threat of a complete loss of joint functionality.

In this case, the hyaline cartilage is destroyed and the structure of the bone tissue changes. A total replacement of the hip joint with an artificial mechanism can be performed or measures are taken to stabilize it.

night pain

Sleep becomes impossible and the psychological state unbalanced when there are pains in the hip joint 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 may not be felt as strongly as at night, when a person’s activity is stopped and all feelings are focused on their own physical condition.

However, pain syndromes are a sign of the onset of the disease. Another reason why the hip joint hurts at night is osteochondrosis - a pinched sciatic nerve.

Aseptic necrosis

Necrosis of the head is a consequence of an incorrect metabolic process and blood circulation. As a result, the bone substance of the thigh begins to die, in places where it is adjacent to the acetabulum.

There will be pain in the hip joint on the left or on the right side, it can appear at any time and at any age, due to damage to the joint itself or bone tissue, cartilage, ligaments located next to it.

Often the symptoms are accompanied by numbness and limitation of movement of the entire support, and the leg in the hip joint is very sore. What to do in this case, only a doctor can tell, so delaying a trip to him can be dangerous to health.

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

Hip dysplasia (HJ) is a violation of the development of its structures - the upper parts of the femur or acetabulum. As a result, the configuration of the joint changes, the states of pre-dislocation, subluxation or are revealed. Drugs in the treatment of dysplasia are used only to eliminate symptoms. The main therapy consists in orthopedic correction - the use of Vilensky's splint, Pavlik's stirrups.

General description of the disease

A child is born with a flatter acetabulum, which is not oblique, as in an adult, but almost vertical. The ligaments that hold the femoral head in the acetabulum are more elastic, and there is a lot of cartilage in the joint itself. The cartilage ossifies as the hip joint develops. This gives the joint strength, allows you to withstand the load during movement. The task of pediatric orthopedists is to identify before the onset of ossification, when only conservative methods can be applied for the correct further formation of the hip joint.

In newborns

Classification of dysplasia

Violation of the development of the articular cavity is called acetabular dysplasia. Also, the inferiority of the upper parts of the thigh bone is allocated in a separate form. Rotational dysplasia is understood as a violation of the geometry of the bones in the horizontal plane. A generally accepted classification based on the division of the inferiority of the hip joint, depending on the degree of its underdevelopment.

1 degree - immaturity of the components of the tissues of the joint

With dysplasia of the 1st degree, the inferiority of the hip joint is revealed without disturbing its configuration. Such underdevelopment cannot be detected during an external examination of the child; it is established only during a series of instrumental studies. Previously, this was not considered a pathology, and its therapy was not carried out. But it was found that in the absence of treatment, the likelihood of developing degenerative-dystrophic diseases significantly increased. Therefore, when diagnosing dysplasia, measures are taken to prevent coxarthrosis.

Grade 2 - predislocation of the hip joint

Violation of the development of one of the HBS departments leads to its instability. Ligaments, acetabular lip, joint capsule lose their ability to hold the femoral head in a physiological position. A state of pre-dislocation occurs - the femoral head is still in the acetabulum, but any intense impact is enough for it to slip out.

Grade 3 - subluxation of the hip joint

The state of subluxation is indicated by the displacement of the head of the hip joint relative to the acetabulum. In this case, the cartilaginous rim is bent, slightly shifted upwards. The ligaments that fix the femoral head are tense, stretched, and it partially extends beyond the articular cavity.

4 degree - dislocation of the hip joint

With the aggravation of the process, a further displacement of the femoral head occurs, in which contact with the acetabulum is completely lost. Due to the fact that the lip is now located below the head, it is wrapped inside the TBS - a dislocation occurs. If at this stage the treatment is not carried out, then the articular cavity will gradually be filled with tissue (adipose, connective), devoid of any functional activity.

Causes

Hereditary predisposition is one of the causes of hip dysplasia. If it was diagnosed in one parent, then the probability of its detection in a child increases 10 times. The inferiority of TBS can also be triggered by the following factors:

• breech presentation of the fetus - the longitudinal location of the fetus in the uterus, when its legs or buttocks are facing the entrance to the small pelvis;
• frequent toxicosis during childbearing;
• drug correction of pregnancy - taking drugs of certain groups (, cytostatics);
• large weight and size of the fetus;
• oligohydramnios - an anomaly accompanied by a decrease in the volume of amniotic fluid;
• some gynecological diseases in the mother;
• living in ecologically unfavorable areas;
• traditional tight swaddling of a newborn.

