Dysplasia of the hip joints in children under one year old is a congenital pathology caused by a violation of the formation of the joint. It is usually found in the first six months of a baby’s life. If not started at an early age, the disease can lead to serious problems. In the article, we will talk about its types, severity and modern methods of treatment used by orthopedists, and the possible consequences of the violation.
What is Joint Dysplasia in Newborns
Hip dysplasia in children under one year old develops due to changes in the structure of the articular surfaces, which affects mobility.
The hip joint consists of:
- acetabulum – looks like a round capacious fossa, around it there is cartilaginous tissue for deepening the fossa;
- femoral head – has a rounded shape, is located inside the cavity, acts as a hinge during movement;
- ligaments and muscles, cartilage, which hold the head of the femur in the desired position, provide a range of motion, while creating a kind of “support” so that the bones do not injure each other and the movements are painless.
With pathology, the shape, size and ratio of structures to each other change. Dysplasia in a month-old baby does not manifest itself in any way: the baby at this age is in a horizontal position, there is no load on the legs.
The development of the hip joint occurs when the structures begin to interact closely with each other. That is, when the baby starts to sit down and get up. Ideally, in a healthy baby, bone and soft tissues develop in proportion to each other – there are no deviations.
Otherwise, the femoral head is not held inside the cavity: it is shifted outward and slightly upward. With some movements, it partially comes out of the cavity. In difficult cases, the bone completely extends beyond the fossa – this is how the hip is dislocated. Over time, if the situation does not change, the cavity of the fossa is filled with connective and adipose tissue.
Dysplasia Symptoms in Children Under One Year Old
Signs of the disease can be found in an infant already in the first month of life. Mom can do the testing herself. For this, the newborn must be placed, preferably on the table. Make sure that he is in a good mood, does not cry and is not capricious – this can distort the result.
On examination, you will notice the following symptoms:
- Different folds on the buttocks and thighs in the prone position. The folds differ in depth, length, level of arrangement;
- Turn the baby over onto its back. Bend your knees. Pay attention to the level at which the knees are located: they must be the same;
- Spread your legs to the sides. In a healthy infant, they are removed in the same way.
We just talked about unilateral dysplasia. If there is a violation on both sides, you will not notice the difference. In this case, the symptom of a click, or Marx-Ortolani, will help you figure it out. The baby lies on its back, you bend and spread your legs. With the instability of the hip joint, a click is heard, which occurs at the time of dislocation and reduction of the femoral head into the acetabulum.
If his pathology is not diagnosed, an older child walks “on his toes”, develops clubfoot, and his toes turn out. He can also slouch, while various forms of postural disorders arise and progress.
The detected signs are not the basis for a diagnosis by the mother. If you find abnormalities, this is just a reason to consult an orthopedic doctor. The diagnosis is made solely based on examination.
The Reasons For The Development of the Disease
Joint dysplasia in infants develops due to the following factors that act negatively during intrauterine development:
- poor environment, poor quality food and drink;
- pregnancy in a woman over 35;
- overweight, acute and chronic diseases during gestation;
- toxicosis and medication;
- hormonal disorders before and during pregnancy.
At-risk are babies:
- with a body weight of more than 4 kg in newborns – they have an increased load on the lower extremities;
- whose mothers adhere to old traditions and are supporters of tight swaddling – in this position, the head of the femur is in an everted position;
- with a hereditary predisposition to joint diseases;
- with connective tissue dysplasia, in which the structure of connective tissue is disturbed throughout the body;
- girls – it’s all about the relaxation hormone, which is produced in the woman’s body to increase the elasticity of the pelvic ligaments before childbirth. The hormone also acts on the fetus, while girls are more sensitive to it.
In some cases, dysplasia can be one of the consequences of injuries to the pelvic region, lower extremities, acquired deformities of the spine and spinal cord. This is a topic for a separate section and we will not consider it for now.
Depending on the severity of pathological changes in the articular surfaces, the following degrees of dysplasia are distinguished in children under one year old.
The first is the physiological immaturity of the joint in the newborn. He has changed both bone structures (they have a different shape) and soft tissues (they are more elastic, unable to hold bones). At the same time, there are no external changes: the lower limb looks normal, all its parts are proportional. This is true dysplasia in infants, which disappears with the use of conservative correction methods. Bones and cartilage will develop well in the future, there will be no deviations.
Grade 1, or pre-dislocation. The femoral head is slightly displaced. It usually proceeds easily, motor activity remains.
Grade 2, or incomplete dislocation. It is characterized by a pronounced violation of the location of the bone structures of the hip joint. During movement, the ligaments are overstretched, the head of the femur is significantly displaced relative to the pelvic bones.
Grade 3, or true dislocation. It is accompanied by tissue deformation, the formation of contractures, the development of coxarthrosis. This leads to severe pain, lameness and disability. This is an advanced stage that manifests itself in adults with untreated dysplasia.
