Congenital hip dislocation is a dislocation of the femoral head from the acetabulum caused by congenital inferiority of the joint, an undiagnosed hip dislocation in infancy is manifested by the child’s lameness during the first attempts of independent walking. The most effective conservative treatment of congenital hip dislocation in children of the first 3-4 months of life. In case of its inefficiency or delayed diagnosis of pathology, surgical interventions are carried out. The lack of timely treatment of congenital hip dislocation leads to the gradual development of coxarthrosis and disability of the patient.
ICD 10
Q65.0 Q65.1 Q65.2
Meaning
Hip dysplasia and congenital hip dislocation are different degrees of the same pathology resulting from a violation of the normal development of the hip joints. Congenital hip dislocation is one of the most common malformations. According to international researchers, 1 out of 7,000 newborns suffers from this congenital pathology. The disease affects girls about 6 times more often than boys. Unilateral lesion occurs 1.5-2 times more often than bilateral.
Hip dysplasia is a serious disease. Modern traumatology and orthopedics has accumulated quite a lot of experience in the diagnosis and treatment of this pathology. The data obtained indicate that in the absence of timely treatment, the disease can lead to early disability. The earlier treatment is started, the better the result will be, therefore, at the slightest suspicion of a congenital dislocation of the hip, it is necessary to show the child to an orthopedic doctor as soon as possible.
Classification
There are three degrees of dysplasia:
- Hip dysplasia. The articular cavity, head and neck of the thigh are changed. The normal ratio of articular surfaces is preserved.
- Congenital hip subluxation. The articular cavity, head and neck of the thigh are changed. The ratio of articular surfaces is broken. The femoral head is displaced and is located near the outer edge of the hip joint.
- Congenital hip dislocation. The articular cavity, head and neck of the thigh are changed. Articular surfaces are disconnected. The femoral head is located above the articular cavity and away from it.
Symptoms
The hip joints are located deep enough, covered with soft tissues and powerful muscles. Direct examination of the joints is difficult, so pathology is detected mainly on the basis of indirect signs.
Click symptom (Marx-Ortolani symptom)
It is detected only in children under the age of 2-3 months. The baby is laid on his back, his legs are bent, and then gently reduced and bred. With an unstable hip joint, dislocation and reduction of the hip occurs, accompanied by a characteristic click.
Limitation of lead
It is detected in children under one year old. The child is laid on his back, his legs are bent, and then, without effort, they are spread apart. In a healthy child, the hip angle is 80-90 °. Restriction of the lead may indicate hip dysplasia.
It should be borne in mind that in some cases, the restriction of withdrawal is due to a natural increase in muscle tone in a healthy child. In this regard, unilateral restriction of hip abduction is of greater diagnostic importance, which cannot be associated with a change in muscle tone.
Shortening of the limb
The child is laid on his back, his legs are bent and pressed against his stomach. With unilateral hip dysplasia, the asymmetry of the location of the knee joints is revealed, caused by the shortening of the hip on the affected side.
Asymmetry of skin folds
The child is placed first on his back, and then on his stomach to examine the inguinal, gluteal and popliteal skin folds. Normally, all the folds are symmetrical. Asymmetry is evidence of congenital pathology.
External limb rotation
The child’s foot on the affected side is turned outwards. The symptom is more noticeable when the child is sleeping. It should be borne in mind that external limb rotation can also be detected in healthy children.
Other symptoms
In children over the age of 1 year, a gait disorder (“duck gait”, lameness), insufficiency of the gluteal muscles (Duchene-Trendelenburg symptom) and a higher location of the large spit are detected.
The diagnosis of this congenital pathology is made on the basis of x-ray, ultrasound and MRI of the hip joint.
Complications
If the pathology is not treated at an early age, the outcome of dysplasia will be early dysplastic coxarthrosis (at the age of 25-30 years), accompanied by pain, limited joint mobility and gradually leading to disability of the patient. With an untreated hip subluxation, lameness and joint pain appear already at the age of 3-5 years, with congenital hip dislocation, pain and lameness occur immediately after the start of walking.
Treatment
Conservative therapy
With the timely start of treatment, conservative therapy is used. A special individually selected tire is used to keep the child’s legs retracted and bent at the hip and knee joints. Timely comparison of the femoral head with the acetabulum creates normal conditions for the proper development of the joint. The earlier treatment begins, the better results can be achieved.
It is best if the treatment begins in the first days of the baby’s life. The beginning of treatment of hip dysplasia is considered timely if the child has not yet turned 3 months old. In all other cases, treatment is considered to be overdue. Nevertheless, in certain situations, conservative therapy is quite effective in the treatment of children older than 1 year.
Surgical treatment
The best results in the surgical treatment of this pathology are achieved if the child was operated at the age of 5 years. Subsequently, the older the child, the less effect should be expected from the operation.
Operations for congenital hip dislocation can be intra-articular and extra-articular. Intra-articular interventions are performed for children under the age of adolescence. During the operation, the acetabulum is deepened. Adolescents and adults are shown extra-articular operations, the essence of which is to create the roof of the acetabulum. Hip replacement is performed in severe and late-diagnosed cases of congenital hip dislocation with severe impairment of joint function.
Literature
- Congenital hip dysplasia in the light of early and very early diagnosis. Ortolani M. Clin Orthop Relat Res. 1976 Sep;(119):6-10. link
- Current trends in the treatment of congenital dislocation of the hip. MacEwen GD, Zembo MM. Orthopedics. 1987 Dec;10(12):1663-9. link
- [Early diagnosis of hip dysplasia]. Malagón Castro V, Pérez Castellón R, Vélez Hernández F. Bol Med Hosp Infant Mex. 1977 Jul-Aug;34(4):891-901. link
- Neonatal screening in Vancouver for congenital dislocation of the hip. Lehmann EC, Street DG. Can Med Assoc J. 1981 Apr 15;124(8):1003-8. link
- Diagnosis and treatment of congenital dislocation of the hip. Churgay CA, Caruthers BS. Am Fam Physician. 1992 Mar;45(3):1217-28. link