If during pregnancy an increased amount of progesterone was produced in a woman's body, then this could cause excessive elasticity of the ligaments that hold the femoral head in the articular cavity.

Symptoms of pathology

Pain, swelling and stiffness characteristic of others with dysplasia are absent. The underdevelopment of hip joint has specific symptoms that are detected during an external examination of the child. It is carried out by an orthopedist after feeding, in a warm room, in a quiet environment.

Diagnosis of the disease

The primary diagnosis is made on the basis of an external examination of the child, anamnesis data, and the results of a number of functional tests. To confirm it, instrumental studies are carried out. In adults, the inferiority of hip joint is usually detected when diagnosing already developed coxarthrosis.

Collection of anamnesis

Careful history taking allows you to determine whether the newborn is at risk. A pediatric therapist suspects the inferiority of HBS when the mother lives during pregnancy in an unfavorable environmental environment, the child has congenital torticollis or clubfoot, and symptoms of myelodysplasia. Dysplasia is predisposed to increased uterine tone in the 3rd trimester, viral or bacterial infections suffered by a woman at any time.

Inspection

An external examination of the child is carried out a few days after his birth. With grade 1 dysplasia, there are no characteristic signs. Preluxation is recognized by the asymmetry of the skin folds, a positive Marx-Ortolani slip symptom. With subluxation, limitation of hip abduction is also detected, and sometimes shortening of the limb. The clinical picture of dislocation is most pronounced - most of the specific signs of severe HJ underdevelopment are found.

ultrasound

Most preferred when diagnosing dysplasia. It is safe, and its results help to detect the inferiority of the joint, even with minor changes. The bone roof, cartilaginous protrusion are examined, the degree of coverage of the femoral head and its centering at rest and abduction are established. According to the results of ultrasound, the doctor calculates the angle of the acetabulum and compares the data obtained with the normal values.

X-ray diagnostics

In children under 3 months of age, radiography is uninformative, since there are a lot of cartilage tissues in their joints that are not displayed on the obtained pictures. But even when examining an older child, special markings are used to calculate the angle of inclination of the articular cavity and the displacement of the head of the femoral bone. also helps to detect the delay in the process of ossification relative to the norm. The core of ossification should appear in boys at 4 months, in girls - at six months.

Treatment of dysplasia

Conservative treatment of dysplasia begins immediately after the diagnosis is made. An integrated approach is practiced to therapy - physiotherapy and massage, the use of orthopedic devices and daily exercise therapy are prescribed at the same time.

Conservative treatment

For orthopedic correction of hip joint in children up to 3-4 months, constructions made of soft elastic materials are used. They securely fix the child's legs in the abduction position, the most favorable for the correct formation of the hip joints, their "maturation". Tires, pillows, spacers, bandages are used. The most effective method of treatment is fixing the legs with Pavlik's stirrups. This is a fairly soft device in the form of a chest corset with a fastening system in the form of a set of strips. Pavlik's stirrups do not restrict the child's mobility, which is important for his psycho-emotional state.

Physiotherapy

By performing special exercises to strengthen the muscular corset of the thighs, it is possible to restore the range of motion and stabilize all structures of the hip joint. They are selected by the doctor taking into account the degree of underdevelopment of the joint, the general health of the child and the stage of treatment. There are exercises specifically for breeding the legs, keeping the hip joint in the anatomical position and consolidating the results.

Massage

Massage of the gluteal muscles is carried out on a hard, flat surface once a day. In total, 10-15 sessions are prescribed, and then a monthly break is made. Children with dysplasia are shown 2-3 courses of healing procedures, which should be performed only by a massage therapist specializing in children's pathologies of the musculoskeletal system. Orthopedists recommend that parents give their child a classic relaxing massage before bedtime.

Surgery

With the ineffectiveness of conservative treatment, surgical intervention is performed. Corrective operations are performed - open reduction of the dislocation, osteotomy (giving the femoral head the correct configuration), creating a stop for the femoral head. If it is not possible to correct the shape of the HJ structures, then palliative surgical interventions are indicated.

Possible Complications

If the congenital dislocation was not timely reduced, then over time a new joint is formed. It is defective, combined with muscle atrophy, weakness, shortening of the limb. However, it is able to perform some of the functions of a healthy hip joint.

