Hip Dysplasia

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Hip Dysplasia
Hip Dysplasia

Video: Hip Dysplasia

Video: Hip Dysplasia
Video: Understanding Hip Dysplasia | Boston Children's Hospital 2023, March

Hip dysplasia

Hip dysplasia (hip dysplasia, dysplasia coxae congenita, congenital hip dislocation) is a common congenital malposition of the hip joint. The joint socket is too small or not deep enough. It affects up to four percent of all newborns. In pronounced cases, the femoral head can partially or completely slip out of the acetabulum. In these cases one speaks of subluxation or dislocation of the hip joint.


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  • What are the causes of hip dysplasia?
  • ">What are the symptoms?


  • How is the diagnosis made?
  • How is hip dysplasia treated?
  • Whom can I ask?
  • How are the costs going to be covered?


What are the causes of hip dysplasia?

Hip dysplasia is one of the most common congenital malformations. This is usually a malfunction of the hip, more precisely the ossification of the acetabulum. The joint socket is too small and therefore the femoral head is insufficiently covered. A so-called hip dislocation can subsequently develop.

  • Hip dysplasia: The acetabulum is not yet sufficiently developed.
  • Hip dislocation: The head of the hip joint slips out of the socket.

If the femoral head partially leaves the socket, it is called subluxation, if it slips out completely, it is called dislocation. This dislocation is favored on the one hand by the dysplasia and on the other hand by the simultaneous malposition of the femoral neck

The development of hip dysplasia can be promoted by various risk factors. Hip dysplasia is equally common in both sexes, but hip dislocation is five to seven times more common in girls than in boys. Possible causes include a lack of space in the uterus. Twins, premature babies and children after a caesarean section or after birth from a breech position are more often affected. Furthermore, hormonal factors play a role during pregnancy as well as hereditary predisposition.

Hip dysplasia is a congenital deformity and therefore cannot be prevented. However, the risk that the dysplasia will develop into a dislocation can be reduced. Premature extension positions in the hip joint are particularly unfavorable. In order to mature, it must be possible to keep the hip joint in the flexion position that the baby assumed under normal circumstances in the mother's womb. Therefore, it is recommended that the baby

  • to be carried in a sling,
  • to wrap so that his hip joint is flexed,
  • not to lie in the prone position too early and too often.

What are the symptoms?

The hip dysplasia itself usually does not cause any noticeable symptoms in newborns. However, if the malformation is not recognized and treated in good time, a hip dislocation can occur. The children will then not be able to spread the affected leg sufficiently to one side. Further indications can be delayed walking, load-dependent pain in the groin or hip area, and limping on one or both sides. As a long-term consequence, hip arthrosis (coxarthrosis) can develop in adulthood, because the weight transfer from the thigh to the pelvis is unfavorably distributed due to the too small or completely missing acetabular roof and this leads to premature wear of the hip joint.

Parents may recognize hip dysplasia by the following external signs:

  • The baby's legs are of different lengths.
  • The legs cannot be spread evenly.
  • The gluteal folds are at different heights.

that the baby's legs are of different lengths, cannot be spread evenly, or that the gluteal folds are at different heights. However, these signs usually only appear when the dislocation is already present. In the case of bilateral dislocation, there is no asymmetry, but in these children there is an increased hollow back to compensate for it.

How is the diagnosis made?

The child's hip joint can only mature until the end of the second year of life. Correct and early diagnosis is the most important prerequisite for successful treatment. The pediatrician can only determine some of the hip joint diseases by means of a physical examination based on the external signs mentioned. A special investigation is the so-called Ortolani sign. This is a snap sound that occurs in the first few weeks of life when the femoral head can be moved out of the socket by pressure and expansion. The diagnostic standard is the hip ultrasound examination. It is not stressful and painless for babies. The relationship between the femoral head and the acetabulum is assessed and measured.

In the mother-child pass, the first hip ultrasound is provided in the first week of life. This is usually carried out in the hospital. After a home birth, the parents can contact the pediatrician or an orthopedic surgeon for this examination. The second hip ultrasound is done at the age of six to eight weeks. If the findings are abnormal or during the course of therapy, regular checks must be carried out.

With increasing ossification of the femoral head and acetabulum, the significance of the ultrasound decreases, since the ultrasound waves are unable to penetrate bones. X-ray examinations are therefore preferable from the age of two to assess the progress.

How is hip dysplasia treated?

Therapy should be started as early as possible in order to achieve rapid maturation of the hip joint. As a result, the duration of the treatment can be kept short and operations or possible late effects (e.g. restricted movement, pain, need for a hip replacement) can often be avoided. Depending on the severity of the hip dysplasia, different measures are used. The aim is to keep your legs bent and spread apart.

  • Wide wrap: This can be used to treat a minor hip dysplasia diagnosed in the first week of life. For this purpose, a towel that is about 15 centimeters wide is inserted between the body and clothing or an additional diaper is pulled over the actual diaper.
  • Spreader pants: The spreader pants (also called splint splint or brace orthosis) - consisting of a shoulder strap, waist belt and padded leg straps - are worn over clothing and should only be removed for swaddling and bathing. This fixes the legs better than when wrapping them wide.
  • Pavlik bandage: The Pavlik reins consist of a chest strap and two lower leg straps and must be checked appropriately and regularly by the pediatrician or orthopedic surgeon. They cause the kicking movements to push the femoral head towards the socket.
  • Hip cast: used to immobilize in severe cases. It usually extends from the lower rib arch to the baby's lower leg and has a recess in the area of the diaper.
  • Hip surgery: may be necessary in the case of very pronounced hip dysplasia, if all conservative methods such as wearing spreader pants, bandages, splints or plaster of paris do not lead to the desired success or the disease was recognized too late. The aim is to better roof the femoral head so that the body load is distributed over a larger area. Since the introduction of hip ultrasound, however, the number of open hip operations on infants has been reduced significantly. It is currently around 14 per 100,000 newborns.
  • Reduction of dislocated hips: In the event of a dislocation, the hip must be adjusted again and then stabilized for a certain time in order to prevent a new dislocation. This stabilization takes place either with a bandage or a plaster cast.

The duration of the treatment depends on the age of the child at the start of therapy and the hip joint situation. Often it is enough to put on spreader pants for three to six months. In most cases, an early and individually tailored treatment leads to a complete maturation of the hip joint.

Whom can I ask?

Hip dysplasia is diagnosed either in the newborn in hospital or by a pediatrician or an orthopedic surgeon. These specialists are also responsible for conservative therapy - ie for all non-surgical measures. Operative interventions are carried out in the hospital.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Basically, your doctor or the outpatient clinic will settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

If hospitalization is required due to hip dysplasia or dislocation, the hospital costs will be invoiced. The patient has to pay a daily contribution to the costs. Further treatment at home is carried out by the pediatrician or the orthopedist.

For more information, see What does a hospital stay cost?

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