Hip dysplasia, hip dislocation or hip dislocation is a misalignment of the hip joint in which the joint head is not stable in the hip socket. If 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?
Congenital hip dysplasia often causes no symptoms and in many cases heals spontaneously before hip dislocation can develop. In hip dysplasia, the joint socket is deformed.
According to abbreviationfinder, hip dysplasia is a hip socket that has been created incorrectly or is defective in its development. 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 footing in the acetabulum, which can lead to misalignment and dislocation (hip dislocation). Hip dysplasia is one of the most common congenital skeletal abnormalities, occurring in approximately 4% of all newborns. The defective acetabular cup usually forms on both sides, sometimes unilateral malformations also occur.
Girls are affected 4-6 times more often than boys. Hip dysplasia usually only becomes clearly visible after birth. If left untreated, hip osteoarthritis (joint deformity) can develop in later years.
Causes
The exact causes of hip dysplasia are not yet known. There are different approaches to the development of the malformation 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 suspected in cramped conditions in the uterus, as is the case, for example, with multiple pregnancies. An unfavorable position of the embryo, especially the breech position, also represents an increased risk for the development of hip dysplasia and is also one of the mechanical triggers.
Another possible cause is the hormonal change in the body of a pregnant woman. Hormones are produced during pregnancy that cause the mother’s pelvic ring to relax. This effect can also be transmitted to the female fetus, which explains the fact that far more girls suffer from hip dysplasia than boys.
Other possible causes considered are increased maternal blood pressure during pregnancy and insufficient amniotic fluid in the uterus.
Symptoms, Ailments & Signs
Congenital hip dysplasia often causes no symptoms and in many cases heals spontaneously before hip dislocation can develop. In hip dysplasia, the joint socket is deformed. It depends on the severity of the dysplasia and the extent to which a luxation, i.e. a partial or complete displacement of the femoral head from the joint socket, develops.
Hip dysplasia with hip dislocation is characterized by an unstable hip joint (Ortolani sign). In Ortolani’s sign, a clicking sound is heard when the infant’s legs are raised and lowered. This click is caused by the correct displacement of the condyle in the socket. Another symptom is an inhibition of the leg to spread out in the affected area.
In addition, the femoral head dislocates and retracts again and again when the legs are raised and lowered. This symptom is also known as Barlow’s sign. With a unilateral hip dislocation, the folds on the posterior thighs appear asymmetrical. In addition, the leg on the affected side also appears to be shortened in this case.
A unilateral hip dislocation occurs in about 60 percent of cases. The severity of hip dysplasia with hip dislocation is not uniform at birth. In addition to many mild forms of the disease, there are also fully developed hip dislocations. In the case of severe dysplasia, early treatment is necessary to avoid complete death of the femoral head.
Diagnosis & History
Hip dysplasia can be present at birth or develop afterwards, which is much more common. Typical symptoms are an unstable hip joint (Ortolani sign) and asymmetrical folds on the back of the thighs.
The affected leg appears shorter and the femoral head slides easily out of the socket and back again (Barlow’s sign). With an ultrasound examination (sonography), the hip dysplasia can be made visible and the doctor can see to what extent the socket roof is 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 degradation has already taken place.
If hip dysplasia is detected immediately after birth, the chances of recovery are greatest. If the malformation is not recognized, circulatory disorders can occur over time and the bone tissue of the femoral head can be damaged and die as a result.
Complications
Hip dysplasia usually results in a misalignment of the hip joint. In most cases, this misalignment is associated with severe pain and restricted movement and thus always leads to a reduced quality of life for the patient. The hip joint itself feels very unstable and can be dislocated very easily.
This can occur above all with light impacts or jerky movements and thus restrict the everyday life of the person concerned. The pain from the hip can also spread to other regions of the body and cause problems there as well. It is not uncommon for chronic pain to lead to depression and other psychological complaints or upsets. Usually one of the legs is also shortened. With early diagnosis and treatment, hip dysplasia can be treated relatively well and completely.
There are no further complications or other complaints. With the help of various therapies, the joint can be stabilized again so that the symptoms disappear completely. Surgical intervention is only necessary in severe cases. 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 go to the doctor?
