What it is – congenital malformations caused by pathologies of the musculoskeletal system, which are elements of the hip joint, in medicine are called – hip joint dysplasia (DTS).
All its elements can be affected in one way or another:
- femoral head and capsule;
- underdevelopment of surrounding muscles and ligaments.
a brief description of
The role of the hip joints is very large, they experience basic stress when a person walks, runs or just sits. Perform a huge variety of movements.
The joint is a spherical head located in a deep crescent acetabulum. The neck connects it with the rest of the parts. Normal, complex work of the hip joint provides the configuration and the correct internal structure of all its components.
Any impairment in the development of at least one of the components of the link expressed:
- pathology and change in the shape of the femoral head, the discrepancy of its size with the size of the cavity;
- stretching the joint capsule;
- the non-normative depth and structure of the depression itself, the acquisition of an ellipsoidal, flat shape, thickening of the bottom or skewing of the “roof”;
- pathology of the cartilaginous edge – limbus;
- shortening the femoral neck with a change in its anti-version and diaphyseal angle;
- ossification of articular cartilage elements;
- pathologies of the ligament apparatus of the head, manifested hypertrophy or aplasia
What leads to a violation of the functional development of the entire hip apparatus, which is a disease DTS. Depending on the nature of the pathology, dysplasia of the hip joints is divided into different types.
Three main types characterize the pathology of DTS.
one) To acetabular dysplasia include a violation of the structure and pathology in the acetabulum itself, mainly pathology in the limbus cartilage, along the edges of the cavity. Under the action of pressure of the head, it is deformed, pushed out or wrapped inside the joint. What contributes to the stretching of the capsule, the development of ossification of articular cartilage and an increase in the displacement of the femoral head.
2) Mayer dysplasia or epiphyseal – characterized by point ossification of cartilage tissue, which causes joint stiffness, pain and deformity of the legs. The defeat of the proximal femur, expressed by pathological changes in the position of the femoral neck of two types – dysplasia due to an increase in the inclination angle, or dysplasia with a decrease in the diaphyseal angle.
3) Rotational dysplasia – it is characterized by delayed articular development and pathologies expressed by pronounced disturbances in the relative position of the bones relative to the horizontal plane. In itself, such a situation is not considered dysplasia, most likely, is a borderline state.
The degree of development of the disease depends on the severity of the pathological process.
- The 1st, mild DTS is called pre-dislocation – characterized by small deviations due to the angled acetabular corners of the acetabular roof. At the same time, the position of the femoral head, located in the articular cavity, is slightly shifted.
- Grade 2 – subluxation – in the articular cavity is only part of the head of the hip joint. In relation to the cavity, it shifts outwards and upwards.
- 3rd – degree – dislocation, characterized by a complete exit of the head from the depression upward direction.
Causes of hip dysplasia
The reasons as a result of which articular pathological processes in the hip joints are formed are due to several theories:
1) Theories of heredity – suggesting inheritance at the gene level;
2) Hormonal – an increase in the level of progesterone in the last stages of the course of pregnancy causes functional and structural changes in the muscular-ligamentous structures of the fetus, marked instability in the development of the hip apparatus.
3) According to the multifactorial theory, several factors influence the development of a DTS:
- the buttock position of the fetus;
- lack of vitamin and trace elements;
- limited movement of the child in the womb of the uterus – usually, the mobility of the left leg of the child is limited by pressing it with the wall of the uterus, therefore dysplasia is more susceptible to the left hip joint.
As a result of long-term studies, a direct link has been proven to the development of the disease and swaddling of children. For example, in African and Asian countries, children are carried on their backs, not wrapped, while retaining their relative freedom for movement functions.
Taking it as a basis, the Japanese violated their age-old foundations (dense swaddling at DTS). The results struck even the most incredulous scientists – the growth of the disease was reduced almost ten times against the usual.
Symptoms of hip dysplasia in children
Diagnosis of hip dysplasia
The diagnosis of hip joints dysplasia is determined during an orthopedic examination at a specialized examination, usually in the age of up to six months. The diagnosis is based on a physical examination of the baby, certain tests and associated symptoms are used.
In confirmation in polyclinic conditions, ultrasound is used, less frequently X-rays.
- 1) ultrasound has an advantage among many other research methods, as it has been used since birth. It is the safest method (non-invasive), affordable, and reusable.
- 2) X-ray method is not inferior in reliability, but has a number of features. First of all, radiation is not recommended for children under one year old (unless the diagnosis of ultrasound diagnostics is questioned or not possible). Secondly, it is necessary to lay the child under the apparatus with the observance of symmetry, which is difficult in childhood.
- 3) Computed or magnetic resonance imaging is used when there is a question about surgical treatment. Gives a more complete, structured picture.
- 4) Arthrography and arthroscopy are used to supplement the full picture when making a diagnosis in the running conditions. The methods are invasive, performed under general anesthesia, and are not widely used.
Treatment of hip dysplasia in newborns
In pediatric orthopedics, there are many treatments for hip dysplasia in a child.
Each doctor individually selects a treatment program for his or her little patient based on the severity of the disease. These are methods, from elemental wide swaddling, to casting a baby.
So. In order of some methods of treatment of dysplasia.
- one) Widespread swaddling – the most affordable way, even young mothers can do, is used for non-complicated forms.
- 2) Becker pants – the same as wide swaddling, but more convenient to use.
- 3) Tire or Frejka pillow – in functionality as well as pants, but has stiffeners.
- four) Stirrups of Pavlik – came to us from the last century, but are still in demand.
- five) Splinting- use the Vilna or Volkov bus (refer to the elastic type of splinting), also spreading the tire for walking, and gypsum splinting.
- 6) Surgical treatment – this method is used in severe forms, frequent relapses, in children over one year of age.
Additional methods of treatment of dysplasia, they can also be the main ones, if we are talking about the immaturity of the articular elements, or the prevention of TPA in children with a predisposition include:
- full body massage with an emphasis on TBS;
- gymnastics of newborns;
- physiotherapy (using vitamin, with lidazoy, with calcium);
- paraffin therapy, applications for TBS;
- dry heat, mud therapy.
The basic principle of treatment is the timeliness and adequacy of the chosen method.
What are the consequences of dysplasia?
Children with dysplasia are not threatened with a recumbent lifestyle, but they begin to walk much later than their peers. Their gait is unstable, limping. Kids roll over like ducks and kosolapyat.
The formation of new outlines of joints and hollows, the formation of a false joint, which cannot be complete, since it is not able to perform the function of support and full leg abstraction begins. Developed – neoarthrosis
The most serious complication is the formation of dysplastic coxarthrosis, in which an operation to replace a joint is unavoidable. If a early treatment of dysplasias takes a maximum of up to six months, then treatment after twelve years may last for twenty years.
Which doctor to contact for treatment?
If, after reading the article, you assume that you have symptoms characteristic of this disease, then you should consult a general practitioner.