Prevention of hip dysplasia

Orthopedists recommend not using a tight one that fixes the legs of a newborn in the wrong position, limiting free movements. The full formation of the joint is facilitated by carrying the child on its side in the position of the rider.

A congenital pathology in which the hip joint ceases to develop properly is called dysplasia. In the future, it can lead to dislocation or subluxation of the femoral head. With dysplasia, either the immaturity of the joint is detected, or an increase in its motor function, combined with inferiority of the connective tissue. Pathology can develop due to: unfavorable heredity, gynecological diseases of the mother, or violations of intrauterine development of the fetus.

If the disease is not detected in time and treatment is not started, then hip dysplasia in a newborn can provoke a disorder in the functioning of the lower extremities, and even threaten with disability. Therefore, this anomaly should be detected in infants as early as possible. The sooner the pathology is detected and treated, the more effective it will be.

hip dysplasia

This congenital abnormality can cause subluxation or dislocation of the hip. The stages of dysplasia range from severe disorders to excessive mobility combined with weak ligaments. To prevent the adverse effects of hip dysplasia on the health of the baby, it is necessary to identify and begin to treat this disease as early as possible, preferably in the first months of life.

This pathology among congenital and acquired diseases is diagnosed quite often: there are 20-30 children with dysplasia per 1000 newborns. It has also been observed that this anomaly is more common among Indians of America than among other races, and African Americans are less susceptible to it than people of the Caucasian race. It is also noted that in boys this pathology is less common than in girls: the ratio is approximately 20% to 80%.

Hip dysplasia according to ICD 10 is separated into an independent class and group (code M24.8).

Anatomical structure of the hip joint and its disorders

This joint consists of the head of the femur, which connects to the acetabulum. The acetabular lip is attached to the upper part of the acetabulum - this is a plate of cartilaginous tissue that increases the area of ​​contact of the joint surface and the depth of the acetabulum. In children in the first month of life, this joint even normally differs from the structure of the adult hip joint: a flatter acetabulum is located almost vertically and the ligamentous apparatus is more elastic. The femoral head is fixed in the cavity by a rounded ligament, articular capsule and acetabular lip.

There are the following forms of hip dysplasia: acetabular, which is characterized by a violation of the formation of the acetabulum, upper dysplasia hip bones and rotational dysplasia, at which the bones are displaced relative to the horizontal.

If there is an anomaly in the formation of any part of the hip joint, this means that the femoral head is not held by the acetabular lip, as well as by the articular capsule and ligamentous apparatus in the right place. As a result, it moves outwards and upwards. Also, the acetabular lip is displaced, which will no longer be able to fix the femoral head. With a partial exit of the femoral head beyond the acetabulum, a subluxation of the femur is formed.

With the further development of the pathology, the femoral head shifts even higher, and it completely loses contact with the acetabulum. Thus, the head is higher than the acetabular lip, which is wrapped inside the joint - a dislocation of the hip is formed. If you do not start treatment, the acetabulum is filled with connective and adipose tissue. Restoring a running state is almost impossible.

Reasons for the development of hip dysplasia

The appearance of dysplasia can be caused by many reasons.

• Firstly, heredity: the percentage of this developmental anomaly in a child increases if the father or mother was also diagnosed with dysplasia at birth.
• Secondly, breech presentation of the fetus and other factors that disrupt the normal intrauterine development of the child.
• Thirdly, unfavorable environmental conditions (in areas where the level of air pollution exceeds the permissible level, this pathology occurs 5-6 times more often than in places where the environment is more favorable).

Experts have found that the practice of tight swaddling also causes a predisposition for the development of hip dysplasia in an infant. The child must be allowed to move freely with his legs.

Diagnosis of hip dysplasia

If the doctor suspected the presence of hip dysplasia in an infant, it is necessary to visit an orthopedic pediatrician within 21 days after discharge from the hospital. The specialist examines the child and prescribes the appropriate treatment. For the timely detection of this disease, children are examined by a specialist with the following age intervals - at 1 month, at 3 months, at 6 months and a year.

The child is more prone to developing this anomaly in the presence of the following factors: maternal toxicosis during pregnancy, high birth weight, breech presentation, and diagnosing dysplasia in the mother or father. Newborns at risk are examined with particular care.

The baby is examined when he is calm and full. In the room where the inspection takes place, it must be warm and quiet. The doctor checks for the following signs indicating pathology: asymmetric skin folds on the legs, shortening of the hip, limited hip abduction, and the Marx-Ortolani symptom.