Types of Dysplasia
Dysplasia in a month-old baby can be unilateral or bilateral. With unilateral pathology, the left limb suffers more often, since it is in a more bent position in the uterus than the right one.
There are 3 types of pathology, depending on the structural features and the level of damage:
- dysplasia of the acetabulum, or acetabular, dislocation – corresponds to 1 degree, pre-dislocation;
- dysplasia of the femur, or epiphyseal – corresponds to grade 2, subluxation. It is accompanied by compaction of bones, violation of the biomechanics of the articulation. Point foci of ossification appear in the cartilaginous tissue, which limits movement;
- rotational dysplasia – corresponds to grade 3. It is accompanied by gross anatomical defects. The toes walk inward is characteristic.
Diagnosis of Hip Dysplasia in Newborns
The diagnosis is made by an orthopedist. The survey begins with an examination. The doctor reveals the asymmetry of the skin folds on the buttocks and thighs, knees of different heights, limitation of the leg abduction to the side, a click symptom.
The second stage of diagnosis is instrumental examination methods:
- Ultrasound procedure. A harmless and affordable diagnostic method that is carried out repeatedly. The doctor receives data on the state of bone structures and soft tissues, the presence or absence of pathology;
- X-ray examination, that is, taking a picture of the joint. The procedure can be carried out after 3 months of age. The image is deciphered by a radiologist, on the basis of which the orthopedist detects or refutes joint dysplasia in infants and, if necessary, selects the treatment.
Ultrasound and X-ray are the diagnostic standards. If the results do not allow for an accurate diagnosis, or it is necessary to decide on the expediency of surgical treatment, the doctor may send for additional examinations: CT and MRI.
Dysplasia Treatment Methods
Typically, the management of hip dysplasia in infants is as follows. The diagnosis is made in newborns in a maternity hospital or in a polyclinic. Then conservative methods of treatment are prescribed and monitored. Evaluation of the dynamics allows you to determine whether there is an improvement or not. If not, the orthopedist selects more radical methods.
Conservative methods of treatment are used, which are based on the use of special devices, or structures. They hold the limbs in the flexion and extension position for a long time. Thanks to this, bone structures and cartilage develop in proportion.
All this time, the head of the femur is in a physiological position: subluxation, dislocation does not occur, and there is no load on the lower limb.
The following methods are used:
- Becker’s pants – in appearance, the device resembles children’s panties, there is a flexible rigid pad between the legs, which does not allow the legs to be brought together;
- wide swaddling – using ordinary diapers in the amount of 3 pieces, two of which are laid between the legs, the third fixes them;
- Pavlik’s stirrups are an orthopedic device made of soft tissue, which has a chest and abduction parts. Consists of a chest and ankle brace, reins and fixation straps. The legs are fixed in a bent position, while the baby can move the legs;
- pillow (perinka) Freyka is a roller-shaped structure that is fixed between the legs with straps.
Hip abduction in newborns and young infants is also facilitated by the simplest devices: children’s backpacks, carriers, kangaroo bags, slings. But the decision about which method is shown in your case is up to the doctor.
Be sure to supplement your treatment with physical therapy and massage. They stimulate motor skills, prevent congestion, and contribute to the harmonious development of your baby’s crumbs.
Gymnastics at home
You can do gymnastics yourself at home. When in doubt, ask your doctor to show you the basic movements. This way you can be sure that you are doing everything correctly.
For a good result, you need to do gymnastics regularly: 2 – 3 times a day, 10 – 15 repetitions. It is necessary that during the manipulations your baby is in a good mood, does not want to sleep. Do all the movements carefully and gently so as not to scare the child or hurt him. Watch his reaction. The exercises are:
- The “bicycle” is performed lying on your back. Bend the legs at the knees and hip joints and do movements that simulate cycling;
- Flexion and extension of the baby’s legs: first simultaneously, then alternately;
- “Okay” with the feet of the crumbs.
Prevention of hip dysplasia in newborns
For the hip joint to develop correctly, the legs must be kept apart. Disposable diapers do a great job with this. Also, do the exercises described earlier. Regularly visit doctors and undergo medical examinations – these measures will allow you to detect pathology in time and undergo treatment.
What Complications Can Be If Not Treated?
The main task of parents and doctors is to put the head of the femur in place while the baby is not walking and there is no load. In newborns and in the first months of life, conservative methods can still be dispensed with. Without treatment, the disease begins to progress with the onset of bipedal locomotion. Subluxations occur, then dislocations.
As long-term consequences of dysplasia, a change in gait and even lameness, pain, inflammation, arthrosis are possible. The listed conditions require more radical measures, often surgery. After them, a long rehabilitation period, children recover for a long time. This is a colossal psychological burden on the whole family and on the little patient.
Complications in adults are treated surgically and conservatively. Prescribe anti-inflammatory drugs, drugs for the restoration of cartilage tissue. Extremely advanced dysplasias threaten with disability and immobilization.