Hip dysplasia

Synonyms in a broader sense

Hip dislocation, hip arthrosis, conversion surgery, Salter surgery, Chiari surgery, containment, triple osteotomy, triple osteotomy, derotating femoral osteotomy

definition

At a Hip dysplasia it is a childish maturation disorder with disturbance of the acetabular ossification. In the further development the femoral head can dislocate from the socket and become a Hip dislocation develop.
Hip dysplasia is a high risk factor for developing hip arthrosis (coxarthrosis). Due to the lack of a pan roof (bay window), the weight is transferred from the thigh (femur) to the pool unfavorable due to a lack of congruence between the joint partners

Gender distribution

The gender ratio female to male is 4: 1.

Risk factors

There are several risk factors that promote the development of hip dysplasia.
Factors during pregnancy have been proven:

• A so-called breech position causes the hips in the uterus to flex strongly, which prevents the acetabular roof from developing properly.
• Lack of amniotic fluid, which means that the child does not have sufficient freedom of movement.
• Primiparous women are at increased risk, as the tight abdominal muscles and uterus also restrict the fetus' freedom of movement.
• Premature births

Another risk factor is a weakness of the connective tissue:

• All risk factors are combined with increased ligament laxity, which means that the capsule and ligaments are too elastic. This allows the femoral head to slide out of the socket more easily.
• The laxity of the ligaments is increased by the female sex hormones estrogen and progesterone.

Genetic factors play an important role:

• Children of parents with hip dysplasia or hip dislocation have a 5-10 times higher risk
• Chromosomal changes that can be combined with hip dysplasia are trisomy 18 = Edwards syndrome, Ulrich Turner syndrome = X0 syndrome, arthrogryposis multiplex congenita.
  These diseases are usually combined with other congenital malformations, such as club feet.

Appointment with a hip expert?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
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Further information about myself can be found at Dr. Nicolas Gumpert

Cause / etiology

There are basically three different causes of hip dysplasia:

1. mechanical causes

2. genetic causes

3. hormonal causes

Clinic / symptoms

A hip dysplasia or maybe Hip dislocation does not have to cause any discomfort in the newborn. A hip disease can only be noticed once you start running. The childlike hip joint but only has a post-maturation potential until the end of the second year of life. Early diagnosis is therefore of paramount importance.
Indicative symptoms can be delayed walking, load-dependent pain in the groin area or lateral hip area.
If the hip joint is dislocated, the mechanical levers of the hip change. The pelvis can no longer be held horizontally by the muscles while running. This leads to a kind of “waddling walk” known as the Duchenne limp. When standing on one leg on the affected side, the pelvis falls through Muscle weakness the hip spreader (abductors) to the opposite side. This phenomenon is rated as a positive Trendelenburg test.

Hip dysplasia pain

The Hip dysplasia occurs in newborns and can already cause symptoms at this point in time or manifest itself later in the absence of therapy.
Many newborns have an unstable hip joint, and often one Difference in length of legs. Then as the children grow up and start walking, other symptoms may show up.

It also often happens that these children start walking much later. Pain can also occur. They are often localized in the groin area and around the hip joint itself. This can also be a reason if children do not walk often or very unsteadily. In addition, there is a drop in the affected side when running.
A Hip dysplasia in adulthood also manifests itself with pain in the groin. This pain is sharp and increases with exertion. In addition, there can be pain around the joint, and last but not least, the lack of stress also shows increasing wear, so that the hip dysplasia triggers osteoarthritis in the affected joint.

Diagnosis of hip dysplasia

anamnese

The medical history (med. anamnese) should be targeted to the risk factors mentioned above.

Other important questions are when the first attempts at running were made. Whether a limp was noticed. If Asymmetries in the area of the buttocks consist. Whether a reinforced Hollow back formation stands out while standing.

Inspection (consideration)

By a Dislocation of the hip joint the femoral head steps higher. A unilateral dislocation therefore leads to a Asymmetry of the gluteal folds. However, the conclusion that every fold asymmetry must necessarily be a hip dislocation is not permissible.
There is no asymmetry in bilateral dislocation because both hips are dislocated. However, there is a compensatory factor in these children increased hollow back formation (Hyperlordosis). (please refer: Hip dysplasia in the child)

examination

When examining the hip joint, the stability is checked in particular. Particular attention is paid to the stability and dislocation of the joint.
Especially those Ortolani method of investigation is to be mentioned here. This form of investigation tries to hip joint By applying pressure from outside on the femoral head, or at least placing it on the edge of the pelvis.
By changing the position of the femoral head, the examiner tries to let the femoral head spring back into the socket, which is clearly noticeable Snap or click becomes perceptible. This phenomenon is to be seen as a positive Ortolani sign. At a healthy hip joint the Ortolani sign cannot be triggered.
The examination is problematic in the case of a hip dislocation (femoral head is not in the socket), which does not spring back into the socket. This can also be done here Ortolani sign not trigger.
Critics of this examination method complain that the femoral head could be damaged by snapping.

Ultrasound (sonography)

Of the Ultrasonic The infant hip represents the most important diagnostic tool Hip dysplasia of an infant.
Since large parts of the hip joint are not yet bony, just cartilaginous, this has X-ray image only limited informative value regarding the early diagnosis.
The ultrasound (sonography) of the hip joint, on the other hand, can make soft tissue structures of the joint visible. The cartilaginous portion of the acetabular roof and femoral head with regard to dysplasia can be assessed well by sonography. It should be carried out routinely at U2 and U3.
The method of ultrasound examination of the infant hip was used by the Austrian Professor Dr. Graf (Stolzalpe) Developed in the early 80s. The advantage of this method is that it is free from any radiation exposure (no x-rays). It can therefore be repeated as often as required. A dynamic examination is also possible. This means that the hip joint can be examined while moving and the behavior of the femoral head in relation to the socket can be assessed when moving.
With increasing ossification of the femoral head and acetabulum, the meaningfulness of the ultrasound decreases. Since the ultrasound waves cannot penetrate the bone, an ultrasound examination to assess hip dysplasia can be carried out up to the end of the first year of life, after which the X-ray examination is preferable.
Professor Graf developed as an assessment aid two measuring angles for evaluation of the pan roof.
Based on the acetabular roof angle alpha and cartilage roof angle beta, the degree of dysplasia can be assessed, taking into account the age of the child, and forms of therapy derived from it.

