Treatment of congenital hip dislocation

The goal of treating congenital hip dislocation and hip dysplasia is concentric reduction of the femoral head into the acetabulum with the creation and maximum maintenance of conditions for the development of joint components. This goal is achieved by functional conservative and surgical treatment. The treatment eliminates obstacles to reduction, corrects underdevelopment of the acetabulum and disturbances in the spatial orientation of the proximal femur and acetabulum.

The basis and achievement of good long-term results is the early initiation of functional treatment.

Early functional treatment of congenital hip dislocation

Treatment is carried out as follows:

• pre-repositioning preparation of joint components for the use of abduction splints and structures for 2 weeks with massage of the hip joint area, passive movements, warm baths, thermal procedures (UHF, paraffin, ozokerite), myotomy of adductors in case of severe tension;
• use of the same splints and structures; first X-ray control after 1 month; treatment using the structure until the child is 1 year old.

Compliance of the X-ray data of the joint components with the norm or deviation from the norm by no more than 10% is the criterion for permission to walk.

Patients undergo mandatory annual X-ray examination with interpretation of the data obtained by a specialist competent in surgical treatment. A normal X-ray anatomical picture by the age of 7 indicates the success of treatment, without eliminating the need for further annual examination and X-ray control.

To a large extent, the reduction of the severity of the problem of dysplastic coxarthrosis as an outcome of hip dysplasia depends on the implementation of the following provisions:

• organization of a system of dispensary observation of patients with hip dysplasia with the participation of orthopedic surgeons specializing in the surgical treatment of hip joint pathology;
• refusal of treatment for hip dysplasia that involves rigid immobilization with a plaster cast;
• elimination of outdated surgical treatment methods from the arsenal of pediatric orthopedic surgeons.

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Surgical treatment of congenital hip dislocation

Indication for surgical treatment of hip dysplasia is a violation of the relationship of the pelvic and femoral components of the joint in the form of a deficiency in the coverage of the femoral head by the acetabulum cartilage. The nature of previous treatment measures and iatrogenic damage to the joint structures, which occurs when using non-functional treatment methods in more than 90% of children, are extremely important for prognosis and determination of surgical treatment tactics. The proximal femur is most vulnerable in this regard, where even minimal ischemic disorders subsequently lead to its gross deformation with a violation of the relationship in the joint.

General principles of surgical treatment

• Maximum care for the cartilaginous and soft tissue components of the joint. Prevention of avascular disorders during surgical treatment with optimal terms for restoration of free walking - the most important element of joint formation.
• Restoring correct anatomical relationships in the growing hip joint while ensuring congruence of the articular surfaces is an effective preventive measure for preventing deforming coxarthrosis.
• Reconstruction of joint components to increase the area of contact surfaces with a change in biomechanical parameters is an effective measure for the treatment or delay of the progression of dysplastic coxarthrosis.