Hip dysplasia in infancy

We can define as dysplasia in the infantile hip any alteration of the normal morphology or evolution of the infantile hip. It is a “catch-all” term that encompasses different pathologies, but especially because of its frequency and importance, congenital dislocation of the hip.

Female sex, previous family history of hip dysplasia, cesarean delivery and primiparity are very important influencing factors in hip dysplasia. And they are frequently associated with deformities such as congenital torticollis (neck deviated rigidly to one side or the other), metatarsus adductus of the feet (feet deviated markedly inwards) and talus valgus feet (feet with hypermobility towards the leg), among the most common.

What are the consequences?

Basically, there are 2 possible developments in congenital dislocation of the hip:

  • At birth, the hip is already dislocated.
  • The hip, at birth, is unstable and follows two paths of evolution: towards normality, with proper monitoring and orthopedic treatment, or towards greater instability or dislocation.

The first possibility is fortunately very rare and is always associated with syndromes with important deformities, such as arthrogryposis (rigid flexion contracture of several joints). In the second evolution, the most common case, the precept that prevention is always better than cure is fulfilled. Any clinical instability, which is evidenced in the clinical examination, with the Barlow and Ortolani tests, should be closely monitored, especially in the first 4 months of life and up to 2 or 3 years of age, to avoid dislocation of the hip, which in almost all cases requires complex surgical treatments.

The consequence of hip dysplasia is the progression of hip deformity, both in the acetabulum (spherical socket where the femoral head articulates) and in the proximal femur. Early osteoarthritis is the rule. This precocity is conditioned by the greater or lesser irregularity and orientation, in space, of the acetabulum and the proximal portion of the femur. It can cause symptoms from adolescence due to this osteoarthritis and its solutions are necessarily aggressive and surgical and often lead to a total hip prosthesis, which is not a desirable option in such young patients.

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What happens if hip dysplasia is not treated?

The clinical evolution is always towards a continuously painful hip, even at rest, obvious lameness and alteration of the load axis, which influences the correct functioning of the knee and, of course, of the spine. Radiographically, there is an evident deformity and incongruity and dislocation of the hip joint (acetabulum and femoral head) with early evolution towards significant osteoarthritis.

How can it be treated?

Several stages can be identified according to the age of the child.

  • The first 4 to 6 months of age are crucial. In them the treatment is similar to a tripod: monitoring by clinical tests, ultrasound control until 4 – 5 months of age and orthosis or devices to keep the hip correctly reduced.
  • Between 6 months and 1 year and a half: In this age group, the following treatments are required in a gradual way: reduction of the hip and cast, already performed under anesthesia; reduction and tenotomies of muscles that prevent the reduction of the hip and cast for 2 – 3 months; reduction by opening and eliminating anatomical obstacles inside the joint that prevent the correct reduction and coinciding or not with this previous arthrotomy (opening of the hip joint), osteotomies (section of a bone) of the pelvis and/or of the proximal femur.
  • The ideal objective is to obtain a congruent joint with regular and stable articular surfaces by the age of 2.5 years or at the latest by the age of 4 years. Otherwise, evolution towards prearthrosis and severe arthrosis is the rule.