Congenital dislocation of the hip

Congenital hip dislocation is a severe pathology characterized by underdevelopment of all elements of the hip joint (bones, ligaments, joint capsule, muscles, vessels, nerves) and disruption of the spatial relationships of the femoral head and acetabulum. This is one of the most common diseases of the musculoskeletal system in children.

Anatomical, functional and trophic disorders in the joint without adequate treatment progress and lead to severe secondary changes in the joint structures. The functions of support and movement of the limb are impaired, the position of the pelvis changes, the spine is curved, deforming osteochondrosis and dysplastic coxarthrosis develop - a severe progressive disease that occupies a significant share in the structure of disability of young patients.

ICD-10 code

Q65.1 Congenital dislocation of hip, bilateral.

Causes of congenital hip dislocation

Congenital dislocation occurs due to improper formation of the hip joint.

The anatomical substrate of the pathology - hip dysplasia - ranks among the most common congenital deformities and occurs with a frequency of 1-2 per 1000 births. The prevalence of pathology in girls (1:3) on the left side (1:1.5) is statistically significant, and is more common in breech presentation. Cases of inheritance of the pathology have been described.

The disease is much more common in girls than in boys. There is evidence that among children born in breech presentation, the incidence of congenital hip dislocation is significantly higher than among children born in cephalic presentation. Congenital hip dislocation is often unilateral. Hip joint disorders leading to the development of dislocation can occur in utero as a result of exposure to many unfavorable factors: hereditary diseases (congenital hip dislocation in the mother, other diseases of the musculoskeletal system), diseases suffered by the mother during pregnancy, improper nutrition of the mother during pregnancy (lack of vitamins A, C, D, group B), the use of drugs (including antibiotics), especially in the first 3 months of intrauterine development of the fetus, when its organs are formed.

The realization of anatomical prerequisites for hip dislocation is facilitated by underdevelopment of the acetabulum, weakness of the ligament-muscle apparatus of the hip joint, the beginning of walking, leading to qualitatively new mechanisms for the occurrence of the most severe form of pathology - hip dislocation. It has been established that about 2-3% of dislocations are teratogenic, i.e. they are formed in the womb at any stage of embryogenesis.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

How to recognize congenital hip dislocation?

Signs of hip joint underdevelopment can be detected during a careful examination in the first days of a newborn's life, most often during swaddling. Noticeable is the limitation of the abduction of one or both legs bent at a right angle at the hip and knee joints, an unequal number and different levels of skin folds on the thighs. In case of unilateral dislocation, the inguinal and gluteal folds differ in depth and length, the folds in the popliteal fossa do not match. On the side of the dislocation, the folds are located higher, there are more of them, they are deeper and longer. Sometimes (often during bathing) a symptom of external rotation is visible: in a child lying on his back, the kneecaps are contoured from above, and from the side due to the rotation of the legs.

The presence of congenital hip dislocation may be indicated by a crunch or click heard during swaddling in the area of one or both hip joints, which occurs as a result of the head of the femur slipping out of the glenoid cavity when the legs are adducted and straightened.

If congenital hip dislocation is not diagnosed in the first months of life, and treatment of the pathology is not started, a shortening of the limb can be detected from the age of 5-6 months. The possibility of congenital dislocation should also be considered if the child spares one leg, does not sit or stand, and especially does not walk at the age required. An orthopedist examines all newborns in the maternity hospital, but congenital hip dislocation cannot always be detected immediately after birth. A repeat examination of the child by an orthopedist is mandatory at the age of 1-3 months, then at 12 months.

Depending on the severity of the disease at the time of the child’s birth, the following forms are distinguished:

1. dysplasia (simple underdevelopment) of joints - the relationship in the joint of the head of the femur and the acetabulum is normal, the acetabulum is underdeveloped;
2. subluxation (the head of the femur partially comes out of the glenoid fossa);
3. dislocation (the head of the femur comes out completely from the glenoid cavity).

Diagnosis of congenital hip dislocation

Treatment of congenital hip dislocation

Recovery with full anatomical restoration is possible only with early functional treatment. The principles of treatment of dysplasia or dislocation involve achieving reduction and maintaining optimal conditions for further development of the acetabulum and femoral head. It is necessary to consider the possibility of surgical intervention to change the unfavorable course of the disease, residual subluxation and/or residual dysplasia.

In case of late diagnosis and, accordingly, treatment, in severe forms of pathology (teratogenic dislocations), improvement of anatomical and functional parameters and restoration of the limb's support capacity are achieved by reconstructive and restorative operations on the bone and joint apparatus. Such treatment reduces functional disorders, improves the prognosis of life activity and increases social adaptation in the most active age.

Treatment of congenital hip dislocation

Early diagnosis and immediate initiation of treatment are extremely important for the treatment of congenital hip dislocation. Every missed month lengthens the treatment period, complicates the methods of its implementation and reduces its effectiveness.

The essence of the treatment of congenital hip dislocation is to bend the legs in the hip joints and completely spread them ("frog position"). In this position, the heads of the femurs are opposed to the acetabulum. To hold the legs in this position, wide swaddling, orthopedic panties, and various bandages are used. The child spends a long time in this position (from 3 to 8 months). During this time, the hip joint is formed normally.

If the disease is diagnosed late, metal splints and devices are used to reposition the dislocated femoral head, followed by surgical treatment.

A child's forced stay in a splint for a long time creates many inconveniences when performing hygienic care for him. You should pay attention to the cleanliness of the splint, do not allow contamination with feces and urine. You need to wash the baby carefully so that the splint does not get wet. A baby in a splint needs a massage of the feet and upper half of the body.

The baby can and should be placed on his stomach from the second month of life. To create the correct body position, place a small soft cushion under the chest, and after removing the splint, sit the baby down so that the legs are spread apart.

Physiotherapeutic procedures are an integral part of the conservative treatment complex. Before applying a plaster cast, medicinal electrophoresis with a 1-2% solution of novocaine is performed on the hip joints or on the adductor muscles of the thighs, the course consists of 10-12 procedures.

During the period of plaster immobilization and after removal of the plaster cast, procedures are prescribed to improve blood circulation and mineral electrophoresis with a 3-5% solution of calcium chloride on the hip joint and a 2% solution of euphyllin, 1% solution of nicotinic acid on the segmental zone (lumbosacral spine).

To stimulate weakened gluteal muscles and improve joint nutrition, sinusoidal modulated currents from the Amplipulse device are prescribed. A course of 10-15 procedures is indicated. The use of therapeutic exercise, relaxing massage for the adductor muscles of the thighs, strengthening massage for the gluteal muscles, 10-15 sessions per course, repeated 3-4 times a year, after 2.5-3 months, is justified.