Brief overview
- Treatment: control by ultrasound or X-ray, maturation treatment in babies, wide wrapping or spreader pants, “dislocation”: bandaging or plastering, extension treatment in older children, physiotherapy in children and adults, surgery.
- Causes: Incorrect or constricted position of the fetus in the womb, hormonal factors of the mother during pregnancy, genetic predisposition, neurological or muscular diseases of the baby, deformities in the spine, legs or feet.
- Diagnosis: routinely at screening U2 by pediatrician, ultrasound at U3, in adults: Checking hip mobility and gait pattern, X-ray.
- Prevention: no preventive measures possible, wide swaddling for babies and toddlers favorable for hip joints
What is hip dysplasia?
Hip dysplasia and hip dislocation occur either at one hip joint or at both joints. If the deformity is unilateral, the right hip joint is affected much more often than the left.
Frequency of hip dysplasia
For every 100 newborns, two to three have hip dysplasia. Hip dislocation is much less common, with an incidence of about 0.2 percent. Girls are more commonly affected than boys.
Hip dysplasia in adults
Since girls suffer from hip dysplasia more often, consequently more women than men are found among adult patients.
How is hip dysplasia treated?
The treatment of hip dysplasia depends on the severity of the changes. Both conservative and surgical measures are available.
Conservative treatment of hip dysplasia or hip dislocation consists of three pillars: Maturation treatment, reduction and retention.
Maturation treatment for babies
The maturation of the hip joint is supported by wrapping the child especially wide. “Wide swaddling” means that an additional insert, such as a molleton cloth or small towel, is placed between the baby’s legs over the normal diaper. The insert is folded into a tie about 15 centimeters wide and placed between the diaper and the bodysuit or pants. It is advisable to put underpants one dress size larger over the insert.
In the case of higher-grade hip dysplasia, but where the femoral head is still in the acetabulum, the baby is given a fitted spreader, also called an abduction splint. The duration of treatment depends on the severity of the dysplasia and continues until a normal acetabulum is formed.
Reduction and retention in babies and children
If the femoral head of a child with hip dysplasia has slipped out of the socket (dislocation), it is “set back” into the socket (reduction) and then held and stabilized there (retention).
Another option is to manually adjust the “slipped” femoral head and then apply a cast in a sitting-hock position for several weeks. It keeps the femoral head stable and permanent in the acetabulum. Due to the restored contact, the head and the acetabulum develop normally.
Physiotherapy for children and adults
In the case of hip dysplasia, physiotherapy or functional training specifically for hip osteoarthritis patients helps to relieve pain and counteract limitations in walking. In the process, those affected train primarily those muscles that stabilize the hip. They also learn which movements help them to remain as pain-free as possible.
Surgery for children and adults
In some cases, surgery is unavoidable. This includes when conservative measures to treat hip dysplasia are unsuccessful or the deformity is detected too late. The latter refers to children who are three years old or older, or to adolescents or adults. Various surgical procedures are available for this purpose.
What are the symptoms of hip dysplasia?
In older children, hip dysplasia may result in a hollow back or a “waddling gait”.
In adults, advanced wear and tear in the hip joint is manifested by pain and increasing immobility in the hip area.
What are the causes and risk factors for hip dysplasia?
The exact causes of hip dysplasia are not known. But there are risk factors that promote the development of this deformity:
- Constrictive conditions in the womb, such as in a multiple pregnancy.
- Hormonal factors: the pregnancy hormone progesterone, which loosens the maternal pelvic ring in preparation for birth, is thought to cause greater loosening of the hip joint capsule in female fetuses.
- Genetic predisposition: Other family members already had hip dysplasia.
- Malformations of the spine, legs and feet
How is hip dysplasia examined and diagnosed?
On physical examination, the following signs indicate possible hip dysplasia:
- Unevenly developed skin folds at the base of the thigh (gluteal fold asymmetry).
- One leg cannot be splayed as far as usual (splay inhibition).
- Unstable hip joint
Course of the disease and prognosis
The sooner hip dysplasia is treated, the sooner it can be corrected and the greater the chances of recovery. With consistent treatment in the first weeks and months of life, the hip joints develop normally in over 90 percent of affected children.
On the other hand, if hip dysplasia is detected late, there is a risk of hip dislocation and osteoarthritis in young adulthood.
Are there any preventive measures?
Hip dysplasia cannot be prevented. However, wide diapering causes babies and toddlers to spread their legs more. This is considered to be beneficial for the hip joints.