The asymmetry of skin folds in the groin, under the knees, as well as on the buttocks, becomes more noticeable in a child at 2-3 months. When examining a newborn, the doctor carefully looks at the level of the folds on both legs, as well as their shape and depth. However, the presence or absence of this symptom is not a sufficient basis for an accurate diagnosis. The symmetry of the skin folds is observed in a child with bilateral dysplasia, as well as in half of newborns with impaired development of one hip joint. The asymmetry of the skin folds in the groin in infants up to 2 months also does not give rise to the detection of hip dysplasia, as it is sometimes present in a healthy child.

A more accurate diagnosis can be made by identifying such a sign as hip shortening. The child needs to be put on his back and his legs bent at the knees and at the hip joint. If in this position of the legs it is visible that one knee is located higher than the other, this indicates that the child has the most serious form of this pathology, namely, congenital hip dislocation.

But the main confirmation of congenital dislocation of the hip is Marx-Ortolani symptom. The baby should be placed on its back. The doctor should bend the child's legs and clasp his hips with his palms so that the thumbs are placed on the inside, and the rest of the fingers on the outside of the thigh. Taking the child's legs, the doctor carefully and evenly begins to move the hips to the sides. A symptom indicating the presence of pathology is a click that is felt when the femoral head is set into the acetabulum. It must be borne in mind that this symptom is not sufficiently informative in newborns in the first weeks of life. Appearing in 40% of children born recently, it subsequently disappears without a trace.

Limited movement in the hip joint also indicates a violation in its development. A healthy child's legs can be abducted 80° or 90° and, without effort, put them on the table surface. If the pedicles are not abducted more than 50° or 60°, this suggests a developmental anomaly. At 7-8 months in healthy children, the legs can be abducted by 60 ° or 70 °, and in children with congenital dislocation only by 40 ° or 50 °.

If the doctor doubts the diagnosis, he can confirm or refute it with the help of x-ray and ultrasound. However, to diagnose pathology in a child who is not yet 3 months old, x-rays are not done. At this age, most of the joint is formed by cartilage, which is not displayed on the X-ray photo. In the future, special schemes are used to read x-rays of babies. By the way the joint looks in the picture, the doctor determines the severity of dysplasia.

In the first months of life, ultrasonography is used to examine infants. This method successfully replaces X-rays - at this age it is not dangerous and provides a lot of information.

The diagnosis of "dysplasia" is made only if there are symptoms of pathology and abnormalities in the development of the joint, identified by X-ray or ultrasound. If a developmental disorder was not detected in time, then bilateral dysplasia of the right and left joints can result in very serious consequences for the child's health, up to disability.

How to treat hip dysplasia

It is necessary to treat and take measures to prevent dysplasia immediately, starting from an early date. For this, a variety of means are used that help keep the baby's legs in a bent and retracted position: special pillows, tires, apparatus, panties, stirrups. For the treatment of newborns in the first months of life, the use of soft and elastic devices is provided, the wearing of which does not prevent the child from moving his legs. If it is not possible to fully treat the child, you need to start swaddling him widely. This method is also suitable for infants who are at risk, as well as children who have symptoms of an immature joint during an ultrasound examination.

A good effect in the treatment of hip dysplasia in children under one year is the use of Pavlik's stirrups. This soft fabric construction is a chest brace, with a system of special straps attached to it, which hold the baby's legs in a bent and retracted position. Pavlik's stirrups serve to fix the child's legs in the desired position, but at the same time give him the opportunity to move freely.

To fully restore movement and enhance the effect of treatment, it is necessary to do exercises to strengthen the muscles. At each stage: when spreading the legs, to keep the joints in the right position, as well as for rehabilitation, their own exercises are performed.

In addition, for more effective treatment, the baby begins to massage the muscles on the buttocks.

A severe degree of pathology is treated with the help of a closed one-stage reduction of the dislocation, followed by the application of a plaster bandage for immobilization. This method is used to treat children from 2 to 4 years of age, less often at 5 or 6 years. A child over 6 years old and a teenager can no longer be corrected with a dislocation. Sometimes, for the treatment of dislocations, children aged 1 year 6 months to 8 years, do a skeletal hood.

If conventional therapy fails, a corrective operation is performed: the dislocation is reduced, and surgical intervention is performed on the upper part of the femur and acetabulum.