Treatment of congenital hip dislocation

The purpose of treatment of congenital dislocation of the hip and dysplasia of the hip joint is concentric insertion of the femoral head into the acetabulum, with the creation and maximum maintenance of the conditions for the development of the joint components. This goal is achieved by functional conservative and operative treatment. The treatment eliminates obstacles for correction, corrects the underdevelopment of the acetabulum and disturbs the spatial orientation of the proximal femur and acetabulum.

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

Early functional treatment of congenital hip dislocation

Treatment is carried out as follows:

• pre-position preparation of joint components for the use of tapping tires and structures for 2 weeks with massage of the region of the hip joints, passive movements, warm baths, thermal procedures (UHF Paraffin, ozocerite), myotomy of adductors with expressed stress;
• application of the same tires and structures; first radiologic control after 1 month; treatment with application of the design up to the age of the child 1 year.

Correspondence of the X-ray data of the joint components to the norm or deviation from the norm by no more than 10% is the criterion of the walking permit.

Patients undergo mandatory annual X-ray examination with interpretation of the findings by a specialist competent in surgical treatment. A normal roentgenoanatomical 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 relief 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 to treat hip dysplasia, which involves hard immobilization with a plaster bandage;
• Out of the arsenal of pediatric orthopedic surgeons, obsolete methods of surgical treatment.

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

Surgical treatment of congenital dislocation of the hip

Indication for surgical treatment of hip dysplasia is a violation of the ratio of the pelvic and femoral components of the joint in the form of deficiency of the head covering of the femur with the cartilage of the acetabulum. For the prediction and determination of the tactics of surgical treatment, the nature of the previous treatment measures and the iatrogenic lesions of the joint structures that arise when non-functional methods of treatment are used in more than 90% of children are extremely important. The proximal femur section is most vulnerable in this respect, in which even minimal ischemic disturbances subsequently lead to its gross deformation with violation of the relationship in the joint.

General principles of surgical treatment

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