A visible misalignment of the hip joint must be clarified by a doctor. If there are other signs of hip dysplasia, it is best to seek medical advice immediately. Restricted movement in the area of the hip joint must always be clarified by a doctor. Likewise, medical advice should be obtained with externally visible bone changes.
Parents who notice the signs of hip dysplasia in their child are best advised to speak to their pediatrician. If the malposition only develops later in life, unusual symptoms and non-specific pain must be seen by a doctor who can clarify the symptoms and, if necessary, initiate treatment immediately. Hip dysplasia mostly affects girls and often occurs as a result of complications during pregnancy. For mothers who have hormonal problems or high blood pressure during pregnancy, there is an increased risk of giving birth to a child with hip dysplasia. Anyone who belongs to these risk groups should contact the responsible doctor. The child can then be examined and medically treated immediately after birth.
Treatment & Therapy
The treatment of hip dysplasia depends on how severe it is. If there is only a slight malformation, a special changing technique with extra wide diapers or the use of spreader pants is usually sufficient.
These actions flex the hips and spread the legs, causing the condyle to slide deep into the acetabulum and stabilizing the joint. Accompanying physiotherapeutic exercises are recommended. If the femoral head keeps popping out of the socket, bandages or splints are attached to keep the joint head stable in the socket. In some cases, the joint is immobilized with a plaster splint.
With these treatments, mild hip dysplasia often heals within the first year of life. If hip dysplasia is diagnosed late and the misalignment has already caused damage to the bone, an operation is usually necessary to bring the joint back into the correct position and to stabilize it.
Prevention
Most hip dysplasias develop after birth. Simple measures are often enough to avoid this. So you shouldn’t stretch a baby’s hip joint too early. The natural posture is the bent position, in which the hip joint can fully mature. Therefore, it is important to avoid placing the baby in the tummy position too early and too often, as this stretches the hips. On the other hand, carrying the baby in a sling supports the correct posture to prevent hip dysplasia.
Aftercare
The follow-up care of hip dysplasia (hip dislocation) in childhood differs from the follow-up care of the same in adulthood. In childhood, follow-up care for hip dysplasia (hip dislocation) lasts until growth is complete. Regular checks prevent the risk of tardive dysplasia. An X-ray is necessary during the major growth phases (at the age of 1.5 years, after the start of running, as well as shortly before starting school and at the beginning of puberty).
Further treatment or a new treatment concept depends on these findings. Wearing a spreader splint or a sit-squat cast, renewed and corrective adjustment of the joint by holding the femoral head in the socket (operatively) or extension treatment.
Regular follow-up care after an operation to correct hip dysplasia (hip dislocation) is also necessary in adulthood. These include: Partial weight bearing on forearm crutches, physiotherapy and bandages to avoid secondary diseases. Corrective operations (on the hip socket and/or thigh) can be performed at any age and prevent wear and tear (arthrosis) in the hip.
If there is secondary hip dysplasia that has been treated with conservative measures (splints, Botox injections), an operative measure may be necessary as part of the aftercare. Severity, underlying disease and age are taken into account in the surgical measure. Combined interventions (bony corrections with soft tissue interventions) are common.
You can do that yourself
Self-help options for hip dysplasia depend on the age of the patient. Hip dysplasia is often seen in infants, so it is the parents’ responsibility to deal with the disease appropriately. With the right measures, for example a special changing technique or wearing spreader pants, the parents can have a positive influence on the course of the disease. Undetected and untreated, hip dysplasia often leads to serious problems later in the patient’s life, which are associated with a reduced quality of life.
Even with successful therapy in infancy, follow-up checks are still necessary in children to ensure that the joint continues to develop without complications as it grows. If problems arise, the affected children take part in physiotherapy and follow medical advice on exercising. Prescribed shoe inserts to correct misalignments must also be worn.
If adults still have symptoms caused by congenital hip dysplasia, they often remain for life. For example, some patients develop early arthrosis in the affected joints. Persistent pain sometimes leads to depression, so that the affected persons visit a psychotherapist.