Developmental dysplasia of the hip joint

INFORMATION

Developmental hip dysplasia (DDH) is a condition in which there is subluxation (the head of the femur maintains partial contact with the pelvis) or dislocation (no contact between the head of the femur and the pelvis) of the hip joint in a newborn or infant. Hip dysplasia in infantsmost often occurs unilaterally (bilaterally about 20%), with a frequency of 1:1000 live births, six times more often in girls. Gluteal positioning of the fetus is a risk factor for the development of DDH. Developmental hip dysplasia should not be confused with teratologic hip dislocation, which is diagnosed intrauterine.

Abnormal intrauterine fetal positioning is thought to be the cause from which developmental hip dysplasia arises. It also often co-occurs with torticollis and clubfoot.

If left untreated, DDH can manifest as pain and limping, eventually leading to the development of hip dysplasia and osteoarthritis.

Developmental dysplasia is usually detected during an orthopedic examination at a preluxation clinic. To make the diagnosis confirmation by ultrasound examination is necessary.

Treatment consists of using wide diaphragm or wearing an abduction orthosis. In some cases, surgical treatment is necessary.

TREATMENT

When hip dysplasia is present, its treatment varies depending on the age of the patient. When hip dysplasia in infants is detected early enough, treatment is simpler and can be done non-invasively.If dysplasia is detected in the first year of a child's life, the recommended treatment method is the use of Pavlik harnesses. This is a non-invasive method of keeping the lower limbs in visitation. The harness is maintained for about a month. The effectiveness of this method reaches nearly 90%. Note that this is not an indicated method of treatment for neurological forms of dysplasia, such as spina bifida or cerebral palsy. Another treatment method used is the placement of a cast for a period of 6 weeks.

If conservative treatment is unsuccessful, surgery should be considered. When there is hip dysplasia in children, surgery is recommended when the child reaches the age of 2.

Hip dysplasia surgery provided by pediatric orthopedics at our center, consists of open repositioning, that is, placing the head of the femur in the acetabulum. Depending on the severity of the anatomical disorder, a pelvic osteotomy is performed. Sometimes a femoral osteotomy is additionally required to achieve satisfactory coverage of the head by the acetabulum. In severe cases where there is a significant dislocation, a slight shortening of the thigh is performed. This is only a temporary shortening that does not affect the difference in limb length in later years - the spontaneous compensation of the defect occurs over the years.

During surgery, the ligament that physiologically holds the head in the joint is shortened and reattached to the bone. With open repositioning, when an osteotomy is performed, there is a high probability of blood transfusion during or after surgery in the pediatric ward.

Then, while still in the operating room, a plaster covering the lower limbs and abdomen, which keeps the legs in a visitation. After 3-4 days of hospitalization, the patient is released home. After a week, if wound healing is going well and the doctor and physiotherapist see no contraindications, the cast is replaced with a removable orthosis.

After six weeks, an X-ray without the orthosis is taken to evaluate the result of the treatment. If there are no contraindications, rehabilitation begins.