pathology: hip dysplasia

yogabook / pathologie / hip dysplasia

hip dysplasia

Definition of

Hip dysplasia is a congenital or acquired malformation of the hip joint socket (acetabulum). From infancy onwards, the hip joint (both acetabulum and femoral head), which initially consists largely of cartilage, becomes increasingly ossified, a process to which controlled movement also contributes. Malpositions and malformations of the hip joint disrupt this process; these can be dislocations and subluxations, incongruities or inadequate enclosure of the femoral head.

In this case, the hip joint usually has a clearly limited load-bearing capacity. Sports with higher mileage can therefore only be allowed after a detailed examination. The athlete’s career must then be monitored and attention must be paid to the changes taking place, especially during puberty. Dysplasia that only develops after puberty or the aggravation of existing dysplasia is possible.

In the long term, these disorders lead to painful dysfunctions and osteoarthritis. Enclosing the femoral head in too small an area is also problematic, as it increases the tendency to dislocation/subluxation. The risk of hip dysplasia as the only disorder in this area is W:M 13:1, but the risk of a complex disorder is roughly equally distributed. Children born in the breech or pelvic presentation are about 25 times more likely to have hip dysplasia.

Further risk factors are assumed to be intrauterine space restriction, e.g. due to a lack of amniotic fluid, multiple pregnancies and a high fetal weight. Familial disposition and regional clustering are considered certain. While hip dysplasia occurs in 4% of children throughout Germany, the figure is significantly higher in Hesse, the Upper Palatinate, Franconia and Saxony. The incidence is even more inconsistent in the various nations, with up to 50% being reported, although this figure is partly due to different classifications of the mild forms. The incidence is lowest in Central Africa and highest among Indians and the Scandinavian Sami. In Eastern Europe, figures of up to 36% are recorded.

Hip dysplasia can occur unilaterally or bilaterally; in unilateral hip dysplasia, the right hip joint is affected much more frequently. The first indication of hip dysplasia is seen after birth in the form of uneven buttock folds. An Ortolani test then confirms the suspicion. An examination for dysplasia should be carried out as early as U2, but no later than U3. Early intervention significantly improves the prognosis. With timely and adequate intervention, 90% of children develop normally. Hip dysplasia can remain asymptomatic over a longer period of time.

As the condition progresses, the most common symptoms are asymmetrical gait to avoid pain, painful abduction inhibitionand an apparent difference in leg length. The avoidance of pain can later lead to a hollow back and a waddling gait. If hip dysplasia is not recognized and treated, there is a risk of severe damage to the hip joint later on, which can restrict the choice of occupation and lead to disability. The disorder of the hip joint is usually classified according to Graf (without specifying the subdivision of grades):

  1. Normally developed and mature hip: no therapy
  2. Delayed maturation of the hip (dysplasia): between „no therapy necessary“ and „immediate spreader treatment, safe immobilization necessary“
  3. Decentered hip joints (dysplasia with malalignment): Immediate inpatient treatment
  4. Complete hip dislocation (severe dysplasia with severe malposition): Immediate inpatient treatment, correction of the hip position

Cause

  1. congenital
  2. acquired, see risk factors

Predisposing

  1. Breech or pelvic presentation of the fetus
  2. Multiple pregnancy
  3. endocrinological factors such as the mother’s progesterone level before the birth
  4. Family and regional disposition
  5. Dysplasia in the area of the spine, legs, feet
  6. Muscular or neurological diseases, e.g. spina bifida
  7. Poor posture after birth

Diagnosis

  1. Tests and signs: Ortolani (not without controversy, as it can increase existing damage)
  2. Sono, mandatory as part of the U3 check-up
  3. X-ray, MRI if necessary

Symptoms

  1. Early symotoma of the baby: uneven buttock folds in prone position
  2. Painful abduction or avoidance of abduction
  3. Duchenne limp / waddling gait
  4. apparent leg length difference
  5. Asymmetrical gait pattern

Complications

  1. untreated: Coxarthrosis (dysplasia coxarthrosis), often already in young adulthood
  2. Untreated: multiple disorders of the musculoskeletal system
  3. untreated: possibly invalidity

Therapy

  1. Maturation treatment: dysplasia due to maturation delay heals spontaneously in 80% of cases, monitoring and wide swaddling is often sufficient, if more severe: spreader pants or spreader splint
  2. Reduction and retention: reduction bandage if necessary
  3. If necessary: plaster cast in a sitting-squatting position for several weeks
  4. If necessary, extension treatment to treat shortened muscles
  5. if necessary, especially in case of late detection: surgery