Quite often in a maternity hospital, at the first scheduled appointment with a pediatrician or when visiting a pediatric orthopedist, parents hear an alarming diagnosis: “hip dysplasia in newborns.”But this is not a reason for panic – on the contrary, you need to know that only timely and proper treatment of the baby and compliance with all the recommendations of a specialist will help to avoid unpleasant consequences in the future.
What is hip dysplasia?
To date, hip dysplasia is considered the most common pathology of the musculoskeletal system in newborns and infants.
“Dysplasia” in translation means “improper growth”, in this case, one or both of the hip joints.
The development of the disease is associated with a violation of the formation in the prenatal period of the main structures of the joint:
- ligamentous apparatus;
- bone structures and cartilage;
- change in the innervation of the joint.
Most often, dysplasia of the hip joint in newborns and treatment of this pathology is associated with a change in the location of the femoral head in relation to the bony pelvic ring. Therefore, in medicine this disease is called congenital dislocation of the hip.
Treatment should be started from the moment of diagnosing the pathology, the sooner the better, and before the baby begins to walk – from this moment irreversible complications appear. They are associated with an increasing load on the joint and the exit of the bone head completely from the acetabulum with a shift up or to the side.
Changes in walking form in the child: duck walk, significant shortening of the limb, compensatory curvature of the spine. Correct these violations is possible only through surgical intervention. With pronounced changes in the joint, the baby may remain disabled for life.
There are several theories that answer the question – why does dysplasia of the hip joints occur in a newborn – what are the reasons for its formation?
The main factors that negatively affect embryogenesis and the formation of the musculoskeletal system of the fetus are the following.
Family predisposition (in 80% of cases, the development of dysplasia was observed in the next of kin of the baby, most often the disease is transmitted through the female side) – a hereditary theory.
Hormonal disorders in the last months of gestation (hormone theory) – a high level of progesterone and / or other hormones in the blood of a pregnant woman causes a persistent decrease in muscle tone and ligaments of large joints, leading to instability in the hip joints.
These conditions may occur due to:
- with hormonal imbalance against the background of stress, overwork in the last weeks before childbirth;
- endocrine diseases of the pregnant woman (pathology of the thyroid gland, adrenal glands);
- taking hormonal drugs to treat the threat of termination of pregnancy, containing progestins – maturation hormones that inhibit the growth of many structures, including bones.
Violation of the laying of organs due to a lack of trace elements (phosphorus, iron and calcium) and vitamins in the first months of pregnancy – the largest percentage of babies with dysplasia are observed during conception in the winter months.
Exposure to toxic factors:
- adverse ecology;
- occupational hazards;
- taking various medications;
- infectious diseases of the expectant mother;
- intrauterine infections;
- kidney and liver disease in a pregnant woman.
Exposure to several negative factors.
Additional predisposing and provoking causes of pathology are:
- incorrect intrauterine position of the fetus or restriction of free movements of the unborn baby (pelvic presentation, oligohydramnios, large fetus);
- low physical activity of the pregnant woman;
- tight swaddling; more about whether to swaddle a child →
Forms of pathology
In pediatric orthopedics, several forms of the disease are distinguished. Depending on this, signs of hip dysplasia in infants are manifested, and in this regard, pathology treatment methods are chosen.
Most often, the acetabular form of the disease is diagnosed, which occurs as a result of violations of the position of the head of the joint in the acetabulum of various degrees:
- mild dysplasia of the hip joints in newborns – pre-dislocation;
- subluxation – moderate disorders;
- congenital dislocation of the joint.
Congenital malformations are less common:
- rotational form of dysplasia associated with a change in the configuration of bones and structures that form the joint;
- improper development of the hips of the proximal.
Only an orthopedic surgeon can determine the form and degree of dysplasia after examining the child and conducting a full range of different diagnostic methods.
Signs of hip dysplasia in newborns can occur immediately after birth or as the baby grows.
Diagnose pathology in the hospital, with routine examinations of a pediatrician or narrow specialists – a pediatric surgeon or orthopedist
Parents often care about the question: – How to determine hip dysplasia in newborns on their own?
Signs of mild hip dysplasia in infants and subluxations are most often seen only 2-3 weeks after the baby is discharged from the hospital. Parents can notice them when they spread the baby on their stomach or do gymnastics crumbly.