Measurement angle hip dysplasia according to Graf

Hip type 1a ? >60° ? <55° none necessary

Hip type 1b ? >60° ? >55° no control necessary

Hip type 2a ? 50-59° ? >55° no or wide wrap

Hip type 2b ? 50-59° ? <70° Splay treatment

Hip type 2c ? 43-49° ? 70-77° Splay treatment with hip flexion splint

Hip type 2d ? 43-49° ? >77° Splay treatment with secure fixation

Hip type 3a ? 77° Hip dislocated, reduction (balling) and plaster fixation

Hip type 3b ? 77° Hip dislocated, repositioning and plaster fixation, additional cartilage structure disorders in the acetabular roof detectable

Hip type 4 ? 77° Hip dislocated, reduction (balling) and plaster fixation

X-ray image

An x-ray is rarely done before the age of one. It is essential for operational planning.
As a rule, a so-called pelvic overview photograph (BÜS) is made. The pelvis with the hip joints is x-rayed from front to back (a.p. = anterior - posterior)
The position of the femoral head and acetabulum is assessed on this x-ray. Various measured values ​​are also important here.

The following are particularly important:

• Ménard - Shenton line
• the pantile roof angle = AC angle according to Hilgenreiner
• the CE - angle (center - corner - angle) according to Wiberg
• the CCD angle (center - collum - diaphyses - angle = femoral neck - shaft - angle)

The Ménard - Shenton line represents the extension of the inner part of the femoral neck and the lower pubic branch (symphysis). This should result in a harmonious, almost semicircular structure. Compare the blue arch in the child's x-ray to the right of a healthy hip joint
If this line appears broken, stepped or not round, there is a suspicion that the femoral head is not in the center of the socket. The cause can be hip dysplasia or hip dislocation.

In the case of a higher-grade hip dysplasia (type 2d -4), the femoral head must first be returned to the acetabulum (reduction). The Pavlik bandage, for example, is suitable for this. Fixed in this position by a very strong flexion in the hip joint.

However, all the procedures have in common that the fixed position of the femoral head can result in a circulatory disorder. This can cause parts of the femoral head to die off and permanently affect the function of the hip joint.

The fixation

If the reduction result cannot be maintained, fixation with splints and plaster of paris are possible.
The so-called fat white plaster is often used. The hip joint is flexed 100 - 110 ° and spread by approx. 45 °. As a rule, this type of plaster is well tolerated by children

Exercises for hip dysplasia

The Treatment of hip dysplasia often begins with the newborn, where a special swaddling technique and exercises are carried out by the parents to counteract the misalignment of the hips.
The children are swaddled so that the hips are bent as far as possible. In these cases, carrying the child in a sling is also very beneficial.
If the hip dysplasia persists beyond a certain age, it often becomes the so-called Spreader pants used. An orthosis in which the femoral head is pressed more into the socket.
The legs and hips are also bent and spread apart. In adulthood, exercises to strengthen the muscles and improve mobility using targeted physiotherapy are recommended. It is important to use these exercises to counteract osteoarthritis of the hip joint. Exercises can also be performed at home.
The movement of the hip joint can be promoted by first swinging one leg to the side.
This exercise can also be performed with an exercise band (Thera-band) get supported.
Another exercise is done while standing. The heel stays firmly on the ground while the toe and leg rotate in and out from the hip.

Exercise to strengthen the muscles around the hip joint is performed while lying down. To do this, the patient lies on his side and bends his legs slightly. The Thera-Band is now placed around the upper thigh. The other side is held across from the patient by a partner or a solid object. The patient now extends the leg against the resistance and gives way again. Repeat this exercise a few times again and then switch sides.
A similar exercise is performed lying on your back with your legs bent. Now the pelvis is lifted off the ground and an attempt is made to hold it. The upper body and thighs should form a line.
The muscles that turn the hips outward can also be strengthened through targeted exercises. To do this, the patient sits on the floor with his legs stretched out. The Thera-Band is placed around the feet. Now feet are moved against the resistance. In the same way, the band can also be attached just above the knees. Here, too, the movement takes place against the tensile force of the belt.
Conversely, the muscles on the inside of the thigh can also be strengthened. The exercises should be done slowly and consciously. It is important not to train when you are in pain. In addition, patients with known hip dysplasia should first seek guidance from a physiotherapist before doing the exercises on their own. This way it can be better guaranteed that the exercises will have the desired effect.

Hip dysplasia and exercise

Through sport and physical therapy is trying a premature wear of the hip joint. However, it is important to note that not all sports are suitable for people with hip dysplasia. In the case of sports, care should be taken that even and flowing movements are performed and no Sports with fast and abrupt Movements can be selected.

For example, sports such as swim or Aqua aerobics, Nordic walking, To go biking and In-line skating on a straight, even surface. In these types of sport, the build-up of muscles is promoted without putting too much strain on the joints. Also are yoga or Pilates also sports that come into question.

In contrast, there is the popular endurance sport to jog for patients with hip dysplasia not suitablebecause the joints are heavily stressed here.