Hip dysplasia, hip dislocation or hip luxation is a deformity of the hip joint in which the condyle is not stable in the acetabulum. Treated early, hip dysplasia can heal completely. It can be prevented with the right measures, even if there is a genetic predisposition to it.
What is hip dysplasia?
Hip dysplasia is a defectively created or developmentally disturbed acetabulum. In this case, the so-called acetabular roof is either not properly formed or not sufficiently ossified, but is still cartilaginous and soft. As a result, the head of the femur does not find a hold in the acetabulum, which can lead to malposition and dislocation (hip luxation). Hip dysplasia is one of the most common congenital skeletal malformations, occurring in approximately 4% of all newborns. The defective acetabulum usually forms on both sides, sometimes unilateral malformations occur. Girls are affected about 4-6 times more often than boys. Hip dysplasia is usually not clearly visible until after birth. If it is not treated, hip osteoarthritis (deformation of the joint) may develop in later years.
Causes
The exact causes of hip dysplasia are not yet known. There are different approaches to the development of the deformity and a distinction is made between genetic, mechanical and hormonal causes. If there are several cases of hip dysplasia within a family, a genetic predisposition is assumed. Mechanical causes are assumed to be constricted space conditions in the uterus, as is the case in multiple pregnancies, for example. An unfavorable position of the embryo, especially the breech position, also poses an increased risk for the development of hip dysplasia and also belongs to the mechanical triggers. Another possible cause is considered to be hormonal changes in the body of a pregnant woman. During pregnancy, hormones are formed that lead to the loosening of the mother’s pelvic ring. This effect can also pass to the female fetus, which explains the fact that many more girls suffer from hip dysplasia than boys. Other possible causes considered include increased blood pressure in the mother during pregnancy and insufficient amniotic fluid in the uterus.
Symptoms, complaints, and signs
Congenital hip dysplasia often causes no symptoms and, in many cases, heals spontaneously before hip dislocation can develop. In hip dysplasia, the socket of the joint is deformed. The extent to which dislocation develops, i.e. a partial or complete displacement of the femoral head from the joint socket, depends on the extent of the dysplasia. Hip dysplasia with hip luxation is characterized by an unstable hip joint (Ortolani sign). In Ortolani’s sign, a clicking sound is heard when the infant’s legs are spread on and off. This clicking is caused by the correct displacement of the condyle into the socket. Another symptom that occurs is an inhibition of spreading of the leg at the affected site. In addition, the femoral head repeatedly dislocates and retracts during angling and un-anchoring movements of the legs. This symptom is also known as Barlow’s sign. In unilateral hip dislocation, the creases on the posterior thighs appear asymmetrical. In addition, in this case, the leg on the affected side also appears to be shortened. Unilateral hip dislocation occurs in circ 60 percent of cases. The expression of hip dysplasia with hip luxation is not uniform at birth. In addition to many mild forms of the disease, there are also fully developed hip dislocations. In severe dysplasia, early treatment is necessary to avoid complete death of the femoral head.
Diagnosis and course
Hip dysplasia may be clearly present at birth or may develop afterward, which is much more common. Typical symptoms include an unstable hip joint (Ortolani sign) and asymmetric folds on the back of the thigh. The affected leg appears shorter and the femoral head can be easily pushed out of the socket and back again (Barlow sign). With an ultrasound examination (sonography), hip dysplasia can be visualized and the doctor can see to what extent the acetabular roof has ossified.An X-ray also clearly shows an existing hip dysplasia, but is usually not used for purely diagnostic purposes, but rather to document the course of treatment and to check whether joint degeneration has already occurred. If hip dysplasia is detected immediately after birth, the chances of recovery are greatest. If the deformity is not detected, circulation problems can occur over time and the bone tissue of the femoral head can be damaged and die as a result.
Complications
Hip dysplasia usually causes a deformity in the hip joint. In most cases, this malalignment is associated with severe pain and restricted movement and thus always leads to a reduced quality of life for the patient. At the same time, the hip joint itself feels very unstable and can thus be dislocated very easily. This can occur especially with slight jolts or jerky movements and thus limit the daily life of the affected person. The pain from the hip can also spread to other regions of the body and cause discomfort there as well. It is not uncommon for permanent pain to lead to depression and other psychological discomfort or upset. Usually, one of the legs is also shortened. With early diagnosis and treatment, hip dysplasia can be treated relatively well and completely. It also does not lead to further complications or other discomforts. With the help of various therapies, the joint can be stabilized again so that the complaints disappear completely. Only in severe cases is surgical intervention necessary. Life expectancy is not affected by hip dysplasia. However, the affected person may be limited in the performance of various sports in his life.