Symptoms of hip dysplasia in infants:
- asymmetry of the folds on the legs, if you put the baby on the stomach – under the buttocks and on the hips;
- different lengths of the lower extremities – shortening of the leg on the side of the change in the joint is noted;
- limitation of mobility during abduction of the hips – this symptom is more often observed with unilateral damage – dysplasia of the left hip joint in newborns or subluxation to the right;
- the symptom of a “click” is the appearance of a characteristic click when the baby’s hips are moved away at an angle of 90 degrees and pressure is exerted on a large trochanter due to the adjustment of the head to the joint.
If there is no treatment for a long time, then the disease may manifest itself in more serious disorders and manifestations of hip dysplasia in the infant:
- atrophy (thinning) of muscles on the side of the lesion;
- persistent violations when walking: frequent falls, a “duck” gait swaying from side to side, pain when walking, contractures (persistent restriction of movement in the hip joints).
The appearance of these symptoms often indicates a complete exit of the head of the bone from the joint and its displacement up or to the side, which causes the dangerous consequences of dysplasia of the hip joints in the baby.
Detection of pathology and clarification of the diagnosis of hip dysplasia is carried out by means of a comprehensive diagnosis:
- characteristic manifestations of hip dysplasia in a newborn – symptoms of the disease;
- a history of pregnancy and childbirth – the presence of risk factors for the development of pathology;
- instrumental examination methods;
- differential diagnosis
Instrumental methods for diagnosing hip dysplasia include:
- X-ray examination;
- arthrography or arthroscopy;
- Ultrasound – diagnostics;
- CT or MRI of the joints.
Based on the results of instrumental examinations, the specialist clarifies the form and degree of pathology and determines how to treat hip dysplasia in infants.
This type of diagnosis is performed by a pediatric orthopedist to completely eliminate diseases that have similar symptoms:
- pathological dislocations or fractures;
- complications of rickets;
- congenital metabolic disorders and osteodysplasia;
- pathology of the nervous system, complicated by paralytic dislocations.
There are several ways to treat hip dysplasia:
- Conservative therapy.
- Surgical correction, in severe cases, multiple surgical interventions are required – the head is inserted into the joint gradually and fixed by various methods.
With a mild degree of dysplasia and subluxation, a combination of various methods of conservative treatment is used under the supervision of the attending physician:
- Wide swaddling within a month or two – this contributes to the correct formation of the joint and / or self-regulation of the subluxation.
- Wearing various orthopedic devices that keep the baby’s legs in a divorced and bent state (stirrups, pillows, tires, functional plaster bandages).
As well as physiotherapeutic techniques that reduce inflammation, activate trophic processes in the tissues and reduce the risk of contractures, and also reduce pain:
- magnetic laser therapy;
- ultrasound therapy;
- massage for dysplasia of the hip joint in infants;
- mud therapy;
- gymnastics with hip dysplasia in newborns.
Timely conservative comprehensive treatment of this ailment in 90% of cases gives a positive result and a complete cure for the baby without the formation of health complications.
Improper therapy or its absence in hip dysplasia in newborns causes serious health consequences and the need for surgical intervention. But even the surgical treatment of hip dysplasia in an infant cannot always completely correct orthopedic disorders caused by persistent displacement and complete exit of the femoral head from the joint.
Quite often, a child observes:
- pronounced curvature of the spine;
- limb shortening;
- persistent disturbances when walking;
- severe pain syndrome, in connection with the development of arthropathy or arthrosis of the hip joint.
Massage for hip dysplasia in newborns is carried out by courses prescribed by the orthopedist.
Parents should know that even after the active treatment of this pathology has ended, it is necessary to continue to perform exercises for hip joint dysplasia in newborns, not to use walkers and avoid early walking training.
Prevention of hip dysplasia in newborns is to eliminate all predisposing and provoking factors and causes of the development of pathology during pregnancy and after childbirth.
It is important to know that if the disease is not detected in time or if its treatment is not taken seriously, the child may form shortening of the limb, gait disturbance, persistent deformity of the spine and constant pain in the back and joints. Therefore, parents should know the signs and methods of treating this complex pathology.