Hip problems in infancy

Childhood trauma specialists say there are many problems that can affect a child’s hip during infancy. These differ according to age.

Dysplasia is the main childhood disease related to the hip. In the newborn it is the most frequent pathology. The baby’s joint does not have a normal anatomy and this can lead to hip dislocation with the consequent disability to walk or run.

During the first five years of life, hip synovitis is common. These are inflammatory processes limited to a few days and are therefore called fleeting coxitis. Infections affecting the joint itself or the surrounding bones, femur or pelvis, are also common.

Between 5 and 7 years of age, the so-called Perthes disease may appear. This disease is characterized in that part of the femoral head undergoes necrosis, that is, the bone tissue dies.

Children who begin pubertal sprouting, especially if they have a very rapid growth, may develop a problem of detachment of the growth zone of the femoral head called epiphysiolysis.

Causes of infantile hip problems

Hip dysplasia occurs more frequently in girls because they are more sensitive to maternal female hormones and these cause more joint laxity and the possibility of placing the joint in forced positions during pregnancy. It is also associated with a breech position in utero because it places the hip in an abnormal posture. The existence of parental history increases the possibility of dysplasia probably due to a constitutional anatomical factor.

As for hip synovitis, its cause is related to a viral infection of the upper respiratory tract (cold, bronchitis…) in the previous days and seems to be a distant reaction of this virasis.

Hip infections are in the context of the passage of a microorganism into the blood (for example from a cutaneous wound of scratching) and arriving in this joint. Unlike in adults, osteoarticular infections are frequent in children.

The cause of Perthes disease remains unknown today. Although some studies point to a coagulation disorder that may facilitate a local infarction in the femoral head, it may be that the process is multifactorial.

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Epiphysiolysis is caused by a mechanical weakness of the growth zone of the femoral head, which allows a displacement of the head with respect to the neck with secondary anatomical deformity or even complete detachment.

Treatment for infantile hip problems

Hip dysplasia is treated by placing a special harness that places the femoral head oriented towards the growth area of the coccyx, where it articulates in the pelvis. This technique, which lasts approximately three months, stimulates the correct anatomical development of the hip. Hip synovitis is treated by restricting physical activity and anti-inflammatory medication for the duration of the symptomatology.

Perthes disease is usually treated with physical therapy if there is significant contracture of the musculature around the hip. In more severe cases, a bone intervention may be necessary to improve the mechanical conditions and help bone regeneration of the necrotic area.

In epiphysiolysis, the detachment is blocked by fixation of the femoral head to the femoral neck with a screw. In severe cases of severe displacement, more complex surgery is required to restore the femoral head to its anatomical position.

Surgery is only required in the case of hip infection. This is necessary to perform an urgent cleaning in addition to antibiotic treatment by vein.

What happens if an infantile hip problem is not treated?

Untreated hip dysplasia can lead to dislocation or joint destruction. This in the future will require complex surgeries or the placement of a joint prosthesis. If a hip infection is left untreated, destruction of the joint can occur, becoming life-threatening if the infection spreads. Untreated epiphysiolysis may progress to epiphyseal detachment and destruction of the hip joint. Perthes disease usually has a benign course when it affects young children, but it can also lead to alteration of the shape of the femoral head if regeneration is not performed properly, resulting in loss of mobility and early wear and tear of the joint.

However, transient synovitis does not cause sequelae because it is a self-limiting process.