When should you see a doctor?
A visible deformity of the hip joint must be clarified by a doctor. If other signs of hip dysplasia are added, it is best to seek medical advice immediately. For example, movement restrictions in the area of the hip joint must be clarified by a doctor in any case. Likewise, medical advice should be sought with externally visible bone changes. Parents who notice signs of hip dysplasia in their child are best advised to talk to their pediatrician. If the deformity does not develop until later in life, a doctor must be consulted in the event of unusual symptoms and unspecific pain, so that the symptoms can be clarified and, if necessary, treatment can be initiated directly. Hip dysplasia mainly affects girls and often occurs as a result of complications during pregnancy. For mothers who have hormonal problems or elevated blood pressure during pregnancy, there is an increased risk of giving birth to a child with hip dysplasia. Those who belong to these high-risk groups should consult the doctor in charge. The child can then be examined and given medical care immediately after birth.
Treatment and therapy
Treatment of hip dysplasia depends on how severe it is. If there is only a slight deformity, a special wrapping technique with extra-wide diapers or the application of spreader pants is usually sufficient. These measures bend the hip and spread the legs, which causes the condyle to move deep into the acetabulum and stabilizes the joint. Accompanying physiotherapeutic exercises are recommended. If the femoral head keeps popping out of the socket, bandages or splints are applied to keep the femoral head stable in the socket. In some cases, the joint is immobilized with a plaster splint. With these treatments, mild hip dysplasia often heals during the first year of life. If hip dysplasia is diagnosed late and the deformity has already caused damage to the bone, then surgery is usually needed to restore the joint to its proper position and stabilize it.
Prevention
Most hip dysplasias do not form until after birth. To prevent this, simple measures are often enough. For example, a baby’s hip joint should not be stretched too soon. The natural position is the flexed position, in which the hip joint can fully mature. It is therefore important to avoid putting the baby in the prone position too early and too often, as this stretches the hip.In contrast, carrying the baby in a sling supports proper posture to prevent hip dysplasia.
Aftercare
Follow-up care for hip dysplasia (hip dislocation) in childhood is different from follow-up care for the same in adulthood. In childhood, follow-up care for hip dysplasia (hip dislocation)lasts until growth completion. Regular check-ups prevent the risk of late dysplasia. An X-ray is necessary during the major growth phases (at the age of 1.5 years, after the start of walking, and shortly before starting school and at the beginning of puberty). Further treatment or a new treatment concept depends on these findings. Wearing of a spreading splint or a sitting-squatting cast, renewed and corrective adjustment of the joint by holding the femoral head in the socket (surgically)or extension treatment. In adulthood, regular follow-up after surgery has been performed to correct hip dysplasia (hip dislocation) is also necessary. This includes: Partial weight bearing on forearm crutches, physical therapy, and bandaging to prevent sequelae. Corrective surgery (on the acetabulum and/or femur) can be performed at any age and prevents joint wear (osteoarthritis) of the hip. If there is secondary hip dysplasia that has been treated with conservative measures (splinting, Botox injections), surgery may be necessary in the course of follow-up care. Severity, underlying disease and age are taken into account in the surgical measure. Combined procedures (bony corrections with soft tissue interventions) are common.
What you can do yourself
Self-help options for hip dysplasia depend on the patient’s age. Hip dysplasia often manifests in infants, so adequate management of the condition is the responsibility of parents. With the right measures, for example a special wrapping technique or the wearing of spreader pants, parents have a positive influence on the course of the disease. Undetected and untreated, hip dysplasia often leads to serious complaints in the further course of the patient’s life, which are associated with a reduced quality of life. Even with successful treatment in infancy, follow-up visits are still necessary in children to ensure that the joint continues to develop without complications as they grow. If problems are evident, affected children participate in physical therapy and follow medical advice regarding exercise. Prescribed shoe inserts to correct deformities should also be worn. If adults still show symptoms from congenital hip dysplasia, they often persist throughout life. For example, some patients develop early arthrosis in the affected joints. Permanent pain sometimes causes depression, so affected individuals visit a psychotherapist.
